EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III – Abdominal Treatment Procedures (Short Version)

Abstract

The third part of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines on Interventional Ultrasound assesses the evidence for ultrasound-guided and assisted interventions in abdominal treatment procedures. Recommendations for clinical practice are presented covering indications, contraindications, safety and efficacy of the broad variety of these techniques. In particular, drainage of abscesses and fluid collections, interventional tumor ablation techniques, interventional treatment of symptomatic cysts and echinococcosis, percutaneous transhepatic cholangiography and drainage, percutaneous gastrostomy, urinary bladder drainage, and nephrostomy are addressed (short version; a long version is published online).

Zusammenfassung

Der dritte Teil der Leitlinien der European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) zur interventionellen Sonografie im Abdomen bewertet die Evidenz für transkutane sonografisch gestützte und assistierte therapeutische Interventionen im Abdomen. Auf der Grundlage publizierter Daten werden zu Indikationen, Kontraindikationen sowie zur sicheren und effizienten Durchführung Empfehlungen für die klinische Praxis gegeben. Berücksichtigung finden die sonografisch geführte Drainage von Abszessen und Flüssigkeitsansammlungen, Tumorablationstechniken, transkutane Zystensklerosierung symptomatischer Zysten und der Echinokokkose, die perkutane transhepatische Cholangiografie und Drainage, die perkutane Gastrostomie, die Harnblasenpunktion und Drainage sowie die Nephrostomie (Kurzversion; eine Langversion ist online publiziert).

Key words

guideline - ultrasound guidance - abscess - hepatocellular carcinoma - liver metastases - radiofrequency ablation - drainage - safety

Introduction

This is the third of three guidelines (parts I – III) within the framework of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines on Interventional Ultrasound describing ultrasound (US)-guided percutaneous diagnostic and therapeutic interventions of the abdomen. Part III deals with the indications and clinical impact of US-guided therapeutic interventions and gives evidence-based recommendations for the safety and efficacy of these techniques using the available evidence at the time of manuscript preparation. It is complemented by guidelines on general aspects of US-guided interventions (part I) [1] and US-guided diagnostic interventions (part II) [2]. In addition, EFSUMB also will publish guidelines on the use of diagnostic and therapeutic endoscopic ultrasound [3] [4] and ultrasound-guided vascular interventions [5].

Methods of guideline development are described in the introduction to the EFSUMB Guidelines on Interventional Ultrasound [6]. Levels of evidence (LoE) and grades of recommendations (GoR) have been assigned according to the Oxford Centre for Evidence-based Medicine criteria (March 2009 edition) [http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009].

Local ablative procedures

Introduction

Local ablative procedures play a key role in the management of patients with malignancies, primarily with hepatocellular carcinoma (HCC), but also with metastases [7] [8] [9] [10].

Treatment intention

Local ablative procedures can be classified according to the treatment intention as curative or palliative [11] [12].

Curative intention

Tumor ablation is usually performed with curative intent. This applies mainly to small HCCs (≤ 5 cm), as well as to colorectal liver metastases [12] [13] [14] [15] [16] [17] [18]. The decision for local ablation over resection should take into account data such as the patient’s age, co-morbidities, normal parenchymal reserve and tumor distribution inside the liver, as well as the risks for metachronous tumor growth, and all these should be weighed against the invasiveness of the procedure [11].

Palliative strategy

The main indication for palliative treatment of liver tumors is metastatic neuroendocrine tumor load. Other primary [19] and secondary liver tumors may also be treated [11] [20] [21] [22] [23] [24] [25] [26] [27].

Combined treatment options

With multiple liver metastases (commonly colorectal) not suitable for surgical resection because of their number or location (e. g., proximity of vascular or biliary structures), a combined approach should be considered [28].

Ablation in conjunction with resection is increasingly used as a parenchyma-sparing curative strategy that combines effective ablative treatment of small tumors with resection of large tumors, for which ablation is less effective [29] [30] [31] [32] [33] [34] [35] [36]. Similar concepts can be applied to hepatocellular carcinoma (HCC) in a cirrhotic liver, when extensive surgical sacrifice of the parenchyma must be avoided.

Hepatocellular carcinoma (HCC)

The treatment options for HCC in a cirrhotic liver are transplantation, surgical resection, local ablative therapies, transarterial chemoembolization (TACE), radioembolization with Yttrium90 loaded beads (transarterial radioembolization) (TARE), and, in cases of advanced disease, systemic therapy with sorafenib (Nexavar^®). Image-guided percutaneous ablation therapies, such as radiofrequency ablation (RFA) [37] [38] [39], percutaneous ethanol injection (PEI) [40] [41] [42] and microwave ablation [43], have been performed mainly with small HCCs, according to the Milan criteria [44]. These are potentially curative, minimally invasive, and repeatable in case of recurrence [45].

Local ablative treatment techniques for HCC

Size of tumors

As a single RFA needle usually coagulates a region of about 2 cm in diameter, potentially non-spherical (depending on the RF system) multiple sequential insertions may be required to achieve a safety margin.

To overcome this limitation, multi-needle systems have been introduced for simultaneous ablations and stereotactically guided RFA [46] [47] [48] [49]. There is no accepted maximum tumor size that can be ablated in a single session but the size is generally in the 4 to 5 cm range. The ablated zone should encompass the treated tumor and a circumferential margin of 5 – 10 mm around the tumor [50].

Location of tumors

HCC tumors in a subcapsular location or adjacent to the gallbladder have a higher likelihood of incomplete ablation [51] or major complications [52] [53] [54].

To reduce the number of complications, attention must be paid to vulnerable structures close to the tumor or the ablation zone. This applies to the porta hepatis, gallbladder, stomach, small intestine and colon, all of which are particularly sensitive to thermal damage [55] [56]. In case of subdiaphragmatic lesions, pulmonary, pleural or cardiac heat damage might occur, usually with only minor clinical significance [57] [58].

Number of tumors

The maximum number of tumors that can be ablated in a single procedure is not clearly defined, but ranges from 3 to 5 in most centers [11]. Overall survival is best for patients with solitary tumors, intermediate for those with 2 to 3 tumors, and worst for those with ≥ 3 tumors [59].

RFA versus surgical resection in small HCCs

There is inconclusive evidence as to whether RFA is as effective as surgical resection as the first-line treatment for patients with small, solitary HCCs [50] [51] [53] [54] [55] [56] [60] [61] [62] [63]. A systematic review of 8000 patients [64] with a current Cochrane analysis [65] reported uncertainty regarding the question of the impact of RFA versus surgery. However, a more recent meta-analysis, published after the Cochrane analysis [66], showed that there were differences in age and liver function between patients with early HCC submitted to either RFA or resection. When the analysis was corrected for these parameters, no survival differences were observed between RFA and surgery in single HCCs < 2 cm or 2 – 3 HCC tumors < 3 cm, whereas surgery resulted in a longer survival in the case of single HCCs measuring 2 – 5 cm [66]. Mortality and morbidity rates of RFA have been reported to be 0 – 1.5 % and 0.9 – 7.9 %, respectively [67] [68] [69] [70] [71] [72].

Percutaneous ethanol injection (PEI)

PEI was the first ablative procedure, initially reported in the early 1980 s [40] [41] [73].

The procedure is inexpensive and safe, with low mortality and morbidity (0 – 3.2 % and 0 – 0.4 %, respectively) [74] [75] [76]. Even though RFA has replaced PEI [38] [77] [78], PEI can be offered in small HCCs, mainly those for which RFA is not feasible due to tumor location.

RFA versus PEI

Randomized controlled trials comparing RFA with PEI demonstrate that RFA is superior to ethanol injection in terms of treatment response, number of sessions, recurrences, and overall survival [77] [78] [79] [80] [81] [82] [83] as further supported by meta-analyses [65] [82] [84].

The efficacy of the methods is similar for tumors ≤ 2 cm [38] [77] [78] [85]. Meta-analyses, including randomized controlled trials (RCTs), confirmed that treatment with RFA offers a survival benefit as compared to PEI in tumors > 2 cm [82] [83] [84] [86] [87]. RFA has a slightly higher rate of major complications (4 %; 95 % CI, 1.8 – 6.4 %) as compared to PEI (2.7 %; 95 % CI, 0.4 – 5.1 %) [52] [79] [81] [87]. The best results obtained in series of HCC patients treated by RFA provided 5-year survival rates of 40 – 70 % or higher in select groups of patients [47] [67] [88]. The best outcomes have been reported in Child–Pugh A patients with small (< 2 cm) single tumors [70] [89]. Independent predictors of survival with RFA are initial complete response, Child–Pugh score, number or size of nodules, and baseline alpha-fetoprotein levels [90].

Other procedures

Percutaneous microwave ablation (MWA) was introduced into clinical practice in the 1990 s [43] [91] [92] [93] [94] [95] [96] [97].

Selection of ablation technique

With PEI, local response is related to tumor size. PEI has yielded very favorable results for small encapsulated HCCs (< 2 cm) [12] [73]. HCC encapsulation by a cirrhotic liver prevents satellite nodules from being reached, leading to higher rates of local recurrence in comparison to RFA [98] [99] [100] [101]).

Selection of imaging modality (ultrasound, CT, MRI)

US is the first-line imaging modality for local ablative procedures in the liver. CT guidance can be an alternative, particularly when US guidance is not feasible anatomically or with US imaging of occult lesions [102] [103]. MRI guidance is possible but with limited availability and major costs. Local expertise and personal experience determine the modality of choice. Contrast-enhanced imaging must be available during the interventional procedure to confirm the completeness of necrosis. Fusion imaging is an alternative technique that can be used for the guidance of the procedure.

Planning and monitoring ablation treatment

Imaging plays an important role before, during and after ablation procedures. Assessment of tissue perfusion is crucial to differentiate necrotic areas from viable residual tumor. With US-and CT-guided RFA, this requires evaluation with contrast-enhanced imaging during and immediately after ablation. Contrast-enhanced ultrasound (CEUS) can provide important information for assessment during and immediately after ablation [104] [105]:

• assessment of the lesions to be treated by ablation (number, size, degree and homogeneity of lesion enhancement, presence of feeding vessels, to define the eligibility for treatment and the best ablation strategy)

• depiction of previously undetectable lesions with the support of fusion imaging, enabling needle/probe guidance to occult lesions

• detection of viable tumor persistence following loco-regional treatment [50]

CEUS is the most effective method to define local recurrence in a treated nodule because of its real-time capability, the intra-vascular characteristic of the contrast agent and the near-total differentiation between the displayed contrast and background information of current imaging methods [8]. CT and MRI provide better overviews of the liver and adjacent organs, which are necessary for pretreatment staging and useful to detect distant intra- and extra-hepatic tumor recurrence.

Complications

Studies have established that RFA is a low-risk procedure [106] [107] [108] [109], with a mortality of 0.1 – 0.8 % and few adverse events. Major complications occur in 2.2 – 11 % of RFA-treated patients [72] [106] [110] [111] [112]. Bleeding, infection, arteriovenous fistula formation, bile duct damage, and tumor seeding are possible complications of local ablative therapy [11] [12] [18] [113].

Thermal track ablation can potentially reduce the likelihood of tumor seeding in HCC ablation to below 1 % [114] [115] [116] [117].

Colorectal cancer liver metastases

It is estimated that 50 – 60 % of patients with colorectal cancer (CRC) will develop liver metastases [118]. The most successful treatment for hepatic metastases is surgical resection [9] [10] [31] [59] [119] [120] [121] [122] [123] [124] [125]. However, approximately 50 – 70 % of these patients will develop recurrence [126].

Local ablative procedures with curative intent have a role in the management of CRC liver metastases [9] [10]. Depending on the size of the lesions, RFA may be performed alone or combined with resection [127]. Several studies have demonstrated that RFA achieved permanent local ablation of liver metastases and a 5-year survival of 24 % to 43 % [128] [129] [130] [131] [132]. These results are comparable to surgery [31] [59] [119] [120] [121] [122] [123] [124] [125]. Local recurrence occurs more frequently after ablation than with resection [9] [10] [133].

Two meta-analyses confirmed that surgery is superior to RFA with regard to survival outcomes in patients with resectable CRC liver metastases [134] [135]. The first RCT on the efficacy of RFA combined with chemotherapy versus chemotherapy alone was underpowered; RFA plus systemic treatment resulted in significantly longer progression-free survival (PFS) compared with chemotherapy alone [136].

Other liver metastases

Percutaneous thermal ablation or PEI may be a therapeutic option for neuroendocrine liver metastases [23] [24].

Renal malignancies treated with local ablative therapy

Introduction

Possible treatment options for renal cell carcinoma (RCC) are [137]:

• Surgery, either nephrectomy or nephron-sparing (open or laparoscopic)

• Local ablative procedures (percutaneous or laparoscopic)

  • cryoablation

  • RFA

  • MWA

• Active surveillance

Small masses

Standard therapy for small RCCs is nephron-sparing surgery. Local ablative techniques have evolved into alternative procedures, showing excellent results [138].

