Diagnostic and Low-Invasive

Treatment Procedures using

Percutaneal and Endocavity
Approach – IR Concept and
Methods

Prof. Malkhaz Mizandari MD PhD

Tbilisi State Medical University,
“GEOJEFF” - Ultrasound Education Centre
 Radiologist often can see
pathology better, than surgeon
after invasion into the body!
What Happens , if We Can
Image the Instruments the Same Time?

Interventional
Radiology
 Diagnostic and
Diagnostic and Low-Invasive
Low-Invasive
Treatment Procedures
Treatment Procedures Performed
Performed
under Imaging
under Imaging Guidance
Guidance using
using
Percutaneal and
Percutaneal and Endocavity
Endocavity
Approach, Intreaoperative
Approach, Intreaoperative Study
Study
 Diagnostic Procedures
Diagnostic Procedures

Fine Needle
 Fine
 Needle Biopsy
Biopsy for
for Cytology
Cytology
Core Biopsy
 Core
 Biopsy for
for Morphology
Morphology
Fluid Aspiration
 Fluid
 Aspiration for
for Diagnosis
Diagnosis (Ascitic
(Ascitic
Fluid, Amnionic
Fluid, Amnionic Fluid
Fluid etc)
etc)
Intraoperative Studies
 Intraoperative
 Studies
Percutaneal Cholangiography
 Percutaneal
 Cholangiography
Angiography
 Angiography

LIT Procedures
LIT Procedures Performed
Performed under
under Ultrasound,
Ultrasound, CTCT and
and
Combined (Ultrasound-Fluoroscopy
Combined (Ultrasound-Fluoroscopy and and CT-
CT-
Ultrasound-Fluoroscopy) Control
Ultrasound-Fluoroscopy) Control
PTBD, Bile
 PTBD, Bile Duct
Duct Dilatation,
Dilatation, Stenting
Stenting
Nephrostomy
 Nephrostomy
Posttraumatic, Infected
 Posttraumatic, Infected or
or Necrotic
Necrotic Fluid
Fluid
Collection Drainage
Collection Drainage
Different Type
 Different Type Cystic
Cystic Lesions
Lesions (Including
(Including Parasitic)
Parasitic)
Aspiration-Drainage, Sclerotherapy
Aspiration-Drainage, Sclerotherapy
Portal Vein
 Portal Vein Thrombus
Thrombus Percutaneal
Percutaneal
Thrombodestruction and
Thrombodestruction and Thrombolysis,
Thrombolysis, Portal
Portal
Vein Embolization
Vein Embolization
Neural Plexus
 Neural Plexus Sheath
Sheath Catheterization
Catheterization for
for
Anestesia
Anestesia
Thyroid Node
 Thyroid Node Sclerotherapy
Sclerotherapy
 Interventions Performed
Interventions Performed Using
Using
Intraarterial Approach
Intraarterial Approach::

Arterial Embolization
 Arterial
 Embolization
Vascular Ablation
 Vascular
 Ablation
(locoregional Chemotherapy
(locoregional Chemotherapy andand TACE)
TACE)
SIRT –– Selective
 SIRT
 Selective Internal
Internal Radiotherapy
Radiotherapy
Anghioplasty
 Anghioplasty

(Baloon Dilatation,
(Baloon Dilatation, Stenting)
Stenting)
 U Tumor
U Tumor Ablations
Ablations

 Electrochemical Lysis
Electrochemical Lysis ofof Primary
Primary and
and
Methastatic Lesions
Methastatic Lesions
Thermal Ablations
 Thermal Ablations
RFA –– Radiofrequency
RFA Radiofrequency
MWA –– Microwave
MWA Microwave
LITT –Lazer
LITT –Lazer Induced
Induced Thermal
Thermal Treatment
Treatment
HIFU –– High
HIFU High Intensity
Intensity Focused
Focused Ultrasound
Ultrasound
CA -- Cryoablation
CA Cryoablation
LIT Procedures are Used as:

 Radical Treatment
 Preparatory Stage for a Radical
Surgery
 Palliative Treatment to Improve
the Quality of Life of Inoperable
Patients
 Advantages of Low-Invasive
Treatment (LIT) Procedures

 Practically
no Contraindications
 No General Anesthesia
 No Surgical Trauma
 LIT May Be Performed Repeatedly
 Cost-Saving
 What’s Obligatory? What’s
Desirable?
 Image the target
 Find the most appropriate and safe
puncture site
 Possibility of aiming using fixed needle
guide
 Possibility of puncture device movement
control in real-time
 Possibility of vessel imaging in real-time
 LIT Procedures Guidance
Techniques
 Fluoroscopy
 CT
 MRI
 Ultrasound
 Combined Control
a)Ultrasound-Fluoroscopy
b)CT-Ultrasound-Fluoroscopy
 Ultrasound
Ultrasound Control
Control
(Percutaneal
(Percutaneal Approach)
Approach)
Ultrasound Control
(Vaginal Approach)
Ultrasound Control
(Rectal Approach)
CT Control
CT Control
CT Control
CT Control
Combined Ultrasound-Fluoroscopy
Combined Ultrasound-Fluoroscopy Control
Control
Combined CT-Ultrasound-Fluoroscopy
Combined CT-Ultrasound-Fluoroscopy
Control
Control
 Advantages of Ultrasound
 Real-Time Technique
 Noninvasive (no Ionizing Radiation)
 Needle Aiming and Guiding Capability
 Doppler Capability
 Endocavity Approach (Endorectal-
Endovaginal)
 Possibility of Combination with other
Modalities
 Cost-Saving Technique
PTCD with
PTCD with Subsequent
Subsequent Stenting
Stenting
Q PTCD
Q PTCD with
with Subsequent
Subsequent Stenting
Stenting
Percutaneal Management
Percutaneal Management of of
Posttraumatic Pancreatitis
Posttraumatic Pancreatitis
Arterial Embolization
IR isis aa very
IR very creative
creative field!
field!
In conclusion:
 Insulinoma

 Diagnosisand Intraoperative
Ultrasound Guidance for
Surgery