Radiology

Twilight sleep (analgosedation) without intubation. Additional local anaesthesia at the puncture sites.

Tumours and metastases in the following organs: liver, lungs, kidneys, adrenal glands, lymph nodes, thyroid gland, bone

As the oldest ablative technique, RFA can look back on many decades of experience. Tumours and metastases up to 3.5 cm in diameter respond very well to RFA. Successful tumour destruction is precisely indicated by the increase in electrical resistance in the destroyed tissue. There are no interactions between RFA and radiotherapy or chemotherapy.

In the vicinity of vessels, the effectiveness of RFA and thus the safe destruction of tumours is limited. Depending on the target volume, RFA can take up to 30 minutes.

Twilight sleep (analgosedation) without intubation. Additional local anaesthesia at the puncture sites.

Tumours and metastases in the following organs: liver, lung, kidney, adrenal gland, lymph nodes, thyroid gland

The possibility of synchronising several probes with each other (parallel use) allows the MWA to effectively treat even larger tumours and metastases up to 5 cm in diameter. Successful tumour destruction is precisely indicated by the release of gas bubbles in the destroyed tissue. There are no interactions between MWA and radiotherapy or chemotherapy. 

Two key advantages of MWA are MWA is fast – tumour destruction occurs after just a few minutes, depending on the target volume. And: MWA can also achieve more effective tumour destruction in the vicinity of vessels.

Due to the high heat with which the MWA works, it can only be used to a limited extent in the immediate vicinity of risk structures such as nerves and bile ducts.

Twilight sleep (analgosedation) without intubation. Additional local anaesthesia at the puncture sites.

Tumours and metastases in the following organs: liver, lungs, kidneys, adrenal glands, lymph nodes, soft tissue, muscles (sarcomas and desmoids)

The possibility of synchronising several probes with each other (parallel use) allows the CRYO to effectively treat even larger tumours and metastases up to 8 cm in diameter. Successful tumour destruction is demonstrated by the formation of an ice lump that can be precisely imaged. There is no negative interaction between MWA and radiotherapy or chemotherapy. On the contrary: the effectiveness of parallel immunotherapy is significantly increased. Two further advantages of CRYO are Icing is the most painless of all ablations, which means that it can also be used in the immediate vicinity of pain-sensitive structures. And: CRYO can also achieve more effective tumour destruction in the vicinity of vessels.

Repeated freezing and thawing is time-consuming, so the CRYO can take up to 30 minutes, depending on the volume of the target tumour.

General anaesthesia with intubation. Additional local anaesthesia at the puncture sites.

Use: Tumours and metastases in the following organs: liver, kidney, adrenal gland, soft tissue, muscles (sarcomas and desmoids)

ECT is a typical procedure in which several electrodes are used. The tumour must be surrounded by strictly parallel electrodes. The multi-electrode technique also allows very large (even larger than 10 cm in diameter) and irregularly shaped tumours to be treated. As ECT is not a thermal ablation, i.e. not a heat procedure, it can also be used in the immediate vicinity of risk structures (vessels, nerves and bile ducts). Although ECT is the most recent ablation procedure, it has already gained a firm position in local tumour control after just a few years. Bleomycin is mainly effective where it is artificially introduced into the cells, i.e. in the tumour cells. This means that ECT is not accompanied by a systemic effect of the therapeutic agent.

As versatile and gentle as ECT is for the patient, it is probably more challenging for the therapist than any other ablation procedure. The strictly parallel positioning of the electrodes, as described above, requires a great deal of experience in addition to precise navigation. As the tumour cells are only destroyed by the therapeutic agent over the next 48 hours, the success of the therapy cannot be assessed immediately after the treatment. This makes precise planning of the therapy in advance and precise navigation during the procedure all the more important.

Twilight sleep (analgosedation) without intubation. Additional local anaesthesia at the puncture sites.