Tumors < 4 cm in diameter are ideal candidates for ablative techniques. The volume to be treated should include a 5 – 10 mm safety margin [139]. Most tumors < 3 cm can be treated in a single ablation session. Tumors between 3 – 4 cm in diameter can also be successfully treated, although multiple ablation sessions may be required [140] [141] [142] [143] [144] [145] [146] [147] [148].

RCTs comparing surgery and local ablative therapy have not been performed [137] [149]. Cancer-specific survival is similar for both methods [150] [151]. The European and American Urological Associations recommend thermal ablation as a treatment option for patients with a T1 renal mass [152].

Local recurrence-free survival following image-guided tumor ablation is 87 % [153]. The local recurrence of percutaneously performed RFA is estimated at 2.5 – 14 % [154]. Cancer-specific survival of patients treated with RFA is comparable to patients treated with surgery [142] [152] [155]. Both cryotherapy and RFA had a higher risk of recurrence compared to partial nephrectomy [156], but re-intervention is straightforward [142].

The rate of major complications for cryotherapy is 5 %, which is lower than for surgery [152], the most common complication being hemorrhage [213] with 2 % developing distant metastases [152] [155]. Post-procedural ureteric strictures have also been documented [152]. Cryotherapy is preferred over RFA in central tumors in contact with the renal hilum or the ureter [157].

CEUS can be used for surveillance after RFA of RCCs in order to detect local recurrence and to assess for liver metastases [158]. CT of the thorax and abdomen is necessary to exclude metachronous extrahepatic metastases. No RCTs have been performed [159] [160] [161].

Abscess drainage

US-guided percutaneous drainage of abdominal abscesses is a well-established interventional procedure first described in 1974 [162] and is currently the first-line treatment approach for abdominal abscesses.

Definition and classification

Differentiation between phlegmonous inflammation and abscesses is of importance for treatment guidance. An abscess is a pus-containing confined collection, most often caused by bacteria. To be termed an abscess, the fluid has to be viscous and surrounded by an inflammatory wall that develops as a result of effective host defense [163].

Postoperative fluid collection

Fluid collections present on postoperative imaging, localized or generalized (“free fluid”), are common and nonspecific which may represent different pathological entities such as hematoma, exudate, seroma, biloma, lymphocele or an abscess. Fluid seen on imaging is often not characteristic; any patient with a clinical suspicion of an abdominal abscess should have a diagnostic aspiration to guide further management. Sterile fluid collections can become infected postoperatively, requiring diagnostic aspiration and eventually therapeutic drainage.

Ultrasound (US)

US imaging is often the initial modality used in abscess delineation as it allows dynamic evaluation and real-time guidance of needling. Depending on the contents, an abscess can be anechoic, hypoechoic and even hyperechoic. CEUS can be helpful in differentiating vascularized from avascular areas [164] [165].

CT is indicated in technically limited US examinations or inconclusive results.

Diagnostic aspiration

A US-guided diagnostic puncture of a fluid collection with a fine needle or a larger needle (depending on the viscosity) can distinguish an abscess from a non-infected fluid collection.

Puncture and drainage

Catheter drainage versus needle aspiration

A meta-analysis of 5 RCTs comparing catheter drainage and repeated needle aspirations of liver abscesses demonstrated catheter drainage to be more effective, with higher success and shorter time to achieve clinical improvement [166]. Studies of abdominal abscesses of various etiologies have shown good results with repeated needle aspiration in simple abscesses < 5 cm. In larger abscesses catheter drainage performed better than repeat needle aspiration [167] [168] [169] [170] [171].

Small or large catheters

No difference in outcome was seen in a study of intra-abdominal abscesses treated with 7F pigtail catheters and 14F sump drain catheters [172]. Currently large catheters (> 10F) should be reserved for complex abscesses containing thick pus and debris.

Catheter introduction techniques: Trocar versus Seldinger

Two techniques are used for the insertion of a drainage catheter: the trocar (one-step) technique and the Seldinger (two-step) technique. Both have advantages and disadvantages and can be performed with either a free-hand or needle-guided technique, depending on the preference and experience of the operator.

Single versus double lumen

Double lumen catheters are not recommended since they combine the negative features of large diameters and relatively small lumens.

Abscess cavity extension and complexity, fistula, and contrast injection (X-ray, CEUS)

Treatment planning requires careful assessment of the size, shape, content and extent of the abscess, including identification of associated fistulas. Fistulography (or abscessography, sinography) with intracavitary injection of iodinated contrast media under CT or fluoroscopic guidance has been the recommended technique. Direct injection of US contrast agent through the needle or catheter has been reported to facilitate confirmation of correct needle or catheter position and allows evaluation of any communication between cavities in complex abscesses at the bedside [173] [174] [175].

Specific organs and locations

Liver abscess

Pyogenic liver abscesses are often the result of biliary obstruction caused by benign or malignant diseases with consequent cholangitis. For percutaneous drainage, a transhepatic access route is preferred for direct puncture to avoid spillage of pus into the peritoneal cavity. Small amebic abscesses generally respond to conservative treatment and do not require drainage, but large amebic abscesses may need drainage [176].

Splenic abscess

Splenic abscesses are rare, except in immunocompromised patients. Splenic puncture or biopsy is relatively safe as documented in a meta-analysis [177].

Pancreatic abscess

Percutaneous drainage of pancreatic abscesses is often prolonged and may require multiple catheters. The percutaneous approach offers quick access for severely ill patients. As a second stage procedure, conversion to internal drainage with an endosonographic approach should be considered.

Enteric abscess

Abscesses are frequent complications of Crohn´s disease, diverticulitis and appendicitis. In Crohn´s disease, there is no study comparing percutaneous and surgical drainage of abscesses. Percutaneous drainage of Crohn’s-related abscesses has a high success rate, demonstrated in several studies and is the first-line treatment [178] [179]. With early percutaneous drainage, (non-elective) surgery can often be avoided (14 – 85 % of patients) [179] [180] [181] [182] [183].

Abscesses can be detected in 15 % of patients with acute diverticulitis [184] [185]. Antibiotics successfully treat smaller abscesses (< 3 cm) [184] [186] [187], but larger abscesses (> 3 cm) require percutaneous drainage [188] [189]. Peri-appendicular abscesses can occur either as a result of rupture of an infected appendix or post-operatively.

It is generally accepted that a peri-appendicular abscess will respond to percutaneous drainage. Leakage of enteric contents at an anastomosis may lead to abscess formation, which most often requires reconstructive surgery. Sometimes, a non-surgical approach is preferred with usage of long-term percutaneous drainage with large catheters.

Abscess in the lower abdomen and pelvis

For deep pelvic abscesses, alternative puncture routes are available. Transrectal, transvaginal, transperineal and transgluteal accesses have all been shown to be useful and safe [169] [190] [191] [192].

Ultrasound-guided paracentesis

Background

Paracentesis is performed either as a diagnostic or as a therapeutic procedure, in the presence of ascites or suspected bacterial peritonitis. Therapeutic paracentesis provides almost immediate symptomatic relief and is usually well tolerated.

Technical issues

Ascites drainage is usually easily and safely performed by inserting a 14 – 18 gauge needle (including paracentesis-specific devices) or as a one-step catheter under US guidance. Catheters can be pig-tail, they can have an internal string for internal loop fixation, or an internal balloon fixation can be used. A small bore catheter (between 5F and 7F) is usually adequate.

US guidance offers real-time imaging of the needle tip and surroundings during the procedure, making it safe and effective. In most instances, US assistance (i. e., US utilized to select the best access point prior to blind needle insertion) is as safe as US guidance [193].

Complications

Paracentesis is considered a safe procedure, carrying a 1 % risk of overall complications, which include leakage of ascitic fluid, local infection, abdominal wall hematomas, intraperitoneal hemorrhage, and intestinal perforation [194]. It is recommended to follow strict antiseptic practices in all patients [195]. Ultrasound guidance can reduce the risk of complications after paracentesis [193] [196].

Specific considerations

Cirrhosis

Ascites is the most common complication of cirrhosis leading to hospital admission.

Albumin administration

Large-volume paracentesis (> 5 L) is generally an effective and safe procedure, but it does carry a risk of “postparacentesis circulatory dysfunction” (PCD).

Palliative paracentesis for malignant ascites

Malignant ascites accounts for around 10 % of cases and occurs with a variety of neoplasms [197]. Large amounts of ascites can cause increased abdominal pressure with pain, dyspnea, loss of appetite, nausea, and reduced mobility. Long-term paracentesis is indicated for patients with symptoms of increased intraabdominal pressure caused by recurring malignant ascites despite repeated paracentesis.

Sclerotherapy of non-parasitic cysts

Hepatic cysts

Hepatic cysts have a prevalence of 2.5 – 7 %. Most are asymptomatic and do not need treatment [198]. Percutaneous treatment, consisting of aspiration of cystic fluid followed by injection of a sclerosing agent, is usually performed with US guidance, as a minimally invasive option for large or symptomatic cysts.

Indications

Large cysts (> 6 – 10 cm), which are symptomatic (pain or infected) or causing space-occupying effects (abdominal distension, obstructive jaundice or both), require treatment. Other less established indications include symptomatic small sub-capsular cysts located at sites exposed to mechanical stress (beneath the ribs or sternum) [199]. In polycystic liver disease, any cysts may be treated if causing symptoms or to avoid complications (e. g., rupture, bleeding, infection) [200] [201] [202] [203] [204] [205].

Contraindications

Caution is required when treating hydatid cysts; the nature of a cyst may not be known prior to aspiration [199]. A relative contraindication is hemorrhagic cysts [206] although they can be treated with similar results once infection or malignancy has been excluded [202]. Ascites and planned liver transplantation are other relative contraindications.

Multidisciplinary decision making

Multidisciplinary decision (gastroenterologists, surgeons, interventional radiologists) for the procedure is mandatory as other options include open surgery and laparoscopic deroofing which are effective treatments. These treatments are associated with substantial morbidity and mortality and require expertise [207] [208]. Percutaneous treatments have similar efficacy, allowing surgery to be reserved for complicated cases or if percutaneous sclerotherapy fails [201] [209].

Sclerotherapy versus surgery (fenestration)

No randomized prospective study comparing fenestration and sclerotherapy has been published. In most centers, sclerotherapy is attempted first as a noninvasive option, and laparoscopic fenestration is indicated in refractory cases [209].

Prognosis

The majority of patients who undergo percutaneous sclerotherapy are symptomatically improved immediately following the procedure, but only 20 % will have partial or full regression of the dominant and symptomatic cyst [208]. In polycystic liver disease both sclerotherapy and surgery are disappointing (77 – 100 % recurrence rate) [9].

Materials and technical issues

The treatment consists of evacuation of the cystic contents (either by aspiration or drainage via a catheter) followed by sclerotherapy of the inner epithelium using standard agents (ethanol, polidocanol, tetracycline chloride, minocycline chloride, hypertonic saline solution and ethanolamine oleate) [210] [211] [212] [213] [214]. A radiopaque contrast medium or US contrast agent should be instilled into the cyst to exclude a connection with the biliary tree [215]. If contrast medium enters the bile ducts, sclerotherapy is contraindicated.

Ethanol sclerotherapy

Ethanol (95 – 98 % concentration) is most commonly used for sclerotherapy of hepatic cysts [216] [217] [218]. Single or multiple sessions may be needed with evacuation of the fluid content performed using 6 – 8F catheters or a Chiba needle (18 – 20 gauge) [216] [217] [218]. After ethanol sclerotherapy, an 80 – 100 % reduction of cyst volume may be achieved [198] [201] [210] [216] [218] [219].

The main complications during ethanol sclerotherapy are pain, ethanol-induced fever or hyperthermia, intoxication, intra-cystic bleeding and iatrogenic pleurisy or peritonitis [202] [211].

Sclerotherapy using other substances

Several other substances with better safety profiles, ease of use and low cost have been tested with good results and few complications [210] [211] [212] [213] [214]. Polidocanol 1 – 3 % (aethoxysklerol) may be preferred for its local anesthetic properties (it is less painful than alcohol) and its slight bactericidal activity [199].

Ultrasonographic follow-up

In polidocanol therapy maximum volume reduction occurred 1 year after the procedure [215]. Follow-up examinations may only be necessary in symptomatic patients.

Renal cysts

Indications

Simple renal cysts are mostly asymptomatic and do not require treatment. In 2 – 4 % the cyst may become symptomatic because it enlarges or develops complications such as hemorrhage, infection, rupture or compression [220]. Cysts that develop adjacent to the renal hilum may obstruct the urinary tract [221]. US-guided cyst aspiration with or without sclerosing therapy is a minimally invasive, simple, safe and low-cost procedure [221].

