Radiographic Local Control of Spinal Metastases with Percutaneous Radiofrequency Ablation and Vertebral Augmentation

A 29-year-old woman with stage IV (T1b, N1, M1) cardiac angiosarcoma who presented with low back pain. Sagittal T1-weighted (A) and STIR (B) MR imaging show diffuse T1 hypointensity and heterogeneous T2 hyperintensity of the lumbar vertebral body marrow, consistent with marrow-replacing tumor. She was treated with conventional external-beam radiation therapy (30 Gy in 10 fractions); however, her back pain persisted. Sagittal STIR (C) and T1-weighted, fat-suppressed, postcontrast (D) MR imaging performed 5 months later show interval progression of multiple spinal metastases with new epidural extension of tumor at T11, L1, L2, and L3 (black block arrows) and pathologic fractures of the L2 and L3 vertebral bodies. She could not receive additional radiation therapy due to the cumulative dose to the spinal cord. Consequently, she underwent radiofrequency ablation and vertebral augmentation of T11, L1, L2, and L3. Anteroposterior (E) and lateral (F) fluoroscopic images show percutaneous cannulae in both pedicles of T11 and the ablation probe curving into the left posteroinferior vertebral body (black arrowheads). Sagittal STIR (G) and T1-weighted, fat-suppressed, postcontrast (H) MR imaging performed 6 months later show interval retraction of the epidural tumor at T11, L1, L2, and L3. Signal void corresponding to cement (white asterisks) with surrounding T2-hyperintense, enhancing granulation tissue is noted at the treated levels (white block arrows).