Painful fractures of vertebral bodies or the sacrum due to osteoporosis or metastases

Both kyphoplasty and sacroplasty are safe procedures that lead to immediate stabilisation of the affected bone and rapid, usually immediately noticeable pain relief. The rapid pain relief enables a rapid reduction or discontinuation of pain medication, which is usually associated with side effects. A particular advantage of balloon kyphoplasty compared to simple vertebroplasty (cementing without straightening) is that the elevation of the collapsed vertebral body leads to additional pain relief. Although patients are able to bear weight quickly after kyphoplasty and vertebroplasty, accompanying physiotherapy/ergotherapeutic follow-up treatment is recommended.

Bone cement hardens within a few minutes. If bone cement does escape from the vertebral body, surrounding nerves or vessels may be affected. However, serious complications are very rare.

Angiography is usually performed under local anesthesia at the puncture site, which means that general anesthesia is not required. This method is minimally invasive and is well tolerated, as the procedure does not cause any pain within the blood vessels.

Angiography is used for the diagnosis and treatment of vascular diseases as well as the targeted treatment of tumors and vascular malformations. It enables detailed imaging of arteries and veins and is often used to treat tumors by probing and blocking tumor-supplying vessels in order to inhibit tumor growth. It can also be used diagnostically and therapeutically for malformations or occlusions of the vessels.

Angiography offers precise and gentle diagnosis and treatment, which is made possible in particular by high-resolution DSA. The method allows highly selective treatment in which target areas are precisely targeted and the surrounding tissue is spared. Patients

benefit from a minimally invasive method that is generally painless and can be performed without general anesthesia. The procedure leads to fast and effective treatment, particularly in the case of tumour treatment, as embolization cuts off the tumour tissue from the nutrient supply and can therefore inhibit its growth. In many cases, this means that further treatments such as the administration of painkillers can be reduced.

Although angiography is a very safe procedure, complications can occur in rare cases. Possible risks include infection at the puncture site, bleeding, accidental misperfusion or embolization of adjacent vessels and side effects from the administration of contrast agents or chemotherapeutic agents. However, these risks are very rare due to the precise control and continuous image monitoring.

PAE is usually performed under local anesthesia, allowing for a procedure without general anesthesia. The procedure is largely painless and the patient can remain awake during the procedure.

Prostate artery embolization is used in patients with a benignly enlarged prostate if medication does not have the desired effect or if surgery is to be avoided. Typical symptoms caused by enlargement of the prostate include urinary retention, frequent urination (especially at night), a weak urinary stream and a feeling of incomplete bladder emptying. PAE offers an effective, minimally invasive alternative to surgical procedures such as transurethral resection of the prostate (TURP).

Prostate artery embolization is a gentle procedure that leads to a permanent reduction in prostate size and a significant improvement in symptoms. The minimally invasive approach enables a quick recovery and requires only a short hospitalization. The procedure spares surrounding structures and can counteract the possible side effects of surgical interventions such as incontinence or sexual dysfunction. As the prostate is accessed via the pelvic vessels, no incision is required in the abdomen, which reduces stress for the patient and shortens the recovery time.

A urethral catheter is required for 24 hours after the procedure and the patient must remain on bed rest until the morning after the procedure. Despite the precision of the procedure, complications can occur in rare cases, such as slight pain, temporary fever or inflammation of the urinary tract. However, serious complications are rare and the method is considered to be well tolerated.

UFE is usually performed under local anesthesia. This means that the procedure is largely pain-free and does not require general anesthesia, allowing patients to remain awake during the procedure.

Uterine fibroid embolization is used in patients with benign, enlarged uterine fibroids that are causing symptoms. Typical symptoms include heavy menstrual bleeding, pain in the pelvic area, a feeling of pressure in the lower abdomen and occasionally bladder or bowel problems due to the size of the fibroids. UFE offers an effective, minimally invasive alternative to surgical removal of the fibroids, such as a myomectomy or hysterectomy.