Multidisciplinary decision making

A multidisciplinary decision regarding procedure choice is recommended as surgical excision via open, percutaneous, laparoscopic or robotic surgery is effective but more invasive. Laparoscopic deroofing achieves better results than percutaneous sclerotherapy (PS) [220] [221].

Materials and technical aspects

A variety of substances are used for sclerotherapy of the cystic wall [214] [222] [223] [224] [225] [226] [227] [228] [229] [230] [231] as described for liver cysts.

Simple cyst drainage without sclerotherapy

After simple aspiration, the recurrence ranges from 30 – 80 % [171] [232].

Ethanol sclerotherapy

The most common sclerotherapy agent for renal cysts is ethanol [227] [228] [229] [230] [231]. A concentration of 95 – 99 % destroys the secreting cells of the cyst wall without affecting the renal parenchyma [220]. Single or multiple sessions have been used, with better results but with higher complications for multiple sessions [221] [228] [229] [230] [231] [232] [233].

The main complications that may occur during ethanol sclerotherapy are pain, fever, and systemic reactions [220].

Ultrasonographic follow-up

Follow-up examinations may only be necessary in symptomatic patients.

Abdominal echinococcal cysts, puncture, aspiration, injection and re-aspiration (PAIR)

Introduction

Echinococcosis is a chronic, complex and neglected zoonosis with widespread global distribution. 70 % of cases of cystic echinococcosis (CE) are located in the liver [234]. US has an important role in the diagnosis, treatment and follow-up of abdominal CE and is established in the interventional treatment of abdominal CE [235] [236].

Classification

The WHO echinococcal cyst classification [237] [238] is US-based and was introduced to guide treatment options and to predict prognosis [239]. Type CE1 and CE2 are the typical active cysts. Type CE1 is unilocular, whereas CE2 is multilocular with daughter cysts. The Gharbi classification is still widely used [240].

Diagnosis and differential diagnosis

Imaging

US is the imaging modality most appropriate for diagnosis and differential diagnosis [238], while US guidance is usually used for intervention [241] [242].

Serological tests

Serological tests for echinococcosis should be obtained, where available, before the procedure [243] [244].

PAIR indication

PAIR is most appropriate for CE1 and CE3a according to the WHO classification (Gharbi type I and II cysts) [244] [245].

Relative contraindications

Hydatid cysts with multiple daughter cysts and solid components (Gharbi Type III-IV and WHO CE2-CE3b) are not suitable for PAIR [236] [245] [246]. It is reported that aggressive percutaneous evacuation for these complex cysts is useful, but not widely accepted.

Pretreatment procedures

As with any interventional procedure, the patient should be carefully evaluated before the PAIR procedure. Albendazole should be started one week (or at least one day) prior to the procedure for prophylaxis against abdominal contamination [247], and thereafter continued for at least one month [236] [248].

Procedure, puncture and drainage

The procedure consists of puncture, aspiration, injection and re-aspiration [239] [249] [250] using a 20-gauge fine needle [251] [252].

Outcome

RCTs showed PAIR to be superior to albendazole alone [253] and to surgical treatment [239] [254]. PAIR combined with albendazole was more effective than surgery and was associated with a lower rate of adverse events and a shorter hospital stay. Retrospective studies favor PAIR over surgery in Gharbi type I and II cysts and found surgical treatment most appropriate in the other Gharbi types [249] [255].

A meta-analysis reported severe adverse events (anaphylaxis, cyst infection, abscess, sepsis, biliary fistula) in 7.9 % of patients treated with PAIR plus albendazole [256].

Percutaneous transhepatic cholangiodrainage (PTCD)

Introduction

Percutaneous transhepatic cholangiography and drainage (PTCD) is a commonly used procedure for the diagnosis and treatment of benign and malignant biliary diseases [257] [258]. PTCD also allows therapeutic interventions, such as placement of a stent across a malignant stricture, dilatation of benign biliary strictures and extraction of biliary tract stones [259].

Endoscopic retrograde cholangiography versus PTCD versus endoscopic ultrasound-guided cholangiodrainage

Endoscopic retrograde cholangiography (ERC) is the method of choice for patients with indications for (therapeutic) biliary access [260] [261]. The following surgically altered anatomical situations have a high likelihood for ERC failure: Roux-en-Y with gastric bypass, Kausch-Whipple resection, pylorus-preserving Whipple resection, Roux-en-Y with hepaticojejunostomy, choledochojejunostomy, and pancreaticojejunostomy [262].

Alternative methods are PTCD, EUS-guided interventions (EUS cholangiodrainage, EUS-CD) [192] and balloon-assisted enteroscopy (BAE).

Special problems

Ultrasound guidance versus fluoroscopic guidance

A blind percutaneous puncture of peripherally located intrahepatic bile ducts has limitations especially with non-dilated bile ducts [263] [264]. Real-time imaging with US is useful for the guidance of PTCD (US-PTCD), especially in patients with non-dilated ducts and for left-sided PTCD [265] [266] [267]. Fluoroscopy delivers significant irradiation both to the patient and to the interventional team. The “As Low As Reasonably Achievable” (ALARA) principle should be applied [268].

Percutaneous cholecystostomy

Introduction

Acute calculous cholecystitis (ACC) is a common cause of acute surgical admission. Early cholecystectomy (CCE) is a widely accepted method of treatment [269]. Laparoscopic cholecystectomy (LCCE) in acute cases has minimal morbidity [270]. In high-risk patients morbidity and mortality increase to 14 – 46 % [271].

Alternatively, percutaneous cholecystostomy (PC) is a bridging process, especially in otherwise healthy patients (e. g. ASA I and II) who are severely septic and may become fit in due course for semi-elective surgery [272].

Clinical efficacy

A meta-analysis of 53 studies (n = 1918 patients) reported successful PC for 85.6 % of patients. The procedure-related mortality rate of PC was 0.4 % [273].

Evaluation of US-guided percutaneous cholecystostomy (USPC) for patients with acute acalculous cholecystitis (AAC) is more difficult because it is normally a complication of serious medical and surgical illnesses [274] [275]. A study compared clinical efficacy and adverse events of PC and CCE in a large group of severely ill patients with AAC and showed PC to be a safe and cost-effective bridging treatment strategy, with perioperative outcomes superior to those of open CCE. Compared with open or laparascopic CCE (n = 1021), PC (n = 704) was superior in terms of morbidity, intensive-care unit admissions, length of hospital stay, and costs [276]. Two studies showed that in seriously ill patients with AAC, PC is an effective procedure and may be regarded as a definite treatment option in the majority of patients [277] [278].

Data is limited with respect to the duration of gallbladder drainage. Before removal of the drain, laboratory and clinical data should confirm resolution of sepsis [279]. Patients should be re-evaluated following recovery to assess fitness for elective surgery. Cholecystitis recurrence of 10 – 30 % is reported, and should be weighed against the mortality and morbidity risk in the individual patient.

Drainage route

The transhepatic route has advantages regarding tract formation and the avoiding of peritonitis [280] [281]. The transperitoneal approach has been reported to be similar in relation to complications, but formation of a mature tract without leakage as a precondition for catheter removal is significantly delayed compared with the transhepatic approach [280] [282] [283]. EUS-guided transmural gallbladder drainage may be performed as an alternative to USPC [192].

Percutaneous gastrostomy

Introduction

Gastrostomy can be offered when oral food uptake is temporarily or permanently compromised. Gastrostomy may be used in patients with neurological disorders (e. g., neurological degeneration) and advanced (oncological) diseases, e. g. in gastrointestinal stenosis with intractable vomiting where surgical treatment is not feasible or is declined. The endoscopic approach (percutaneous endoscopic gastrostomy, PEG) with the “pull” technique is the most common technique.

Image-guided percutaneous gastrostomy (without endoscopic access)

The percutaneous approach (image-guided percutaneous gastrostomy, PG) can be performed under fluoroscopy (radiologically inserted gastrostomy, RIG) or US guidance (USPG).

US guidance in experienced hands allows the identification of the position of (a) the stomach, (b) the liver, and (c) in most instances, the transverse colon. Usually the stomach is filled with water by a nasogastric tube, but if US is used to assist endoscopy, air distension is sufficient.

US may be used in the following situations:

• In cases of anticipated difficulty locating the stomach (scars, advanced gastric cancer, obesity, surgically altered stomach anatomy).

• In endoscopic approach when trans-illumination fails.

• In cases without access to the upper gastrointestinal tract (complete esophageal obstruction).

Antibiotic prophylaxis is mandatory for PEG using the pull technique for prevention of peristomal infection. For introducer techniques, antibiotic prophylaxis is not necessary. The database for antibiotic prophylaxis in PEG is comprehensive [284]. There is data for RIG showing no wound infections [285].

Percutaneous nephrostomy

Introduction

Percutaneous nephrostomy (PCN) remains the procedure of choice for temporary drainage of the obstructed collecting system when the transureteral (or retrograde) approach is not indicated or feasible [286] [287]. PCN is also used for urinary diversion and to gain access to the urinary tract for subsequent interventional urologic procedures. PCN can be successfully performed in 95 – 98 % of patients who have a dilated renal collecting system [250].

Indications and contraindications

Indications

PCN may be performed for diagnostic or therapeutic purposes [288] [289].

• Relief of urinary obstruction related to malignancy, urinary stones or iatrogenic causes [289].

• Pyonephrosis and obstructive acute pyelonephritis.

• Urinary diversion in patients with urinary fistula, leakage or hemorrhagic cystitis [290] [291].

• Access for endourologic procedures, such as nephrolithotomy and removal of urinary stones, dilation or stenting of a ureteral stricture [288].

• Diagnostic testing, such as antegrade pyelography, ureteral perfusion (Whitaker test) [290].

• Specific situations, e. g., uroenteric diversion.

• Treatment of urolithiasis in transplanted kidneys and external malignant obstruction [292] [293] [294] [295].

Contraindications

There is no absolute contraindication for PCN, but the benefits and risks must be weighed for each individual [288] [289]. Relative contraindications are:

• Renal vascular malformations such as an arterial aneurysm [290],

• Severe life-threatening electrolyte imbalances such as hyperkalemia, or severe metabolic acidosis [288],

• Severe coagulopathy [296].

Imaging modalities

The optimal imaging methods to guide PCN vary at individual centers. The procedure can be performed with the guidance of fluoroscopy, US, CT, and various combinations of those techniques [297] [298] [299].

Ultrasound guidance

US-guided puncture of the collecting system with subsequent placement of the drainage tube under fluoroscopic control is regarded as the standard technique for PCN [290] [300] [301]. US is helpful to identify the most appropriate calyx for puncture and the presence of stones or blood clots or other intraluminal filling defects and to avoid damage to surrounding organs [302]. In addition, it is an ideal method for patient follow-up [302].

Injection of US contrast agents via a needle or catheter can also confirm whether the needle or PCN catheter have been correctly inserted in the renal pelvis, with reduction in radiation exposure which may be especially important in the first trimester of pregnancy [303]. Fluoroscopy is recommended to determine the position of the needle and guidewire. The catheter can be visualized by injecting diluted US contrast agent.

Technical aspects and indications

Methods

Positioning

The risk of adjacent organ injury during percutaneous nephrostomy is minimized when the nephrostomy is inserted below the 12th rib. Attempts should be made to achieve catheter placement through a calyx, particularly if percutaneous nephrolithotomy or other large-bore catheter placement is considered [290].

Seldinger or trocar technique

US-guided PCN tube placement has a success rate of 92 – 94 % [304] [305]. The trocar and Seldinger techniques are equally effective [306].

Size

A 6 – 10F catheter is recommended for PCN. If the collecting system is punctured for further procedures (e. g., tumor or stone removal), a larger catheter may be considered (14 – 22F).

Post-procedure catheter management and patient care

Vital signs should be monitored during initial recovery (> 24 hours) [288]. Urinary output should be charted. Urine will be blood-tinged initially but prolonged hematuria (> 24 – 48 hours) should serve as an alert to persistent bleeding from vascular injury [288] [307]. Long-term indwelling catheters should be changed every 4 – 6 weeks [250].

Complications

The incidence of major complications ranges from 0 – 8 % [286] [299] [308] [309]. Minor complications occur in 2 – 38 % [286] [299] [308] [309].

Suprapubic puncture of the bladder

Introduction

Suprapubic puncture of the bladder is a safe and reliable method to drain the bladder, while avoiding urethral catheterization [310]. US guidance improves the success rate [311] [312] [313] [314].

US is recommended to assess the position and volume of the bladder, and to avoid the inadvertent puncture of other structures [315] [316].

