Evaluating the Accuracy and Efficiency of Imaging Modalities in Guiding Ablation for Metastatic Spinal Column Tumors: A Systematic Review
by
, , ,
Siran Aslan
1,2, 
Mohammad Walid Al-Smadi
1,3,
Murtadha Qais Al-Khafaji
3
,
András Gati
3,
Mustafa Qais Al-Khafaji
3,
Réka Viola
3,4,
Yousif Qais Al-Khafaji
5,
Ákos Viola
3,
Thaer Alnofal
3,6 and
Árpád Viola
1,3,* 1
Department of Neurotraumatology, Semmelweis University, 1081 Budapest, Hungary
2
Doctoral School of Clinical Medicine, Semmelweis University, 1083 Budapest, Hungary
3
Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary
4
Department of Psychiatry, Peterfy Sandor Hospital, 1076 Budapest, Hungary
5
Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
6
Department of Cardiology, Ferenc Flór Hospital, 2143 Kistarcsa, Hungary
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(23), 3946; https://doi.org/10.3390/cancers16233946
Submission received: 20 October 2024
/
Revised: 11 November 2024
/
Accepted: 21 November 2024
/
Published: 25 November 2024
(This article belongs to the Special Issue Bone and Spine Metastases)
Simple Summary
Spinal metastases are a serious complication in cancer patients, often leading to pain and damage to the spine. One way to treat these metastases is by using special techniques that destroy the tumors with heat, a process known as thermal ablation. To do this safely and effectively, doctors use imaging tools like CT scans, MRI, or X-rays to guide the procedure. In this review, we compared these different imaging methods to determine which ones work best for guiding thermal ablation. We found that CT is commonly used and works well, but combining CT with MRI could improve safety by helping doctors see the tumor better and avoid nearby nerves. This research may help doctors choose the best imaging tools for treating spinal metastases, improving patient outcomes, and reducing risks.
Abstract
Background/Objectives: Spinal metastases are a frequent and serious complication in cancer patients, often causing severe pain, instability, and neurological deficits. Thermal ablation techniques such as radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CA) have emerged as minimally invasive treatments. These techniques rely on precise imaging guidance to effectively target lesions while minimizing complications. This systematic review aims to compare the efficacy of different imaging modalities—computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, and mixed techniques—in guiding thermal ablation for spinal metastases, focusing on success rates and complications. Methods: A systematic literature search was conducted across PubMed, OVID, Google Scholar, and Web of Science databases, yielding 3733 studies. After screening, 51 studies met the eligibility criteria. Data on success rates, tumor recurrence, complications, and patient outcomes were extracted. Success was defined as no procedure-related mortality, tumor recurrence or expansion, or nerve injury. This systematic review followed PRISMA guidelines and was registered with PROSPERO (ID: CRD42024567174). Results: CT-guided thermal ablation demonstrated high success rates, especially with RFA (75% complete success). Although less frequently employed, MRI guidance showed lower complication rates and improved soft-tissue contrast. Fluoroscopy-guided procedures were effective but had a higher incidence of nerve injury and incomplete tumor control. Mixed imaging techniques, such as CBCT-MRI fusion, showed potential for reducing complications and improving targeting accuracy. Conclusions: CT remains the most reliable imaging modality for guiding thermal ablation in spinal metastases, while MRI provides enhanced safety in complex cases. Fluoroscopy, although effective for real-time guidance, presents limitations in soft-tissue contrast. Mixed imaging techniques like CBCT-MRI fusion offer promising solutions by combining the advantages of both CT and MRI, warranting further exploration in future studies.