Uterine fibroid embolization is a gentle procedure that leads to a significant reduction in fibroid size and a marked improvement in symptoms. The minimally invasive nature of the procedure ensures a short recovery time and eliminates the risk of major surgical complications. The procedure makes it possible to preserve the uterus and offers a good alternative to surgical interventions, especially for patients who wish to preserve the uterus in the long term. In addition, the rapid symptom relief can lead to a rapid improvement in quality of life.

A urethral catheter is required for 24 hours after the procedure and patients must remain on bed rest until the following day. A common side effect is the so-called “ischemia pain”, which is caused by the interruption of the blood supply to the fibroids and can last for several days. This pain is treated according to a specially developed pain protocol in order to support the patients as much as possible. Other rare risks include infection or unwanted side effects of embolization, but these can be minimized through careful preparation and monitoring.

CP is performed under local anesthesia, which means that general anesthesia is usually not required. As a result, the procedure is minimally invasive and the stress for the patient is low.

Chemoperfusion/saturation is used for patients with localized, malignant tumours that are not optimally suited to systemic chemotherapy or for whom a targeted, locally high drug concentration is desired. This technique is particularly useful for tumors that are predominantly confined to one organ, such as liver, lung or pancreatic tumors. By targeting chemotherapy to the affected organ, side effects can be reduced and efficacy increased as the drug acts directly in the tumor.

CP offers an effective, gentle alternative to systemic chemotherapy. The targeted administration of medication in the affected organ means that surrounding tissue and the rest of the body are largely spared. This enables highly concentrated treatment of the tumor and reduces systemic side effects, which increases the tolerability of the procedure for patients. In addition, targeted treatment often leads to better tumor control and in some cases to an extension of the treatment-free interval. The minimally invasive nature and short recovery time are further advantages of this procedure.

Although targeted chemoperfusion offers many advantages, several sessions (usually two to three) are required before the success of the therapy can be conclusively assessed. After the procedure, patients must bed rest until the following morning and in some cases must wear a urethral catheter for 24 hours. Chemotypical side effects such as tiredness and fatigue can also occur with this localized form of therapy, albeit to a lesser extent than with systemic chemotherapy. CP is only suitable for tumors that are well localized and supplied via specific vessels.

TACE is usually performed under local anesthesia, which eliminates the need for general anesthesia. This ensures a minimally invasive, gentle procedure in which patients remain awake and can be mobile again more quickly.

The transarterial chemoembolization procedure is primarily used for patients with localized malignant tumours that are not ideal for surgery or systemic chemotherapy. TACE shows particularly good results in liver cancer (hepatocellular carcinoma) and certain metastatic tumors in the liver, as the drug treatment acts directly in the tumor. This form of local chemoembolization is suitable for tumours that are well supplied via specific vessels and do not require too much systemic stress on the body.

TACE offers a targeted treatment option with reduced side effects, as the chemotherapy is introduced directly into the tumor in high concentrations, while the surrounding healthy tissue is largely spared. The combination of chemotherapy and embolization therapy increases the effectiveness of the treatment and can reduce the size of the tumour in the long term or slow down tumour growth. The focused treatment method means that systemic side effects occur less frequently and are less pronounced, which leads to improved tolerability and shorter recovery times.

As with many targeted treatments, several sessions (usually two to three) are required to ensure the success of the treatment and to control tumor growth in the long term. Before the procedure, a urethral catheter is placed in female patients for 24 hours and patients must remain on bed rest until the following day. Possible side effects, such as tiredness and slight nausea, can still occur, albeit usually in a milder form. TACE is particularly suitable for tumors that have a good blood supply and are supplied by feeding vessels.

Varicocele sclerotherapy is usually performed under local anesthesia, so general anesthesia is not required. This reduces the stress on the body and enables a faster recovery.