Main indications

Suprapubic puncture of the bladder is indicated in pathological conditions of the bladder, prostate or urethra that require temporary or permanent drainage of the bladder when urethral catheterization is not possible or is contraindicated.

Contraindications to the percutaneous US-guided procedure

• Absence of visualization of the bladder on US.

• Uncorrected coagulopathy.

• Other relative contraindications are those secondary to complex anatomy due to congenital disorders, habitus, previous surgery or infiltrative pelvic cancer.

Materials and technical problems

The procedure is performed under sterile conditions after the administration of local anesthesia. Sedation may be useful in select cases. The position and volume of the bladder are identified by US and US is used for real-time guidance of the percutaneous puncture [315] [316]. Catheters are placed by either the Seldinger or the trocar technique, with dilation of the percutaneous track when necessary. Catheters of 10F are large enough to relieve acute urinary retention. Large catheters (> 16F) are recommended in patients who require prolonged drainage of the bladder in circumstances such as bladder rupture or complicated urethral stricture [310].

Complications

US guidance can decrease the complication rate of suprapubic puncture [310] [314] [317]. Major complications are rare and include perforation of intestinal loops [318]. Minor complications include pain, infection, hemorrhage, blockage, hematuria and catheter misplacement, all of which are less common when US guidance is performed [314] [317] [319].

Palliative care

Palliative care patients often have alterations in locoregional anatomy, vascular patterns and coagulation factors. Therefore, for any invasive procedure it is recommended to consider US guidance to improve safety and help minimize complications and patient discomfort. There are no contraindications of US-guided procedures in palliative care [320]. The management of cancer complications indicates potential roles for home-performed US and US-guided procedures at the end of life [321].

Acknowledgement

The authors kindly thank David Cosgrove (UK), Barbara Braden (UK), Liliana Chiorean (France), Franca Meloni (Italy), Andrej Potthoff (Germany), Klaus Schlottmann (Germany), Wolf B. Schwerk (Germany), and Trygve Syversveen (Norway). We would like to acknowledge the endless support and advice from Lynne Rudd, EFSUMB general secretary.

