Complex vertebral masses can be successfully ablated using embolization and percutaneous cryoablation with the single cryoprobe using ProSense cryoablation system in one session with a relocation technique. Combing cryoablation with embolization of hypervascular tumors is a promising technique to limit the cold sink effect. The same cryoablation introducer can be used for easy and efficient cementoplasty.
The challenge: To treat a vertebral metastasis using cryoablation and cementoplasty combined with embolization to prevent the “cold sink effect” in hypervascular tumors.
Patient Background: 77-year-old patient with stage IV vesicular thyroid carcinoma diagnosed in 2012. Previously
underwent surgery, radioiodine therapy, followed by further radiofrequency and surgery, radiotherapy
and cryoablation to treat skull bone and iliac bone metastases.
Following a PET/CT in October 2020, a T10-T11 musculoskeletal vertebrae bone lesion discovered,
causing severe pain and at high risk of fracture. A multidisciplinary team decided to treat with
percutaneous cryoablation and cementoplasty.
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 considered due
to the cold sink effect, where hypervascular tumors may lessen the freezing effect of cryoablation.
Treatment: Embolization of the T11 intercostal artery was performed to limit the cold sink effect with a decrease in the tumor vascularization.
Two introducers were positioned at T10 and T11 with IMACTIS CT-Navigation™. A single cryoprobe was
relocated to create two ice balls to ablate the lesion 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 final thawing, cementoplasty was performed with cement injected via the same introducer.
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.
A special thanks to Prof. Julien Frandon, MD and Dr. Touimi Benjelloun Ghizlane, MD, from the Radiology Department at CHU de Nîmes, France.
