Overview:
The challenge:
Treating a vertebral metastasis required an innovative combination of cryoablation, cementoplasty, and embolization. The goal was to counteract the “cold sink effect” often observed in hypervascular tumors.
Patient Background:
The patient was a 77-year-old diagnosed with stage IV vesicular thyroid carcinoma in 2012. Prior treatments included surgery, radioiodine therapy, radiofrequency ablation, radiotherapy, and cryoablation for metastases in the skull and iliac bones.
In October 2020, a PET/CT scan revealed a lesion in the T10-T11 vertebrae. This lesion caused severe pain and posed a high risk of fracture. A multidisciplinary team decided on percutaneous cryoablation and cementoplasty to address the issue.
An initial round of percutaneous cryoablation treatment was performed the previous week. The
control MRI showed a small area with no contrast uptake within the lesion. This was attributed to the cold sink effect, where hypervascular tumors limit freezing efficacy during cryoablation.
Treatment:
First, the T11 intercostal artery was embolized to reduce tumor vascularization and mitigate the cold sink effect.
Then, two introducers were positioned at T10 and T11 with IMACTIS CT-Navigation™. A single cryoprobe was
relocated to create two ice balls, enabling complete lesion ablation in one session. Hydrodissection was performed prior to cryoablation to protect at-risk structures using the Chiba needle.
Two cycles of 10-minutes freeze, 10-minute thaw, and 12-minutes freeze were performed at each site. After the final thawing, cementoplasty was performed. Cement was injected through the same introducer used for the cryoprobe.
Outcome:
The local control of the treated metastasis was satisfactory with no complications reported. Cryoablation was effective in relieving pain in musculoskeletal disorders.
At 3 months post cryoablation, there was no contrast uptake on T1W fat saturation enhanced images within the treated area. At 7 months post cryoablation, no metabolic activity of the lesion was visible under PET/CT.
Conclusion
This case highlights the effectiveness of combining embolization, cryoablation, and cementoplasty for treating hypervascular vertebral metastases. The multidisciplinary approach ensured precise treatment, pain relief, and long-term tumor control.
A special thanks to Prof. Julien Frandon, MD and Dr. Touimi Benjelloun Ghizlane, MD, from the Radiology Department at CHU de Nîmes, France.