• References

• 1 Lorentzen T, Nolsoe CP, Ewertsen C et al. EFSUMB Guidelines on Interventional Ultrasound, Part I: General Aspects. Ultraschall in Med 2015; 36: 464-472
• 2 Sidhu PS, Bradbrand K, Cantisani V et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part II: Diagnostic Ultrasound Guided Interventional Procedures. Ultraschall in Med 2015; in press
• 3 Jenssen C, Hocke M, Fusaroli P et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part IV: EUS-guided Interventions: General Aspects and EUS-guided Sampling. Ultraschall in Med 2015; in press
• 4 Fusaroli P, Jenssen C, Hocke M et al. EFSUMB INVUS Guidelines, Part V: EUS-guided Therapeutic Interventions. Ultraschall in Med 2015; in press
• 5 Jenssen C, Brkljacic B, Hocke M et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part VI: Ultrasound-Guided Vascular Interventions. Ultraschall in Med 2015; in Press
• 6 Dietrich CF, Lorentzen T, Sidhu PS et al. An introduction into the EFSUMB guidelines on interventional ultrasound. Ultraschall in Med 2015; 36: 460-463
• 7 Claudon M, Dietrich CF, Choi BI et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall in Med 2013; 34: 11-29
• 8 Claudon M, Dietrich CF, Choi BI et al. Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver – update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol 2013; 39: 187-210
• 9 Dietrich CF, Cui XW, Chiorean L et al. Local ablative procedures of the liver. Z Gastroenterol 2015; 53: 579-590
• 10 Gillams A, Goldberg N, Ahmed M et al. Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, the interventional oncology sans frontieres meeting 2013. Eur Radiol 2015;
• 11 Dietrich CF, Albrecht T, Bernatik T et al. Lokal ablative Verfahren von Lebertumoren; Radiofrequenzablation (RFA). In: Dietrich CF, Nurnberg D, eds. Interventionelle Sonografie. Thieme Verlag; 2011: 264-282
• 12 Dietrich CF, Braden B, Hocke M. Lokal ablative Verfahren, Perkutane Alkoholinjektion. In: Dietrich CF, Nurnberg D, eds. Interventionelle Sonografie. Thieme Verlag; 2011: 257-263
• 13 Ebert MP, Auernhammer C, Caca K et al. Gastrointestinal oncology – therapy update 2008 / 2009. Z Gastroenterol 2009; 47: 296-306
• 14 Greten TF, Malek NP, Schmidt S et al. Diagnosis of and therapy for hepatocellular carcinoma. Z Gastroenterol 2013; 51: 1269-1326
• 15 Abi-Jaoudeh N, Duffy AG, Greten TF et al. Personalized oncology in interventional radiology. J Vasc Interv Radiol 2013; 24: 1083-1092
• 16 Vivarelli M, Guglielmi A, Ruzzenente A et al. Surgical resection versus percutaneous radiofrequency ablation in the treatment of hepatocellular carcinoma on cirrhotic liver. Ann Surg 2004; 240: 102-107
• 17 Ruzzenente A, Guglielmi A, Sandri M et al. Surgical resection versus local ablation for HCC on cirrhosis: results from a propensity case-matched study. J Gastrointest Surg 2012; 16: 301-311
• 18 Dietrich CF, Braden B. Perkutane Zystensklerosierung. In: Dietrich CF, Nuernberg D, eds. Interventionelle Sonografie. Thieme; 2011: 233-239
• 19 Carrafiello G, Lagana D, Cotta E et al. Radiofrequency ablation of intrahepatic cholangiocarcinoma: preliminary experience. Cardiovasc Intervent Radiol 2010; 33: 835-839
• 20 Mazziotti A, Grazi GL, Gardini A et al. An appraisal of percutaneous treatment of liver metastases. Liver Transpl Surg 1998; 4: 271-275
• 21 Ploeckinger U, Kloeppel G, Wiedenmann B et al. The German NET-registry: an audit on the diagnosis and therapy of neuroendocrine tumors. Neuroendocrinology 2009; 90: 349-363
• 22 Auernhammer CJ, Jauch KW, Hoffmann JN. Liver metastases from neuroendocrine tumours of the gastroenteropancreatic system--therapeutic strategies. Zentralbl Chir 2009; 134: 410-417
• 23 Atwell TD, Charboneau JW, Que FG et al. Treatment of neuroendocrine cancer metastatic to the liver: the role of ablative techniques. Cardiovasc Intervent Radiol 2005; 28: 409-421
• 24 Siperstein AE, Berber E. Cryoablation, percutaneous alcohol injection, and radiofrequency ablation for treatment of neuroendocrine liver metastases. World J Surg 2001; 25: 693-696
• 25 Illing R, Gillams A. Radiofrequency ablation in the treatment of breast cancer liver metastases. Clin Oncol (R Coll Radiol) 2010; 22: 781-784
• 26 Solbiati L, Ahmed M, Cova L et al. Small liver colorectal metastases treated with percutaneous radiofrequency ablation: local response rate and long-term survival with up to 10-year follow-up. Radiology 2012; 265: 958-968
• 27 Meloni MF, Andreano A, Laeseke PF et al. Breast cancer liver metastases: US-guided percutaneous radiofrequency ablation--intermediate and long-term survival rates. Radiology 2009; 253: 861-869
• 28 Nikfarjam M, Shereef S, Kimchi ET et al. Survival outcomes of patients with colorectal liver metastases following hepatic resection or ablation in the era of effective chemotherapy. Ann Surg Oncol 2009; 16: 1860-1867
• 29 Pox C, Schmiegel W, Reinacher-Schick A. Colorectal carcinoma: what's new?. Dtsch Med Wochenschr 2012; 137: 2577-2580
• 30 Pox C, Aretz S, Bischoff SC et al. S3-guideline colorectal cancer version 1.0. Z Gastroenterol 2013; 51: 753-854
• 31 Miller G, Biernacki P, Kemeny NE et al. Outcomes after resection of synchronous or metachronous hepatic and pulmonary colorectal metastases. J Am Coll Surg 2007; 205: 231-238
• 32 Adam R, Avisar E, Ariche A et al. Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal. Ann Surg Oncol 2001; 8: 347-353
• 33 Abdalla EK, Vauthey JN. Chemotherapy prior to hepatic resection for colorectal liver metastases: helpful until harmful?. Dig Surg 2008; 25: 421-429
• 34 Abdalla EK. Commentary: Radiofrequency ablation for colorectal liver metastases: do not blame the biology when it is the technology. Am J Surg 2009; 197: 737-739
• 35 Evrard S, Poston G, Kissmeyer-Nielsen P et al. Combined Ablation and Resection (CARe) as an Effective Parenchymal Sparing Treatment for Extensive Colorectal Liver Metastases. PLoS One 2014; 9: e114404
• 36 Livraghi T, Solbiati L, Meloni F et al. Percutaneous radiofrequency ablation of liver metastases in potential candidates for resection: the "test-of-time approach". Cancer 2003; 97: 3027-3035
• 37 Rossi S, Di Stasi M, Buscarini E et al. Percutaneous radiofrequency interstitial thermal ablation in the treatment of small hepatocellular carcinoma. Cancer J Sci Am 1995; 1: 73-81
• 38 Livraghi T, Goldberg SN, Lazzaroni S et al. Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection. Radiology 1999; 210: 655-661
• 39 Shiina S, Teratani T, Obi S et al. Nonsurgical treatment of hepatocellular carcinoma: from percutaneous ethanol injection therapy and percutaneous microwave coagulation therapy to radiofrequency ablation. Oncology 2002; 62: 64-68
• 40 Sugiura N, Takara K, Ohto M et al. Percutaneous intratumoral injection of ethanol under ultrasound imaging for treatment of small hepatocellular carcinoma. Acta Hepatol Jpn 1983; 24: 920
• 41 Livraghi T, Festi D, Monti F et al. US-guided percutaneous alcohol injection of small hepatic and abdominal tumors. Radiology 1986; 161: 309-312
• 42 Shiina S, Tagawa K, Niwa Y et al. Percutaneous ethanol injection therapy for hepatocellular carcinoma: results in 146 patients. Am J Roentgenol 1993; 160: 1023-1028
• 43 Seki T, Wakabayashi M, Nakagawa T et al. Ultrasonically guided percutaneous microwave coagulation therapy for small hepatocellular carcinoma. Cancer 1994; 74: 817-825
• 44 Mazzaferro V, Regalia E, Doci R et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996; 334: 693-699
• 45 Omata M, Lesmana LA, Tateishi R et al. Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 2010; 4: 439-474
• 46 Seror O, N'Kontchou G, Ibraheem M et al. Large (>or=5.0-cm) HCCs: multipolar RF ablation with three internally cooled bipolar electrodes--initial experience in 26 patients. Radiology 2008; 248: 288-296
• 47 N'Kontchou G, Mahamoudi A, Aout M et al. Radiofrequency ablation of hepatocellular carcinoma: long-term results and prognostic factors in 235 Western patients with cirrhosis. Hepatology 2009; 50: 1475-1483
• 48 Chen MH, Yang W, Yan K et al. Large liver tumors: protocol for radiofrequency ablation and its clinical application in 110 patients--mathematic model, overlapping mode, and electrode placement process. Radiology 2004; 232: 260-271
• 49 Bale R, Widmann G, Haidu M. Stereotactic Radiofrequency Ablation. Cardiovasc Intervent Radiol 2010;
• 50 Sainani NI, Gervais DA, Mueller PR et al. Imaging after percutaneous radiofrequency ablation of hepatic tumors: Part 1, Normal findings. Am J Roentgenol 2013; 200: 184-193
• 51 Komorizono Y, Oketani M, Sako K et al. Risk factors for local recurrence of small hepatocellular carcinoma tumors after a single session, single application of percutaneous radiofrequency ablation. Cancer 2003; 97: 1253-1262
• 52 Imamura J, Tateishi R, Shiina S et al. Neoplastic seeding after radiofrequency ablation for hepatocellular carcinoma. Am J Gastroenterol 2008; 103: 3057-3062
• 53 Llovet JM, Vilana R, Bru C et al. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology 2001; 33: 1124-1129
• 54 Teratani T, Yoshida H, Shiina S et al. Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations. Hepatology 2006; 43: 1101-1108
• 55 Ritz JP, Lehmann K, Isbert C et al. Effectivity of laser-induced thermotherapy: in vivo comparison of arterial microembolization and complete hepatic inflow occlusion. Lasers Surg Med 2005; 36: 238-244
• 56 Kim SW, Rhim H, Park M et al. Percutaneous radiofrequency ablation of hepatocellular carcinomas adjacent to the gallbladder with internally cooled electrodes: assessment of safety and therapeutic efficacy. Korean J Radiol 2009; 10: 366-376
• 57 Kang TW, Rhim H, Kim EY et al. Percutaneous radiofrequency ablation for the hepatocellular carcinoma abutting the diaphragm: assessment of safety and therapeutic efficacy. Korean J Radiol 2009; 10: 34-42
• 58 Head HW, Dodd III GD, Dalrymple NC et al. Percutaneous radiofrequency ablation of hepatic tumors against the diaphragm: frequency of diaphragmatic injury. Radiology 2007; 243: 877-884
• 59 Abdalla EK, Vauthey JN, Ellis LM et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 2004; 239: 818-825
• 60 Wang Y, Luo Q, Li Y et al. Radiofrequency ablation versus hepatic resection for small hepatocellular carcinomas: a meta-analysis of randomized and nonrandomized controlled trials. PLoS One 2014; 9: e84484
• 61 Goldberg SN, Kamel IR, Kruskal JB et al. Radiofrequency ablation of hepatic tumors: increased tumor destruction with adjuvant liposomal doxorubicin therapy. Am J Roentgenol 2002; 179: 93-101
• 62 Shirato K, Morimoto M, Tomita N et al. Small hepatocellular carcinoma: therapeutic effectiveness of percutaneous radio frequency ablation therapy with a LeVeen needle electrode. J Ultrasound Med 2002; 21: 67-76
• 63 Rossi S, Buscarini E, Garbagnati F et al. Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode. Am J Roentgenol 1998; 170: 1015-1022
• 64 Cucchetti A, Piscaglia F, Cescon M et al. Systematic review of surgical resection vs radiofrequency ablation for hepatocellular carcinoma. World J Gastroenterol 2013; 19: 4106-4118
• 65 Weis S, Franke A, Mossner J et al. Radiofrequency (thermal) ablation versus no intervention or other interventions for hepatocellular carcinoma. Cochrane Database Syst Rev 2013; 12: CD003046
• 66 Cucchetti A, Piscaglia F, Cescon M et al. An explorative data-analysis to support the choice between hepatic resection and radiofrequency ablation in the treatment of hepatocellular carcinoma. Dig Liver Dis 2014; 46: 257-263
• 67 Lencioni R, Cioni D, Crocetti L et al. Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology 2005; 234: 961-967
• 68 Tateishi R, Shiina S, Teratani T et al. Percutaneous radiofrequency ablation for hepatocellular carcinoma. An analysis of 1000 cases. Cancer 2005; 103: 1201-1209
• 69 Cabassa P, Donato F, Simeone F et al. Radiofrequency ablation of hepatocellular carcinoma: long-term experience with expandable needle electrodes. Am J Roentgenol 2006; 186: S316-S321
• 70 Livraghi T, Meloni F, Di Stasi M et al. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice?. Hepatology 2008; 47: 82-89
• 71 Yan K, Chen MH, Yang W et al. Radiofrequency ablation of hepatocellular carcinoma: long-term outcome and prognostic factors. Eur J Radiol 2008; 67: 336-347
• 72 Kasugai H, Osaki Y, Oka H et al. Severe complications of radiofrequency ablation therapy for hepatocellular carcinoma: an analysis of 3891 ablations in 2614 patients. Oncology 2007; 72: 72-75
• 73 Shiina S, Tagawa K, Unuma T et al. Percutaneous ethanol injection therapy for hepatocellular carcinoma. A histopathologic study. Cancer 1991; 68: 1524-1530
• 74 Sung YM, Choi D, Lim HK et al. Long-term results of percutaneous ethanol injection for the treatment of hepatocellular carcinoma in Korea. Korean J Radiol 2006; 7: 187-192
• 75 Livraghi T, Giorgio A, Marin G et al. Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection. Radiology 1995; 197: 101-108
• 76 Dietrich CF, Hocke M, Jenssen C. Ultrasound for abdominal lymphadenopathy. Dtsch Med Wochenschr 2013; 138: 1001-1018
• 77 Brunello F, Veltri A, Carucci P et al. Radiofrequency ablation versus ethanol injection for early hepatocellular carcinoma: A randomized controlled trial. Scand J Gastroenterol 2008; 43: 727-735
• 78 Lencioni RA, Allgaier HP, Cioni D et al. Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology 2003; 228: 235-240
• 79 Lin SM, Lin CJ, Lin CC et al. Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut 2005; 54: 1151-1156
• 80 Shiina S, Teratani T, Obi S et al. A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology 2005; 129: 122-130
