Objective Nowadays imaging-guided nonvascular interventional procedures are becoming increasingly important in musculoskeletal field. Percutaneous interventional procedures include a broad spectrum of minimal invasive techniques, involving diagnostic and therapeutic procedures. In this article we present our views and suggestions in percutaneous musculoskeletal biopsies, percutaneous periradicular steroids infiltration, diskography, percutaneous cementoplasty, percutaneous treatment of disk herniation, and percutaneous treatment of osteoid osteoma.

Imaging-guided radiofrequency ablation(RFA) is a safe and minimally-invasive interven-tional therapy with satisfactory short-term efficacy and less complications.Nowadays,RFA has been widely and successfully applied in the clinical practice for the treatment of hepatocellular carcinomas,lung cancers,adrenal malignancies,bone tumors and hypersplenism.For recent years,a combination of RFA with transcatheter arterial chemoembolization,chemical ablation or percutaneous vertebroplasty has become a new interventional therapeutic pattern for treating the tumors comprehensively,and it can be anticipated that by combining RFA with other therapeutic programs the effectiveness for tumors will be further improved.

Objective To evaluate the effect of interventional diagnosis and therapy in gastrointestinal hemorrhage. Methods 32 patients with gastrointestinal hemmorrhage, including 12 cases of tumor and 20 cases of vascular malformation were analized retrospectively. DSA was performed in 32 cases, barium meal radiography were undertaken in 27 cases. DSA, CTA and barium meal radiography were all performed in 13 cases. Superselective embolization was performed in 10 cases with vascular malformation. Results DSA showed clearly the radiologic features all gastrointestinal hemorrhage. Coupled DSA with CTA was reliable for diagnosis of intestinal submucosa tumor. All five cases of vascular malformation underwent successful superselective embolization showing no complication and relapse during 6 month to 2 years. Conclusions Superselective DSA and CTA are valuable methods for the diagnosis of gastrointestinal hemorrhage. Interventional embolization is an effective modarity in the treatment of gastrointestinal hemorrhage.

Radiofrequency ablation(RFA) is a local and minimally-invasive therapy.In recent years,RFA has been increasingly practiced in the clinical treatment of bone tumors.RFA is very safe and effective in relieving pain caused by inoperable metastatic bone lesions and in reinforcing the ablated vertebra when combined with bone cement injection,which is helpful in preventing pathologic fracture.RFA offers an ideal and effective alternative for patients with inoperable metastatic bone tumors.

Objective To evaluate the diagnostic value of MRI in patients with trigeminal neuralgia. Methods MR manifestations and operative results of 104 patients with trigeminal neuralgia were reviewed retrospectively. Results (1)Of 104 patients with trigeminal neuralgia,75 patients had neurovascular compression or contact of the cisternal portion of the trigeminal nerve at MR imaging and 69 patients were verified by operation;14 patients had C P angle tumors, 13 cases were diagnosed by MRI and the remaining one was verified by the operation and pathology;5 patients had vascular lesions at MR imaging which were verified by microvascular decompression.(2) The percentages of the neurovascular compression or contact,tumors and vascular lesions which were the etiologles of trigeminal neuralgia were 66 3%(69/104),13 5%(14/104) and 4 8%(5/104) respectively.(3)The sensitivity and specificity of MR diagnosis was 89 4% and 96 6% respectively.Conclusion Neurovascular compression of cisternal portion of the fifth cranial nerve is the main cause of trigeminal neuralgia.MR plays an important role in demonstrating the relationship of the fifth cranial nerve to surrounding vascular structures or tumors.

Objective To evaluate the imaging technique of magnetic resonance tomographic angiography (MRTA) in the investigation of etiology of hemifacial spasm (HFS). Methods Multiplane MRTA imaging of facial nerve of both sides was performed in all 121 HFS patients. Among them, 23 HFS patients received MVD subsequently. Results Among the 121 HFS patients, 119 patients had one side hemifacial spasm and 2 patients had double side hemifacial spasm,among them, neurovascular compression was found in the root entry zone (REZ) of facial nerve in 116 cases by MRTA,and the sensitivity was 94 3%;among the 119 cases which had no HFS,no neurovascular compression was found in the REZ of facial nerve in 112 cases by MRTA,and the specificity was 94 1%. Among 23 patients who received one side MVD, 21 patients had results that agreed with the multiplanar MRTA views. Conclusion Multiplanar MRTA was considered to be a very useful imaging technique for the study of etiology of HFS, and it also seemed to be a very important preoperative examination for MVD.

Objective To evaluate the efficacy of percutaneous CT-guided puncture and steroid injection for the treatment of lumbar intraspinal synovial cysts (LISCs).Methods A patient with clinical symptom of LISCs was undergone percutaneous CT-guided lumbar synovial cyst puncture. After aspiration of the content and steroid injection were accomplished, visual analogue scale was used to evaluate the pain of the patient before and after the treatment.Results Excellent pain relief after aspiration and steroid injection was obtained with the symptom disappearing 4 days after the treatment.Conclusions Aspiration and steroid injection can reduce the pain of the patient with lumbar intraspinal synovial cysts,and it should be the frist choice of non-surgical treatment.

Objective To identify the short and long-term therapeutic benefits of CT-guided transforaminal epidural steroid injections in lumbar spinal stenosis. Methods Thirty six patients with lumbar spinal stenosis shown by CT underwent CT-guided transforaminal epidural steroid injections because of irresponsible to conservative treatment. Patients were evaluated by visual analogue scale (VAS) before the initial injection, at 2 weeks and 1 year after the injection.Results All patients were followed up for 2 weeks and 1 year. 19 ( 52.8%) patients had successful short-term outcome, and 15 ( 41.6%) had long-term outcome. 15 ( 41.6%) patients satisfied with the short-term result and 12 (33.3%) were satisfactory with the long-term result.Conclusions CT-guided transforaminal epidural steroid injection may reduce the pain and improve the quality of life in some patients with lumbar spinal stenosis.

Objective To compare the clinical utility of CT-guided percutaneous biopsies for bone destruction. Methods The retrospective analysis of pathologic outcomes of 89 cases guided by X-ray and MRI, were obtained by needle aspiration (n=13) of 18-20G tru-cut biopsy needles (n=22) and 11-13G Ostycut biopsy needles (n=40). Results Seventy five (84.3%) patients with percutaneous biopsy outcome with concordant results from specimens subsequently obtained at surgery, 14 patients (15.7%) showed pseudo-negative results but no pseudo-positive cases. No obvious differences in pathological results were obtained among these three methods. Conclusions ① CT-guided percutaneous biopsy is effective in the evaluation of skeletal destructive lesions; ② Appropriate selection of percutaneous biopsy method for different kinds of lesion could raise the diagnostie accurracy.

Objective To evaluate the value of CT-guided biopsy of deep-located lesion in the diagnosis of lymphoma. Methods CT-guided percutaneous biopsy was performed in 58 patients with 16-20 gauge core-needle biopsy. The locations of lesion involved mediastinun, lung, retroperitonurn, spleen, kidney, adrenalal and musculoskeletal system. Pathology examination included hematoxylin and eosin staining and immunohistochemical assays. Results In 56 out of 58 cases,the biopsy findings could be confirmed by histologic examination including correctly diagnosed 47 malignant lymphomas, corresponding to a sensitivity of 81%;with fuithecmace subclassification 42 of the 47(89.4%) could be as diagnosed malignant lymphomas on the basis of CT-guided biopsy. Conclusions Biopsy of deeply located lymphoma mass under CT guidance has high diagnostic accuracy and low complication rate with convenience for subclassification of malignant lymphomas.