Varicocele sclerotherapy is performed on men with varicocele that cause pain or are associated with fertility problems. A varicocele occurs when the veins in the scrotum dilate and the blood is no longer adequately drained. This congestion can lead to a build-up of heat, which impairs sperm quality. Varicocele sclerotherapy enables gentle and targeted treatment of the affected veins without the need for major surgery.

The procedure offers an effective and minimally invasive alternative to surgical varicocele treatment. Through the targeted use of tissue glue, the insufficient veins are permanently obliterated so that they recede and normal blood circulation is restored. The procedure is painless and requires only a short recovery period, which reduces the stress for patients. Another advantage of sclerotherapy is that patients can be discharged quickly: just 24 hours after the procedure, patients can leave the clinic and resume normal movement.

Varicocele sclerotherapy requires precise placement of the catheter and exact dosing of the tissue adhesive to ensure successful sclerotherapy. As this is a minimally invasive procedure, the complication rate is low. Nevertheless, local irritation or minor bleeding may occur in rare cases. However, the chances of success with this method are high and repeat procedures are rarely necessary.

Die TAPE/GAE erfolgt meist unter örtlicher Betäubung (Lokalanästhesie).

Wie oben bereits erwähnt, stammt die GAE aus der Hochleistungssport-Medizin und hat sich in den letzten Jahren auch für die breite Bevölkerung bei einer Vielzahl von schmerzhaften Gelenk-Sehnen-Erkrankungen als eine effektive und schonende Alternative zu den Schmerztabletten, Kortisonspritzen und dem Gelenkersatz bewährt. Die GAE ist eine einmalige, gezielte Schmerztherapie bei chronischen Beschwerden in Gelenken, Bändern, Sehnen, Bindegewebe, Faszien; bei Arthrosen, Arthritis, Synovitis, Plantarfasziitis, „Tennisellenbogen“, „Golfellenbogen“, Fersensporn, Aktivierten Arthrosen; Tendinopathien; Tendinosen; Tendinitis; Enthesiopathien; Peritendinitis; Fasziitis; Epicondylitis.

Die GAE/TAPE ist ein schonendes Verfahren, das zu einer signifikanten dauerhaften Schmerzreduktion führt. Da die GAE/TAPE technisch anspruchsvoll ist, sollte sie von erfahrenen Spezialisten durchgeführt werden. Der minimalinvasive Charakter des Eingriffs sorgt für eine kurze Erholungszeit. Das Verfahren ermöglicht es, das Gelenk (z. B. Kniegelenk) zu erhalten und bietet eine gute Alternative zu der Dauermedikation mit Schmerzmitteln, zu Kortisonspritzen und zu dem chirurgischen Gelenkersatz. Die schnelle und dauerhafte Symptomlinderung führt zu einer raschen Verbesserung der Lebensqualität. Die GAE/TAPE kann unproblematisch wiederholt werden. Auch verschließt die Therapie keine der sonstigen Behandlungsoptionen. Im Gegensatz: die GAE ermöglicht eine lange Zeit schmerzfrei zu überbrücken und somit einen verfrühten Gelenkersatz zu vermeiden.

Die GAE/TAPE ist dann am effektivsten, wenn sie zum Zeitpunkt der chronischen Entzündung eingesetzt wird – dann kann sie effektiv die Entzündungskaskade unterbrechen. Das Verfahren ist weit weniger effektiv bei fortgeschrittenen Verschleißerscheinungen, d. h. lange nach der Entzündungsphase. Ob eine GAE/TAPE erfolgversprechend durchgeführt werden kann, zeigt sich am besten im MRT. Da die GAE/TAPE technisch anspruchsvoll ist, sollte sie von erfahrenen Spezialisten durchgeführt werden. Die seltenen Nebenwirkungen umfassen: zeitlich begrenzte lokale Gewebereizung, z. B. Hautrötung, manchmal vergesellschaftet mit Brennen oder Juckreiz. Nachblutung oder Infektion an der Einstichstelle.