• 81 Lin SM, Lin CJ, Lin CC et al. Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma < or =4 cm. Gastroenterology 2004; 127: 1714-1723
• 82 Orlando A, Leandro G, Olivo M et al. Radiofrequency thermal ablation vs. percutaneous ethanol injection for small hepatocellular carcinoma in cirrhosis: meta-analysis of randomized controlled trials. Am J Gastroenterol 2009; 104: 514-524
• 83 Yang B, Zan RY, Wang SY et al. Radiofrequency ablation versus percutaneous ethanol injection for hepatocellular carcinoma: a meta-analysis of randomized controlled trials. World J Surg Oncol 2015; 13: 96
• 84 Cho YK, Kim JK, Kim MY et al. Systematic review of randomized trials for hepatocellular carcinoma treated with percutaneous ablation therapies. Hepatology 2009; 49: 453-459
• 85 Giorgio A, Di Sarno A, De Stefano G et al. Percutaneous radiofrequency ablation of hepatocellular carcinoma compared to percutaneous ethanol injection in treatment of cirrhotic patients: an Italian randomized controlled trial. Anticancer Res 2011; 31: 2291-2295
• 86 Germani G, Pleguezuelo M, Gurusamy K et al. Clinical outcomes of radiofrequency ablation, percutaneous alcohol and acetic acid injection for hepatocelullar carcinoma: a meta-analysis. J Hepatol 2010; 52: 380-388
• 87 Bouza C, Lopez-Cuadrado T, Alcazar R et al. Meta-analysis of percutaneous radiofrequency ablation versus ethanol injection in hepatocellular carcinoma. BMC Gastroenterol 2009; 9: 31
• 88 Omata M, Tateishi R, Yoshida H et al. Treatment of hepatocellular carcinoma by percutaneous tumor ablation methods: Ethanol injection therapy and radiofrequency ablation. Gastroenterology 2004; 127: S159-S166
• 89 Sala M, Llovet JM, Vilana R et al. Initial response to percutaneous ablation predicts survival in patients with hepatocellular carcinoma. Hepatology 2004; 40: 1352-1360
• 90 Guglielmi A, Ruzzenente A, Valdegamberi A et al. Radiofrequency ablation versus surgical resection for the treatment of hepatocellular carcinoma in cirrhosis. J Gastrointest Surg 2008; 12: 192-198
• 91 Liang P, Dong B, Yu X et al. Prognostic factors for survival in patients with hepatocellular carcinoma after percutaneous microwave ablation. Radiology 2005; 235: 299-307
• 92 Liang P, Wang Y. Microwave ablation of hepatocellular carcinoma. Oncology 2007; 72: 124-131
• 93 Liang P, Wang Y, Yu X et al. Malignant liver tumors: treatment with percutaneous microwave ablation--complications among cohort of 1136 patients. Radiology 2009; 251: 933-940
• 94 Lu MD, Xu HX, Xie XY et al. Percutaneous microwave and radiofrequency ablation for hepatocellular carcinoma: a retrospective comparative study. J Gastroenterol 2005; 40: 1054-1060
• 95 Ohmoto K, Miyake I, Tsuduki M et al. Percutaneous microwave coagulation therapy for unresectable hepatocellular carcinoma. Hepatogastroenterology 1999; 46: 2894-2900
• 96 Sato M, Watanabe Y, Ueda S et al. Microwave coagulation therapy for hepatocellular carcinoma. Gastroenterology 1996; 110: 1507-1514
• 97 Yin XY, Xie XY, Lu MD et al. Percutaneous thermal ablation of medium and large hepatocellular carcinoma: long-term outcome and prognostic factors. Cancer 2009; 115: 1914-1923
• 98 Ebara M, Okabe S, Kita K et al. Percutaneous ethanol injection for small hepatocellular carcinoma: therapeutic efficacy based on 20-year observation. J Hepatol 2005; 43: 458-464
• 99 Khan KN, Yatsuhashi H, Yamasaki K et al. Prospective analysis of risk factors for early intrahepatic recurrence of hepatocellular carcinoma following ethanol injection. J Hepatol 2000; 32: 269-278
• 100 Koda M, Murawaki Y, Mitsuda A et al. Predictive factors for intrahepatic recurrence after percutaneous ethanol injection therapy for small hepatocellular carcinoma. Cancer 2000; 88: 529-537
• 101 Pompili M, Rapaccini GL, Covino M et al. Prognostic factors for survival in patients with compensated cirrhosis and small hepatocellular carcinoma after percutaneous ethanol injection therapy. Cancer 2001; 92: 126-135
• 102 Kim YJ, Lee MW, Park HS. Small hepatocellular carcinomas: ultrasonography guided percutaneous radiofrequency ablation. Abdom Imaging 2013; 38: 98-111
• 103 Rajesh S, Mukund A, Arora A et al. Contrast-enhanced US-guided radiofrequency ablation of hepatocellular carcinoma. J Vasc Interv Radiol 2013; 24: 1235-1240
• 104 Choi D, Lim HK, Lee WJ et al. Early assessment of the therapeutic response to radio frequency ablation for hepatocellular carcinoma: utility of gray scale harmonic ultrasonography with a microbubble contrast agent. J Ultrasound Med 2003; 22: 1163-1172
• 105 Minami Y, Kudo M, Chung H et al. Contrast harmonic sonography-guided radiofrequency ablation therapy versus B-mode sonography in hepatocellular carcinoma: prospective randomized controlled trial. Am J Roentgenol 2007; 188: 489-494
• 106 Takaki H, Yamakado K, Nakatsuka A et al. Frequency of and risk factors for complications after liver radiofrequency ablation under CT fluoroscopic guidance in 1500 sessions: single-center experience. Am J Roentgenol 2013; 200: 658-664
• 107 Evrard S, Brouste V, McKelvie-Sebileau P et al. Liver metastases in close contact to hepatic veins ablated under vascular exclusion. Eur J Surg Oncol 2013; 39: 1400-1406
• 108 Desolneux G, Vara J, Razafindratsira T et al. Patterns of complications following intraoperative radiofrequency ablation for liver metastases. HPB (Oxford) 2014; 16: 1002-1008
• 109 Schwartz A, Desolneux G, Desjardin M et al. Symptomatic diaphragmatic hernia after pulmonary radiofrequency ablation. J Visc Surg 2013; 150: 157-158
• 110 Curley SA. Radiofrequency ablation of malignant liver tumors. Oncologist 2001; 6: 14-23
• 111 Livraghi T, Solbiati L, Meloni MF et al. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 2003; 226: 441-451
• 112 de Baère T, Risse O, Kuoch V et al. Adverse events during radiofrequency treatment of 582 hepatic tumors. Am J Roentgenol 2003; 181: 695-700
• 113 Jenssen C, Dietrich CF. Kontraindikationen, Komplikationen, Komplikationsmanagment. In: Dietrich CF, Nuernberg D, eds. Interventionelle Sonografie. Thieme Verlag; 2011: 127-160
• 114 Arienti V, Pretolani S, Goldberg SN et al. How to report and compare complications of image-guided ablation therapies: comments on seeding and the use of a sole common denominator for liver tumors. Radiology 2006; 241: 625-626
• 115 Chang S, Kim SH, Lim HK et al. Needle tract implantation after percutaneous interventional procedures in hepatocellular carcinomas: lessons learned from a 10-year experience. Korean J Radiol 2008; 9: 268-274
• 116 Livraghi T, Lazzaroni S, Meloni F et al. Risk of tumour seeding after percutaneous radiofrequency ablation for hepatocellular carcinoma. Br J Surg 2005; 92: 856-858
• 117 Bolondi L, Gaiani S, Celli N et al. Tumor dissemination after radiofrequency ablation of hepatocellular carcinoma. Hepatology 2001; 34: 608-601
• 118 Kanas GP, Taylor A, Primrose JN et al. Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors. Clin Epidemiol 2012; 4: 283-301
• 119 Bradley AL, Chapman WC, Wright JK et al. Surgical experience with hepatic colorectal metastasis. Am Surg 1999; 65: 560-566
• 120 Doci R, Gennari L, Bignami P et al. One hundred patients with hepatic metastases from colorectal cancer treated by resection: analysis of prognostic determinants. Br J Surg 1991; 78: 797-801
• 121 Fong Y, Fortner J, Sun RL et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999; 230: 309-318
• 122 Ohlsson B, Stenram U, Tranberg KG. Resection of colorectal liver metastases: 25-year experience. World J Surg 1998; 22: 268-276
• 123 Scheele J, Stangl R, Altendorf-Hofmann A et al. Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery 1991; 110: 13-29
• 124 Wagner JS, Adson MA, Van Heerden JA et al. The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment. Ann Surg 1984; 199: 502-508
• 125 Neumann UP, Seehofer D, Neuhaus P. The surgical treatment of hepatic metastases in colorectal carcinoma. Dtsch Arztebl Int 2010; 107: 335-342
• 126 Park IJ, Kim HC, Yu CS et al. Radiofrequency ablation for metachronous liver metastasis from colorectal cancer after curative surgery. Ann Surg Oncol 2008; 15: 227-232
• 127 Lorentzen T, Skjoldbye BO, Nolsoe CP. Microwave ablation of liver metastases guided by contrast-enhanced ultrasound: experience with 125 metastases in 39 patients. Ultraschall in Med 2011; 32: 492-496
• 128 Cho YK, Kim JK, Kim WT et al. Hepatic resection versus radiofrequency ablation for very early stage hepatocellular carcinoma: a Markov model analysis. Hepatology 2010; 51: 1284-1290
• 129 Lee WS, Yun SH, Chun HK et al. Clinical outcomes of hepatic resection and radiofrequency ablation in patients with solitary colorectal liver metastasis. J Clin Gastroenterol 2008; 42: 945-949
• 130 Gillams AR, Lees WR. Five-year survival in 309 patients with colorectal liver metastases treated with radiofrequency ablation. Eur Radiol 2009; 19: 1206-1213
• 131 Gillams AR, Lees WR. Radio-frequency ablation of colorectal liver metastases in 167 patients. Eur Radiol 2004; 14: 2261-2267
• 132 Knudsen AR, Kannerup AS, Mortensen FV et al. Radiofrequency ablation of colorectal liver metastases downstaged by chemotherapy. Acta Radiol 2009; 50: 716-721
• 133 Tanis E, Nordlinger B, Mauer M et al. Local recurrence rates after radiofrequency ablation or resection of colorectal liver metastases. Analysis of the European Organisation for Research and Treatment of Cancer #40004 and #40983. Eur J Cancer 2014; 50: 912-919
• 134 Weng M, Zhang Y, Zhou D et al. Radiofrequency ablation versus resection for colorectal cancer liver metastases: a meta-analysis. PLoS One 2012; 7: e45493
• 135 Bai H, Huangz X, Jing L et al. The effect of radiofrequency ablation vs. liver resection on survival outcome of colorectal liver metastases (CRLM): a meta-analysis. Hepatogastroenterology 2015; 62: 373-377
• 136 Ruers T, Punt C, van Coevorden F et al. Radiofrequency ablation combined with systemic treatment versus systemic treatment alone in patients with non-resectable colorectal liver metastases: a randomized EORTC Intergroup phase II study (EORTC 40004). Ann Oncol 2012; 23: 2619-2626
• 137 Remzi M, Javadli E, Ozsoy M. Management of small renal masses: a review. World J Urol 2010; 28: 275-281
• 138 Aron M, Gill IS. Minimally invasive nephron-sparing surgery (MINSS) for renal tumours. Part II: probe ablative therapy. Eur Urol 2007; 51: 348-357
• 139 Nahum GS, Dupuy DE. Image-guided radiofrequency tumor ablation: challenges and opportunities--part I. J Vasc Interv Radiol 2001; 12: 1021-1032
• 140 Gervais DA, McGovern FJ, Arellano RS et al. Radiofrequency ablation of renal cell carcinoma: part 1, Indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. Am J Roentgenol 2005; 185: 64-71
• 141 Gervais DA, Arellano RS, McGovern FJ et al. Radiofrequency ablation of renal cell carcinoma: part 2, Lessons learned with ablation of 100 tumors. Am J Roentgenol 2005; 185: 72-80
• 142 Tracy CR, Raman JD, Donnally C et al. Durable oncologic outcomes after radiofrequency ablation: experience from treating 243 small renal masses over 7.5 years. Cancer 2010; 116: 3135-3142
• 143 Zagoria RJ, Traver MA, Werle DM et al. Oncologic efficacy of CT-guided percutaneous radiofrequency ablation of renal cell carcinomas. Am J Roentgenol 2007; 189: 429-436
• 144 Breen DJ, Rutherford EE, Stedman B et al. Management of renal tumors by image-guided radiofrequency ablation: experience in 105 tumors. Cardiovasc Intervent Radiol 2007; 30: 936-942
• 145 Levinson AW, Su LM, Agarwal D et al. Long-term oncological and overall outcomes of percutaneous radio frequency ablation in high risk surgical patients with a solitary small renal mass. J Urol 2008; 180: 499-504
• 146 Stein RJ, Kaouk JH. Renal cryotherapy: a detailed review including a 5-year follow-up. BJU Int 2007; 99: 1265-1270
• 147 Atwell TD, Callstrom MR, Farrell MA et al. Percutaneous renal cryoablation: local control at mean 26 months of followup. J Urol 2010; 184: 1291-1295
• 148 Atwell TD, Farrell MA, Callstrom MR et al. Percutaneous cryoablation of large renal masses: technical feasibility and short-term outcome. Am J Roentgenol 2007; 188: 1195-1200
• 149 Klatte T, Kroeger N, Zimmermann U et al. The contemporary role of ablative treatment approaches in the management of renal cell carcinoma (RCC): focus on radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), and cryoablation. World J Urol 2014; 32: 597-605
• 150 El DibR, Touma NJ, Kapoor A. Cryoablation vs radiofrequency ablation for the treatment of renal cell carcinoma: a meta-analysis of case series studies. BJU Int 2012; 110: 510-516
• 151 Goel RK, Kaouk JH. Probe ablative treatment for small renal masses: cryoablation vs. radio frequency ablation. Curr Opin Urol 2008; 18: 467-473
• 152 Wah TM, Irving HC, Gregory W et al. Radiofrequency ablation (RFA) of renal cell carcinoma (RCC): experience in 200 tumours. BJU Int 2014; 113: 416-428
• 153 Goldberg SN, Grassi CJ, Cardella JF et al. Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol 2009; 20: S377-S390
• 154 Campbell SC, Novick AC, Belldegrun A et al. Guideline for management of the clinical T1 renal mass. J Urol 2009; 182: 1271-1279
• 155 Psutka SP, Feldman AS, McDougal WS et al. Long-term oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma. Eur Urol 2013; 63: 486-492
• 156 Kunkle DA, Egleston BL, Uzzo RG. Excise, ablate or observe: the small renal mass dilemma--a meta-analysis and review. J Urol 2008; 179: 1227-1233
• 157 Ljungberg B, Cowan NC, Hanbury DC et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 2010; 58: 398-406
• 158 Meloni MF, Bertolotto M, Alberzoni C et al. Follow-up after percutaneous radiofrequency ablation of renal cell carcinoma: contrast-enhanced sonography versus contrast-enhanced CT or MRI. Am J Roentgenol 2008; 191: 1233-1238
