Therapeutic Percutaneous Injections in the Treatment of Malignant Acetabular Osteolyses1
Anne Cotten, MD,
Xavier Demondion, MD,
Nathalie Boutry, MD,
Bernard Cortet, MD,
Patrick Chastanet, MD,
Bernard Duquesnoy, MD and
David Leblond, MD
1 From the Departments of Skeletal Radiology (A.C., X.D., N.B., P.C.) and Rheumatology (B.C., B.D.), Hôpital Roger Salengro-CHRU de Lille, Blvd du Pr J Leclercq, 59037 Lille, France; and the Department of Radiology, Centre Oscar Lambret, Lille, France (D.L.). Presented as a scientific exhibit at the 1997 RSNA scientific assembly. Received February 19, 1998; revision requested April 27 and received June 10; accepted June 10. Address reprint requests to A.C.
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Figure 1a. (a–d) Posteroanterior radiographs obtained with fluoroscopic guidance show a 10-gauge needle advanced to the cortical bone overlying the osteolytic metastasis of the acetabular roof (a), injection of the lesion with acrylic cement containing tungsten powder to increase its radiopacity (b), subsequent injection at a different site (c), and nearly complete filling in of the lesion (d). (e) CT scan of the acetabular roof helps confirm satisfactory distribution of the bone cement. A small cement leak into the adjacent soft tissue is seen (arrow).
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Figure 1b. (a–d) Posteroanterior radiographs obtained with fluoroscopic guidance show a 10-gauge needle advanced to the cortical bone overlying the osteolytic metastasis of the acetabular roof (a), injection of the lesion with acrylic cement containing tungsten powder to increase its radiopacity (b), subsequent injection at a different site (c), and nearly complete filling in of the lesion (d). (e) CT scan of the acetabular roof helps confirm satisfactory distribution of the bone cement. A small cement leak into the adjacent soft tissue is seen (arrow).
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Figure 1c. (a–d) Posteroanterior radiographs obtained with fluoroscopic guidance show a 10-gauge needle advanced to the cortical bone overlying the osteolytic metastasis of the acetabular roof (a), injection of the lesion with acrylic cement containing tungsten powder to increase its radiopacity (b), subsequent injection at a different site (c), and nearly complete filling in of the lesion (d). (e) CT scan of the acetabular roof helps confirm satisfactory distribution of the bone cement. A small cement leak into the adjacent soft tissue is seen (arrow).
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Figure 1d. (a–d) Posteroanterior radiographs obtained with fluoroscopic guidance show a 10-gauge needle advanced to the cortical bone overlying the osteolytic metastasis of the acetabular roof (a), injection of the lesion with acrylic cement containing tungsten powder to increase its radiopacity (b), subsequent injection at a different site (c), and nearly complete filling in of the lesion (d). (e) CT scan of the acetabular roof helps confirm satisfactory distribution of the bone cement. A small cement leak into the adjacent soft tissue is seen (arrow).
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Figure 1e. (a–d) Posteroanterior radiographs obtained with fluoroscopic guidance show a 10-gauge needle advanced to the cortical bone overlying the osteolytic metastasis of the acetabular roof (a), injection of the lesion with acrylic cement containing tungsten powder to increase its radiopacity (b), subsequent injection at a different site (c), and nearly complete filling in of the lesion (d). (e) CT scan of the acetabular roof helps confirm satisfactory distribution of the bone cement. A small cement leak into the adjacent soft tissue is seen (arrow).
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Figure 2. Figures 2–4. (2) CT scan shows a 20-gauge needle inserted into an extensive osteolytic metastasis that does not involve the weight-bearing part of the acetabulum. (3) CT scan shows injection of contrast material through a 22-gauge needle into an osteolytic lesion of the left ischial bone. (4) CT scan shows injection of contrast material into an osteolytic lesion of the right posterior acetabulum. Note the small leak of contrast material near the needle (arrow), which may be hazardous to the adjacent sciatic nerve (arrowhead).
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Figure 3. Figures 2–4. (2) CT scan shows a 20-gauge needle inserted into an extensive osteolytic metastasis that does not involve the weight-bearing part of the acetabulum. (3) CT scan shows injection of contrast material through a 22-gauge needle into an osteolytic lesion of the left ischial bone. (4) CT scan shows injection of contrast material into an osteolytic lesion of the right posterior acetabulum. Note the small leak of contrast material near the needle (arrow), which may be hazardous to the adjacent sciatic nerve (arrowhead).
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Figure 4. Figures 2–4. (2) CT scan shows a 20-gauge needle inserted into an extensive osteolytic metastasis that does not involve the weight-bearing part of the acetabulum. (3) CT scan shows injection of contrast material through a 22-gauge needle into an osteolytic lesion of the left ischial bone. (4) CT scan shows injection of contrast material into an osteolytic lesion of the right posterior acetabulum. Note the small leak of contrast material near the needle (arrow), which may be hazardous to the adjacent sciatic nerve (arrowhead).
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Figure 5a. (a, b) Anteroposterior radiograph (a) and CT scan (b) depict osteolytic metastasis of the weight-bearing part of the acetabulum and of the acetabular fossa (arrowheads in b). (c) Radiograph obtained 1 month after cement injection reveals that traumatic acetabular protrusion has occurred.
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Figure 5b. (a, b) Anteroposterior radiograph (a) and CT scan (b) depict osteolytic metastasis of the weight-bearing part of the acetabulum and of the acetabular fossa (arrowheads in b). (c) Radiograph obtained 1 month after cement injection reveals that traumatic acetabular protrusion has occurred.
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Figure 5c. (a, b) Anteroposterior radiograph (a) and CT scan (b) depict osteolytic metastasis of the weight-bearing part of the acetabulum and of the acetabular fossa (arrowheads in b). (c) Radiograph obtained 1 month after cement injection reveals that traumatic acetabular protrusion has occurred.
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Figure 6. Figures 6, 7. (6) Anteroposterior radiograph of the right hip demonstrates a leak of bone cement into the joint space (arrowhead) and soft tissue (arrow). (7) CT scan obtained in a different patient demonstrates an intraarticular leak of bone cement (arrowhead).
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Figure 7. Figures 6, 7. (6) Anteroposterior radiograph of the right hip demonstrates a leak of bone cement into the joint space (arrowhead) and soft tissue (arrow). (7) CT scan obtained in a different patient demonstrates an intraarticular leak of bone cement (arrowhead).
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Copyright © 1999 by the Radiological Society of North America.
