Musculoskeletal Interventional Radiology: What Every Doctor Should Know - Dr Rajesh Botchu

There are numerous procedures, this article will provide a taste of the most pertinent procedures to illustrate how musculoskeletal IR can contribute to patient care across a range of applications.

The overarching principle of most musculoskeletal IR procedures is to use imaging to guide a needle to a given area. This can be done for diagnosis, most commonly with percutaneous imaging-guided biopsy (IGB) where a needle is introduced through the skin into a lesion under ultrasound or CT (Computed Tomography) guidance, thereby obtaining tissue samples from suspicious bone or soft tissue lesions.

Alternatives are either a non-guided biopsy (suitable only for superficial lesions) or open surgical biopsies (which are far more invasive). Percutaneous IGB is used mainly for tumours, but also for infections and inflammatory conditions. Accurate tissue diagnosis is essential for guiding further management, including surgery or oncologic treatment.

Therapeutic uses employ the same principles. For example, image-guided injections of corticosteroids, local anaesthetics, hyaluronic acid, biologics, and blood products amongst others help pain relief and inflammation control in chronic conditions like osteoarthritis, tendinitis, or bursitis.

To do so, the injection is directed towards joints (intra-articular), tendons, or soft tissue spaces. Ultrasound, fluoroscopy, and CT are all methods which can be used to guide the needle to the correct site with each modality having its own strengths.

Although procedures can and are also performed without imaging by using landmark techniques, deeper sites of injection or those near vulnerable structures (e.g. nerves and vessels) necessitate imaging to ensure safe and accurate delivery.

Other curative treatments include the destruction of tumours (ablation) using needle tips which generate ice balls (cryotherapy) or heat (radiofrequency ablation).

Symptomatic relief can also provide great patient benefit by enabling mobilisation, such as introducing cement into spinal fractures via a needle (vertebroplasty) or blocking pain sensation from nerves (nerve block).

These are only some examples of the wide range of procedures seen in musculoskeletal IR. Almost every clinician will encounter patients who benefit from such procedures and will benefit from an awareness of the basic principles of using imaging to perform minimally-invasive procedures to facilitate treatment and diagnosis across a range of conditions.