• 159 Kong WT, Zhang WW, Guo HQ et al. Application of contrast-enhanced ultrasonography after radiofrequency ablation for renal cell carcinoma: is it sufficient for assessment of therapeutic response?. Abdom Imaging 2011; 36: 342-347
• 160 Ignee A, Straub B, Brix D et al. The value of contrast enhanced ultrasound (CEUS) in the characterisation of patients with renal masses. Clin Hemorheol Microcirc 2010; 46: 275-290
• 161 Ignee A, Straub B, Schuessler G et al. Contrast enhanced ultrasound of renal masses. World J Radiol 2010; 2: 15-31
• 162 Smith EH, Bartrum Jr RJ. Ultrasonically guided percutaneous aspiration of abscesses. Am J Roentgenol Radium Ther Nucl Med 1974; 122: 308-312
• 163 Wittmann DH, Schein M, Condon RE. Management of secondary peritonitis. Ann Surg 1996; 224: 10-18
• 164 Kishina M, Koda M, Tokunaga S et al. Usefulness of contrast-enhanced ultrasound with Sonazoid for evaluating liver abscess in comparison with conventional B-mode ultrasound. Hepatol Res 2014;
• 165 Liu GJ, Lu MD, Xie XY et al. Real-time contrast-enhanced ultrasound imaging of infected focal liver lesions. J Ultrasound Med 2008; 27: 657-666
• 166 Cai YL, Xiong XZ, Lu J et al. Percutaneous needle aspiration versus catheter drainage in the management of liver abscess: a systematic review and meta-analysis. HPB (Oxford) 2014;
• 167 Zerem E, Hadzic A. Sonographically guided percutaneous catheter drainage versus needle aspiration in the management of pyogenic liver abscess. Am J Roentgenol 2007; 189: W138-W142
• 168 Zerem E, Bergsland J. Ultrasound guided percutaneous treatment for splenic abscesses: the significance in treatment of critically ill patients. World J Gastroenterol 2006; 12: 7341-7345
• 169 Lorentzen T, Nolsoe C, Skjoldbye B. Ultrasound-guided drainage of deep pelvic abscesses: experience with 33 cases. Ultrasound Med Biol 2011; 37: 723-728
• 170 Schwerk WB, Gorg C, Gorg K et al. Percutaneous drainage of liver and splenic abscess. Z Gastroenterol 1991; 29: 146-152
• 171 Schwerk WB, Gorg C, Gorg K et al. Ultrasound-guided percutaneous drainage of pyogenic splenic abscesses. J Clin Ultrasound 1994; 22: 161-166
• 172 Rothlin MA, Schob O, Klotz H et al. Percutaneous drainage of abdominal abscesses: are large-bore catheters necessary?. Eur J Surg 1998; 164: 419-424
• 173 Cui XW, Ignee A, Dietrich CF. Ultrasound-guided percutaneous abscess drainage. In. http://www.efsumb.org/asp/detail06.asp?ref=373&url=/intro/home.asp?ref=1: European Federation of Societies for Ultrasound in Medicine and Biology; 2011
• 174 Ignee A, Schuessler G, Cui XW et al. Intracavitary contrast medium ultrasound – different applications, a review of the literature ad future prospects. Ultraschall in Med 2013; 34: 504-525 ; quiz 526–508
• 175 Ignee A, Jenssen C, Cui XW et al. Intracavitary contrast-enhanced ultrasound in abscess drainage – feasibility and clinical value. Scand J Gastroenterol 2015; 1-7
• 176 Pham Van L, Duong Manh H, Pham Nhu H. Amebic abscess of the liver: ultrasound guided puncture. Ann Chir 1996; 50: 340-343
• 177 McInnes MD, Kielar AZ, Macdonald DB. Percutaneous image-guided biopsy of the spleen: systematic review and meta-analysis of the complication rate and diagnostic accuracy. Radiology 2011; 260: 699-708
• 178 Feagins LA, Holubar SD, Kane SV et al. Current strategies in the management of intra-abdominal abscesses in Crohn's disease. Clin Gastroenterol Hepatol 2011; 9: 842-850
• 179 Gervais DA, Hahn PF, O'Neill MJ et al. Percutaneous abscess drainage in Crohn disease: technical success and short- and long-term outcomes during 14 years. Radiology 2002; 222: 645-651
• 180 Golfieri R, Cappelli A, Giampalma E et al. CT-guided percutaneous pelvic abscess drainage in Crohn's disease. Tech Coloproctol 2006; 10: 99-105
• 181 Sahai A, Belair M, Gianfelice D et al. Percutaneous drainage of intra-abdominal abscesses in Crohn's disease: short and long-term outcome. Am J Gastroenterol 1997; 92: 275-278
• 182 da Luz Moreira A, Stocchi L, Tan E et al. Outcomes of Crohn's disease presenting with abdominopelvic abscess. Dis Colon Rectum 2009; 52: 906-912
• 183 Rypens F, Dubois J, Garel L et al. Percutaneous drainage of abdominal abscesses in pediatric Crohn's disease. Am J Roentgenol 2007; 188: 579-585
• 184 Bahadursingh AM, Virgo KS, Kaminski DL et al. Spectrum of disease and outcome of complicated diverticular disease. Am J Surg 2003; 186: 696-701
• 185 Siewert B, Tye G, Kruskal J et al. Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters. Am J Roentgenol 2006; 186: 680-686
• 186 Brandt D, Gervaz P, Durmishi Y et al. Percutaneous CT scan-guided drainage vs. antibiotherapy alone for Hinchey II diverticulitis: a case-control study. Dis Colon Rectum 2006; 49: 1533-1538
• 187 Kumar RR, Kim JT, Haukoos JS et al. Factors affecting the successful management of intra-abdominal abscesses with antibiotics and the need for percutaneous drainage. Dis Colon Rectum 2006; 49: 183-189
• 188 Kaiser AM, Jiang JK, Lake JP et al. The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol 2005; 100: 910-917
• 189 Durmishi Y, Gervaz P, Brandt D et al. Results from percutaneous drainage of Hinchey stage II diverticulitis guided by computed tomography scan. Surg Endosc 2006; 20: 1129-1133
• 190 Kuligowska E, Keller E, Ferrucci JT. Treatment of pelvic abscesses: value of one-step sonographically guided transrectal needle aspiration and lavage. Am J Roentgenol 1995; 164: 201-206
• 191 Wroblicka JT, Kuligowska E. One-step needle aspiration and lavage for the treatment of abdominal and pelvic abscesses. Am J Roentgenol 1998; 170: 1197-1203
• 192 Fusaroli P, Jenssen C, Hocke M et al. EFSUMB guidelines on interventional ultrasound, part V. EUS-guided therapeutic interventions. Ultraschall in Med 2015; 36
• 193 Mercaldi CJ, Lanes SF. Ultrasound guidance decreases complications and improves the cost of care among patients undergoing thoracentesis and paracentesis. Chest 2013; 143: 532-538
• 194 Sharzehi K, Jain V, Naveed A et al. Hemorrhagic complications of paracentesis: a systematic review of the literature. Gastroenterol Res Pract 2014; 2014: 985141
• 195 Cervini P, Hesley GK, Thompson RL et al. Incidence of infectious complications after an ultrasound-guided intervention. Am J Roentgenol 2010; 195: 846-850
• 196 Cavanna L, Mordenti P, Berte R et al. Ultrasound guidance reduces pneumothorax rate and improves safety of thoracentesis in malignant pleural effusion: report on 445 consecutive patients with advanced cancer. World J Surg Oncol 2014; 12: 139
• 197 Sangisetty SL, Miner TJ. Malignant ascites: A review of prognostic factors, pathophysiology and therapeutic measures. World J Gastrointest Surg 2012; 4: 87-95
• 198 Zerem E, Imamovic G, Omerovic S. Percutaneous treatment of symptomatic non-parasitic benign liver cysts: single-session alcohol sclerotherapy versus prolonged catheter drainage with negative pressure. Eur Radiol 2008; 18: 400-406
• 199 Dietrich CF, Braden B. Percutaneous Sclerotherapy of Cysts. In: Dietrich CF, Nuernberg D, eds. Interventional ultrasound. Stuttgart: Georg Thieme Verlag /Thieme Publisher; 2014: 165-166
• 200 Garber S, Mathieson J, Cooperberg PL. Percutaneous sclerosis of hepatic cysts to treat obstructive jaundice in a patient with polycystic liver disease. Am J Roentgenol 1993; 161: 77-78
• 201 Erdogan D, van Delden OM, Rauws EA et al. Results of percutaneous sclerotherapy and surgical treatment in patients with symptomatic simple liver cysts and polycystic liver disease. World J Gastroenterol 2007; 13: 3095-3100
• 202 Benzimra J, Ronot M, Fuks D et al. Hepatic cysts treated with percutaneous ethanol sclerotherapy: time to extend the indications to haemorrhagic cysts and polycystic liver disease. Eur Radiol 2014; 24: 1030-1038
• 203 Gevers TJ, Drenth JP. Diagnosis and management of polycystic liver disease. Nat Rev Gastroenterol Hepatol 2013; 10: 101-108
• 204 Temmerman F, Missiaen L, Bammens B et al. Systematic review: the pathophysiology and management of polycystic liver disease. Aliment Pharmacol Ther 2011; 34: 702-713
• 205 Macutkiewicz C, Plastow R, Chrispijn M et al. Complications arising in simple and polycystic liver cysts. World J Hepatol 2012; 4: 406-411
• 206 Fong ZV, Wolf AM, Doria C et al. Hemorrhagic hepatic cyst: report of a case and review of the literature with emphasis on clinical approach and management. J Gastrointest Surg 2012; 16: 1782-1789
• 207 Furuta T, Yoshida Y, Saku M et al. Treatment of symptomatic non-parasitic liver cysts--surgical treatment versus alcohol injection therapy. HPB Surg 1990; 2: 269-277 ; discussion 277–269
• 208 Drenth JP, Chrispijn M, Nagorney DM et al. Medical and surgical treatment options for polycystic liver disease. Hepatology 2010; 52: 2223-2230
• 209 Moorthy K, Mihssin N, Houghton PW. The management of simple hepatic cysts: sclerotherapy or laparoscopic fenestration. Ann R Coll Surg Engl 2001; 83: 409-414
• 210 Yang CF, Liang HL, Pan HB et al. Single-session prolonged alcohol-retention sclerotherapy for large hepatic cysts. Am J Roentgenol 2006; 187: 940-943
• 211 Fabrizzi G, Lanza C, Bolli V et al. Symptomatic hepatic cyst in a child: treatment with single-shot injection of tetracycline hydrochloride. Pediatr Radiol 2009; 39: 1091-1094
• 212 Yoshida H, Onda M, Tajiri T et al. Long-term results of multiple minocycline hydrochloride injections for the treatment of symptomatic solitary hepatic cyst. J Gastroenterol Hepatol 2003; 18: 595-598
• 213 Jusufovic R, Zerem E. Percutaneous treatment of symptomatic non-parasitic benign liver cysts with 20% NaCl solution. Med Arh 2011; 65: 35-37
• 214 Yamamoto K, Sakaguchi H, Anai H et al. Sclerotherapy for simple cysts with use of ethanolamine oleate: preliminary experience. Cardiovasc Intervent Radiol 2005; 28: 751-755
• 215 Sparchez Z, Radu P, Zaharie F et al. Percutaneous treatment of symptomatic non-parasitic hepatic cysts. Initial experience with single-session sclerotherapy with polidocanol. Med Ultrason 2014; 16: 222-228
• 216 vanSonnenberg E, Wroblicka JT, D'Agostino HB et al. Symptomatic hepatic cysts: percutaneous drainage and sclerosis. Radiology 1994; 190: 387-392
• 217 Tikkakoski T, Makela JT, Leinonen S et al. Treatment of symptomatic congenital hepatic cysts with single-session percutaneous drainage and ethanol sclerosis: technique and outcome. J Vasc Interv Radiol 1996; 7: 235-239
• 218 Larssen TB, Jensen DK, Viste A et al. Single-session alcohol sclerotherapy in symptomatic benign hepatic cysts. Long-term results. Acta Radiol 1999; 40: 636-638
• 219 Larssen TB, Rosendahl K, Horn A et al. Single-session alcohol sclerotherapy in symptomatic benign hepatic cysts performed with a time of exposure to alcohol of 10 min: initial results. Eur Radiol 2003; 13: 2627-2632
• 220 Skolarikos A, Laguna MP, de la Rosette JJ. Conservative and radiological management of simple renal cysts: a comprehensive review. BJU Int 2012; 110: 170-178
• 221 Okeke AA, Mitchelmore AE, Keeley FX et al. A comparison of aspiration and sclerotherapy with laparoscopic de-roofing in the management of symptomatic simple renal cysts. BJU Int 2003; 92: 610-613
• 222 Ohta S, Fujishiro Y, Fuse H. Polidocanol sclerotherapy for simple renal cysts. Urol Int 1997; 58: 145-147
• 223 Yoo KH, Lee SJ, Jeon SH. Simple renal cyst sclerotherapy with acetic acid: our 10-year experience. J Endourol 2008; 22: 2559-2563
• 224 Madeb R, Feldman PA, Knopf J et al. Povidone-iodine sclerotherapy is ineffective in the treatment of symptomatic renal cysts. J Endourol 2006; 20: 402-404
• 225 Kilinc M, Tufan O, Guven S et al. Percutaneous injection sclerotherapy with tetracycline hydrochloride in simple renal cysts. Int Urol Nephrol 2008; 40: 609-613
• 226 Ohkawa M, Tokunaga S, Orito M et al. Percutaneous injection sclerotherapy with minocycline hydrochloride for simple renal cysts. Int Urol Nephrol 1993; 25: 37-43
• 227 Zerem E, Imamovic G, Omerovic S. Symptomatic simple renal cyst: comparison of continuous negative-pressure catheter drainage and single-session alcohol sclerotherapy. Am J Roentgenol 2008; 190: 1193-1197
• 228 Mohsen T, Gomha MA. Treatment of symptomatic simple renal cysts by percutaneous aspiration and ethanol sclerotherapy. BJU Int 2005; 96: 1369-1372
• 229 Delakas D, Karyotis I, Loumbakis P et al. Long-term results after percutaneous minimally invasive procedure treatment of symptomatic simple renal cysts. Int Urol Nephrol 2001; 32: 321-326
• 230 Chung BH, Kim JH, Hong CH et al. Comparison of single and multiple sessions of percutaneous sclerotherapy for simple renal cyst. BJU Int 2000; 85: 626-627
• 231 Fontana D, Porpiglia F, Morra I et al. Treatment of simple renal cysts by percutaneous drainage with three repeated alcohol injection. Urology 1999; 53: 904-907
• 232 Hanna RM, Dahniya MH. Aspiration and sclerotherapy of symptomatic simple renal cysts: value of two injections of a sclerosing agent. Am J Roentgenol 1996; 167: 781-783
• 233 Egilmez H, Gok V, Oztoprak I et al. Comparison of CT-guided sclerotherapy with using 95% ethanol and 20% hypertonic saline for managing simple renal cyst. Korean J Radiol 2007; 8: 512-519
• 234 McManus DP, Zhang W, Li J et al. Echinococcosis. Lancet 2003; 362: 1295-1304
• 235 Stojkovic M, Rosenberger K, Kauczor HU et al. Diagnosing and staging of cystic echinococcosis: how do CT and MRI perform in comparison to ultrasound?. PLoS Negl Trop Dis 2012; 6: e1880
• 236 Brunetti E, Kern P, Vuitton DA et al. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010; 114: 1-16
