title: MR-guided neurolytic celiac plexus ablation: an evaluation of effect and injection spread pattern in cancer patients with celiac tumor infiltration.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the feasibility, the initial accuracy, and the effects of the MR-guided neurolytic celiac plexus ablation as a method to treat cancer-induced chronic abdominal pain.
  
  
  METHODS
  Thirteen celiac plexus ablations were performed for 12 patients. A 0.23-T open MRI scanner with optical navigation was used for procedural guidance. As an adjunct to the MR-guided needle positioning, the needle location was confirmed with saline injection and consequent MR imaging (STIR sequence). The spread of the ablative injection material (alcohol-lidocaine mix) was observed by repeating this sequence after the therapeutic injection. Pain scores from seven patients (eight ablations) were used to assess the therapy effect.
  
  
  RESULTS
  MR guidance allowed adequate needle positioning and visualization of injection material in all cases. The rest pain scores significantly decreased from 4 (median) at baseline to 1 (median) at 2 weeks (p < 0.05). Average and worst pain experienced during the past week were significantly lower at the 2-week time point compared with the baseline (p < 0.05). However, the intervention did not result in reduction of opioid use at 2 weeks.
  
  
  CONCLUSIONS
  MR guidance is an accurate and safe method for celiac plexus ablation with positive therapeutic effect.
authors.affiliation: Pain Clinic, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Etem
authors.initials: E
authors.lastname: Akural
authors.forename: Risto O
authors.initials: RO
authors.lastname: Ojala
authors.forename: Voitto
authors.initials: V
authors.lastname: Järvimäki
authors.forename: Juho
authors.initials: J
authors.lastname: Kariniemi
authors.forename: Osmo A
authors.initials: OA
authors.lastname: Tervonen
authors.forename: Roberto
authors.initials: R
authors.lastname: Blanco Sequeiros
mesh_terms: D015746:Abdominal Pain / Q000209:etiology* / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage; D017115:Catheter Ablation / Q000379:methods*; D002447:Celiac Plexus / Q000473:pathology*; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications*; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D009339:Needles; D009361:Neoplasm Invasiveness; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010190:Pancreatic Neoplasms / Q000150:complications*; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D000431:Ethanol; D008012:Lidocaine