• 237 Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis. Bull World Health Organ 1996; 74: 231-242
• 238 Group WHOIW. International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop 2003; 85: 253-261
• 239 Khuroo MS, Wani NA, Javid G et al. Percutaneous drainage compared with surgery for hepatic hydatid cysts. N Engl J Med 1997; 337: 881-887
• 240 Gharbi HA, Hassine W, Brauner MW et al. Ultrasound examination of the hydatic liver. Radiology 1981; 139: 459-463
• 241 Ben Amor N, Gargouri M, Gharbi HA et al. Trial therapy of inoperable abdominal hydatid cysts by puncture. Ann Parasitol Hum Comp 1986; 61: 689-692
• 242 Gargouri M, Ben Amor N, Ben Chehida F et al. Percutaneous treatment of hydatid cysts (Echinococcus granulosus). Cardiovasc Intervent Radiol 1990; 13: 169-173
• 243 Zhang W, Li J, McManus DP. Concepts in immunology and diagnosis of hydatid disease. Clin Microbiol Rev 2003; 16: 18-36
• 244 Rinaldi F, Brunetti E, Neumayr A et al. Cystic echinococcosis of the liver: A primer for hepatologists. World J Hepatol 2014; 6: 293-305
• 245 Junghanss T, da Silva AM, Horton J et al. Clinical management of cystic echinococcosis: state of the art, problems, and perspectives. Am J Trop Med Hyg 2008; 79: 301-311
• 246 Giorgio A, de Stefano G, Esposito V et al. Long-term results of percutaneous treatment of hydatid liver cysts: a single center 17 years experience. Infection 2008; 36: 256-261
• 247 Akhan O, Yildiz AE, Akinci D et al. Is the adjuvant albendazole treatment really needed with PAIR in the management of liver hydatid cysts? A prospective, randomized trial with short-term follow-up results. Cardiovasc Intervent Radiol 2014; 37: 1568-1574
• 248 Brunetti E, Junghanss T. Update on cystic hydatid disease. Curr Opin Infect Dis 2009; 22: 497-502
• 249 Kabaalioglu A, Ceken K, Alimoglu E et al. Percutaneous imaging-guided treatment of hydatid liver cysts: do long-term results make it a first choice?. Eur J Radiol 2006; 59: 65-73
• 250 Dietrich CF, Nuernberg D. Interventional Ultrasound: A Practical Guide and Atlas. Stuttgart, New York, Delhi, Rio: Thieme publisher; 2014
• 251 Giorgio A, Tarantino L, de Stefano G et al. Hydatid liver cyst: an 11-year experience of treatment with percutaneous aspiration and ethanol injection. J Ultrasound Med 2001; 20: 729-738
• 252 Giorgio A, Di Sarno A, de Stefano G et al. Sonography and clinical outcome of viable hydatid liver cysts treated with double percutaneous aspiration and ethanol injection as first-line therapy: efficacy and long-term follow-up. Am J Roentgenol 2009; 193: W186-W192
• 253 Khuroo MS, Dar MY, Yattoo GN et al. Percutaneous drainage versus albendazole therapy in hepatic hydatidosis: a prospective, randomized study. Gastroenterology 1993; 104: 1452-1459
• 254 Nasseri-Moghaddam S, Abrishami A, Taefi A et al. Percutaneous needle aspiration, injection, and re-aspiration with or without benzimidazole coverage for uncomplicated hepatic hydatid cysts. Cochrane Database Syst Rev 2011; CD003623
• 255 Gupta N, Javed A, Puri S et al. Hepatic hydatid: PAIR, drain or resect?. J Gastrointest Surg 2011; 15: 1829-1836
• 256 Smego Jr RA, Bhatti S, Khaliq AA et al. Percutaneous aspiration-injection-reaspiration drainage plus albendazole or mebendazole for hepatic cystic echinococcosis: a meta-analysis. Clin Infect Dis 2003; 37: 1073-1083
• 257 Cozzi G, Severini A, Civelli E et al. Percutaneous transhepatic biliary drainage in the management of postsurgical biliary leaks in patients with nondilated intrahepatic bile ducts. Cardiovasc Intervent Radiol 2006; 29: 380-388
• 258 Nagino M, Takada T, Miyazaki M et al. Preoperative biliary drainage for biliary tract and ampullary carcinomas. J Hepatobiliary Pancreat Surg 2008; 15: 25-30
• 259 Kavanagh PV, vanSonnenberg E, Wittich GR et al. Interventional radiology of the biliary tract. Endoscopy 1997; 29: 570-576
• 260 Adler DG, Baron TH, Davila RE et al. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc 2005; 62: 1-8
• 261 Itoi T, Tsuyuguchi T, Takada T et al. TG13 indications and techniques for biliary drainage in acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2013; 20: 71-80
• 262 Skinner M, Popa D, Neumann H et al. ERCP with the overtube-assisted enteroscopy technique: a systematic review. Endoscopy 2014; 46: 560-572
• 263 Kuhn JP, Busemann A, Lerch MM et al. Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts compared with patients with dilated intrahepatic bile ducts. Am J Roentgenol 2010; 195: 851-857
• 264 Weber A, Gaa J, Rosca B et al. Complications of percutaneous transhepatic biliary drainage in patients with dilated and nondilated intrahepatic bile ducts. Eur J Radiol 2009; 72: 412-417
• 265 Lee W, Kim GC, Kim JY et al. Ultrasound and fluoroscopy guided percutaneous transhepatic biliary drainage in patients with nondilated bile ducts. Abdom Imaging 2008; 33: 555-559
• 266 Hayashi N, Sakai T, Kitagawa M et al. US-guided left-sided biliary drainage: nine-year experience. Radiology 1997; 204: 119-122
• 267 Miyazaki M, Shibuya K, Tokue H et al. Percutaneous transhepatic biliary drainage assisted by real-time virtual sonography: a retrospective study. BMC Gastroenterol 2013; 13: 127
• 268 Feigenbaum K, Ellett ML, Miller R et al. ALARA study of teaching effectiveness on reducing radiation exposure. Gastroenterol Nurs 1998; 21: 234-238
• 269 Gurusamy K, Junnarkar S, Farouk M et al. Meta-analysis of randomized controlled trials on the safety and effectiveness of day-case laparoscopic cholecystectomy. Br J Surg 2008; 95: 161-168
• 270 Gurusamy K, Samraj K, Gluud C et al. Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 2010; 97: 141-150
• 271 Houghton PW, Jenkinson LR, Donaldson LA. Cholecystectomy in the elderly: a prospective study. Br J Surg 1985; 72: 220-222
• 272 Sanjay P, Mittapalli D, Marioud A et al. Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis. HPB (Oxford) 2013; 15: 511-516
• 273 Winbladh A, Gullstrand P, Svanvik J et al. Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB (Oxford) 2009; 11: 183-193
• 274 Johanning JM, Gruenberg JC. The changing face of cholecystectomy. Am Surg 1998; 64: 643-647 ; discussion 647–648
• 275 Barie PS, Eachempati SR. Acute acalculous cholecystitis. Curr Gastroenterol Rep 2003; 5: 302-309
• 276 Simorov A, Ranade A, Parcells J et al. Emergent cholecystostomy is superior to open cholecystectomy in extremely ill patients with acalculous cholecystitis: a large multicenter outcome study. Am J Surg 2013; 206: 935-940 ; discussion 940–931
• 277 Chung YH, Choi ER, Kim KM et al. Can percutaneous cholecystostomy be a definitive management for acute acalculous cholecystitis?. J Clin Gastroenterol 2012; 46: 216-219
• 278 Kirkegard J, Horn T, Christensen SD et al. Percutaneous Cholecystostomy is an Effective Definitive Treatment Option for Acute Acalculous Cholecystitis. Scand J Surg 2015;
• 279 Melloul E, Denys A, Demartines N et al. Percutaneous drainage versus emergency cholecystectomy for the treatment of acute cholecystitis in critically ill patients: does it matter?. World J Surg 2011; 35: 826-833
• 280 Hatjidakis AA, Karampekios S, Prassopoulos P et al. Maturation of the tract after percutaneous cholecystostomy with regard to the access route. Cardiovasc Intervent Radiol 1998; 21: 36-40
• 281 Venara A, Carretier V, Lebigot J et al. Technique and indications of percutaneous cholecystostomy in the management of cholecystitis in 2014. J Visc Surg 2014; 151: 435-439
• 282 van Overhagen H, Meyers H, Tilanus HW et al. Percutaneous cholecystectomy for patients with acute cholecystitis and an increased surgical risk. Cardiovasc Intervent Radiol 1996; 19: 72-76
• 283 Loberant N, Notes Y, Eitan A et al. Comparison of early outcome from transperitoneal versus transhepatic percutaneous cholecystostomy. Hepatogastroenterology 2010; 57: 12-17
• 284 Lipp A, Lusardi G. Systemic antimicrobial prophylaxis for percutaneous endoscopic gastrostomy. Cochrane Database Syst Rev 2013; 11: CD005571
• 285 Lowe AS, Laasch HU, Stephenson S et al. Multicentre survey of radiologically inserted gastrostomy feeding tube (RIG) in the UK. Clin Radiol 2012; 67: 843-854
• 286 Wah TM, Weston MJ, Irving HC. Percutaneous nephrostomy insertion: outcome data from a prospective multi-operator study at a UK training centre. Clin Radiol 2004; 59: 255-261
• 287 Hausegger KA, Portugaller HR. Percutaneous nephrostomy and antegrade ureteral stenting: technique-indications-complications. Eur Radiol 2006; 16: 2016-2030
• 288 Mahmood RD, Yizhi L, Tan MLM. Percutaneous Nephrostomy. In: Goeoz M, ed. Chronic Kidney Disease. InTech; 2012: 297-314
• 289 Ramchandani P, Cardella JF, Grassi CJ et al. Quality improvement guidelines for percutaneous nephrostomy. J Vasc Interv Radiol 2003; 14: S277-S281
• 290 Dagli M, Ramchandani P. Percutaneous nephrostomy: technical aspects and indications. Semin Intervent Radiol 2011; 28: 424-437
• 291 Png JC, Chapple CR. Principles of ureteric reconstruction. Curr Opin Urol 2000; 10: 207-212
• 292 Lapitan MC, Buckley BS. Impact of palliative urinary diversion by percutaneous nephrostomy drainage and ureteral stenting among patients with advanced cervical cancer and obstructive uropathy: a prospective cohort. J Obstet Gynaecol Res 2011; 37: 1061-1070
• 293 Ahmad I, Saeed Pansota M, Tariq M et al. Comparison between Double J (DJ) Ureteral Stenting and Percutaneous Nephrostomy (PCN) in Obstructive Uropathy. Pak J Med Sci 2013; 29: 725-729
• 294 Wyatt J, Kolettis PN, Burns JR. Treatment outcomes for percutaneous nephrolithotomy in renal allografts. J Endourol 2009; 23: 1821-1824
• 295 Mahdavi R, Tavakkoli M, Taghavi R et al. Minimally invasive procedures for treatment of urolithiasis in transplanted kidneys. Exp Clin Transplant 2014; 12: 200-204
• 296 Farrell TA, Hicks ME. A review of radiologically guided percutaneous nephrostomies in 303 patients. J Vasc Interv Radiol 1997; 8: 769-774
• 297 Skolarikos A, Alivizatos G, Papatsoris A et al. Ultrasound-guided percutaneous nephrostomy performed by urologists: 10-year experience. Urology 2006; 68: 495-499
• 298 Kariniemi J, Sequeiros RB, Ojala R et al. MRI-guided percutaneous nephrostomy: a feasibility study. Eur Radiol 2009; 19: 1296-1301
• 299 Barbaric ZL, Hall T, Cochran ST et al. Percutaneous nephrostomy: placement under CT and fluoroscopy guidance. Am J Roentgenol 1997; 169: 151-155
• 300 Ray Jr CE, Brown AC, Smith MT et al. Percutaneous access of nondilated renal collecting systems. Semin Intervent Radiol 2014; 31: 98-100
• 301 Patel U, Hussain FF. Percutaneous nephrostomy of nondilated renal collecting systems with fluoroscopic guidance: technique and results. Radiology 2004; 233: 226-233
• 302 Fischbach F, Porsch M, Krenzien F et al. MR imaging guided percutaneous nephrostomy using a 1.0 Tesla open MR scanner. Cardiovasc Intervent Radiol 2011; 34: 857-863
• 303 Cui XW, Ignee A, Maros T et al. The use of ultrasound contrast agent in ultrasound guided percutaneous nephrostomy. In: Lepzig: Z Gastroenterol; 2014: KG264
• 304 Karim R, Sengupta S, Samanta S et al. Percutaneous nephrostomy by direct puncture technique: An observational study. Indian J Nephrol 2010; 20: 84-88
• 305 Regalado SP. Emergency percutaneous nephrostomy. Semin Intervent Radiol 2006; 23: 287-294
• 306 Cangüven O, Göktafl C, Kafkasl A et al. Comparison of direct and Seldinger percutaneous nephrostomy insertion techniques. BTDMJB 2009; 5: 103-105
• 307 Dyer RB, Regan JD, Kavanagh PV et al. Percutaneous nephrostomy with extensions of the technique: step by step. Radiographics 2002; 22: 503-525
• 308 Radecka E, Magnusson A. Complications associated with percutaneous nephrostomies. A retrospective study. Acta Radiol 2004; 45: 184-188
• 309 LeMaitre L, Mestdagh P, Marecaux-Delomez J et al. Percutaneous nephrostomy: placement under laser guidance and real-time CT fluoroscopy. Eur Radiol 2000; 10: 892-895
• 310 Lee MJ, Papanicolaou N, Nocks BN et al. Fluoroscopically guided percutaneous suprapubic cystostomy for long-term bladder drainage: an alternative to surgical cystostomy. Radiology 1993; 188: 787-789
• 311 Gochman RF, Karasic RB, Heller MB. Use of portable ultrasound to assist urine collection by suprapubic aspiration. Ann Emerg Med 1991; 20: 631-635
• 312 Chu RW, Wong YC, Luk SH et al. Comparing suprapubic urine aspiration under real-time ultrasound guidance with conventional blind aspiration. Acta Paediatr 2002; 91: 512-516
• 313 Kiernan SC, Pinckert TL, Keszler M. Ultrasound guidance of suprapubic bladder aspiration in neonates. J Pediatr 1993; 123: 789-791
• 314 Cronin CG, Prakash P, Gervais DA et al. Imaging-guided suprapubic bladder tube insertion: experience in the care of 549 patients. Am J Roentgenol 2011; 196: 182-188
• 315 Jacob P, Rai BP, Todd AW. Suprapubic catheter insertion using an ultrasound-guided technique and literature review. BJU Int 2012; 110: 779-784
• 316 Lawrentschuk N, Lee D, Marriott P et al. Suprapubic stab cystostomy: a safer technique. Urology 2003; 62: 932-934
• 317 Aguilera PA, Choi T, Durham BA. Ultrasound-guided suprapubic cystostomy catheter placement in the emergency department. J Emerg Med 2004; 26: 319-321
• 318 Lamont T, Harrison S, Panesar S et al. Safer insertion of suprapubic catheters: summary of a safety report from the National Patient Safety Agency. BMJ 2011; 342: d924
• 319 Johnson S, Fiscus G, Sudakoff GS et al. The utility of abdominal ultrasound during percutaneous suprapubic catheter placement. Can J Urol 2013; 20: 6840-6843
• 320 Requarth J. Image-guided palliative care procedures. Surg Clin North Am 2011; 91: 367-402, ix
• 321 Mariani PJ, Setla JA. Palliative ultrasound for home care hospice patients. Acad Emerg Med 2010; 17: 293-296