Published online before print October 1, 2001, 10.1148/radiol.2212010262
(Radiology. 2001;221:463-468.)
© RSNA, 2001
Vascular and Interventional Radiology |
Primary Treatment of Chondroblastoma with Percutaneous Radio-frequency Heat Ablation: Report of Three Cases1
Joel K. Erickson, MD,
Daniel I. Rosenthal, MD,
David J. Zaleske, MD,
Mark C. Gebhardt, MD and
Justin M. Cates, MD, PhD
1 From the Departments of Radiology (J.K.E., D.I.R.), Orthopaedic Surgery (D.J.Z., M.C.G.), and Pathology (J.M.C.), Massachusetts General Hospital, 55 Fruit St, Bartlett 405, Boston, MA 02114. Received January 3, 2001; revision requested February 14; revision received April 16; accepted May 2. Address correspondence to D.I.R. (e-mail: rosenthal.daniel@mgh.harvard.edu).
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ABSTRACT
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Chondroblastomas are benign cartilaginous lesions; however, intervention is necessary to stop progression and alleviate pain. The authors evaluated three patients in whom minimally invasive percutaneous radio-frequency heat ablation was used to treat pathologically proven chondroblastoma to determine whether this treatment demonstrated long-term success. The authors found that this approach may be an effective alternative to surgical intervention in some cases.
Index terms: Bone neoplasms, therapy, 44.1269, 45.1269 • Chondroblastoma, 44.3111, 45.3111 • Radio-frequency (RF) ablation, 44.1269, 45.1269
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INTRODUCTION
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Chondroblastomas are benign cartilaginous lesions representing less than 1% of all bone tumors and less than 3% of benign bone tumors (1). The most common presenting symptom is pain (2,3), which may be severe and limit movement in the adjacent joint. Most patients are less than 20 years of age; men are more commonly affected than women. Chondroblastomas generally arise in the epiphysis or apophysis of a long tubular bone such as the femur, humerus, and tibia, although 10% of chondroblastomas arise in the hands or feet.
Chondroblastoma does not undergo spontaneous resolution if left untreated; therefore, intervention is necessary to stop progression and alleviate pain (2). Curettage and packing of the area with bone graft or polymethylmethacrylate is currently the standard treatment (4). However, chondroblastomas may be difficult to eradicate surgically because they are usually located in the epiphysis and may be near an open growth plate and/or articular cartilage. Functional impairment and growth disturbances may occur (5), although most patients are near the end of their growth spurts, and therefore this is not usually a major concern. Local recurrence is a substantial concern in surgically treated patients; articles delineating previous large studies report recurrence rates of 8%–20% (2,3). Our purpose is to evaluate an alternative primary treatment for chondroblastoma with focused radio-frequency heat ablation.
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Case Reports
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Our institutional review board did not require its approval for this study.
Case 1.—A 26-year-old woman presented with intermittent right hip pain of several years duration. The pain markedly limited vigorous activities such as running and partially limited moderate activities such as walking and climbing stairs. The pain was partially relieved with nonsteroidal anti-inflammatory drugs (NSAIDs). Radiography, computed tomography (CT), and magnetic resonance (MR) imaging revealed an 8-mm round, lucent lesion containing central calcification in the head of the femur. The lesion was surrounded by extensive reactive sclerosis (Fig 1a) and exhibited marked radionuclide uptake on bone scans. A presumptive diagnosis of osteoid osteoma was made, and, after informed consent was obtained, the patient underwent CT-guided biopsy. A single core biopsy specimen was obtained and sent for pathologic examination. A frozen section was not obtained, but the lesion was immediately treated with radio-frequency heat ablation, our standard treatment for osteoid osteoma. A single treatment was performed with a 1.2-mm outer diameter electrode with a 5.0-mm exposed tip (Fig 1b). The lesion was heated to 90°C for 6 minutes.
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Figure 1a. (a) Frontal radiograph of the right hip demonstrates a round osteolytic lesion of the femoral head, measuring 8 mm in diameter and surrounded by a thin zone of sclerosis (arrow). (b) Transverse CT scan of the femoral head with the electrode in place demonstrates that despite the slightly eccentric location of the electrode, the entire tumor is within the 5-mm effective range of treatment (arrow). (c) Photomicrograph of the biopsy specimen reveals immature-appearing eosinophilic chondroid matrix and adjacent mononuclear cells (arrow) with eccentrically located, reniform nuclei. This appearance is diagnostic of chondroblastoma. (Hematoxylin-eosin stain; original magnification, x200.) (d) Follow-up frontal radiograph of the right hip obtained 4 years after treatment. The osteolytic lesion (arrow) is indistinct and partially filled with bone. The patient is asymptomatic.
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Figure 1b. (a) Frontal radiograph of the right hip demonstrates a round osteolytic lesion of the femoral head, measuring 8 mm in diameter and surrounded by a thin zone of sclerosis (arrow). (b) Transverse CT scan of the femoral head with the electrode in place demonstrates that despite the slightly eccentric location of the electrode, the entire tumor is within the 5-mm effective range of treatment (arrow). (c) Photomicrograph of the biopsy specimen reveals immature-appearing eosinophilic chondroid matrix and adjacent mononuclear cells (arrow) with eccentrically located, reniform nuclei. This appearance is diagnostic of chondroblastoma. (Hematoxylin-eosin stain; original magnification, x200.) (d) Follow-up frontal radiograph of the right hip obtained 4 years after treatment. The osteolytic lesion (arrow) is indistinct and partially filled with bone. The patient is asymptomatic.
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Figure 1c. (a) Frontal radiograph of the right hip demonstrates a round osteolytic lesion of the femoral head, measuring 8 mm in diameter and surrounded by a thin zone of sclerosis (arrow). (b) Transverse CT scan of the femoral head with the electrode in place demonstrates that despite the slightly eccentric location of the electrode, the entire tumor is within the 5-mm effective range of treatment (arrow). (c) Photomicrograph of the biopsy specimen reveals immature-appearing eosinophilic chondroid matrix and adjacent mononuclear cells (arrow) with eccentrically located, reniform nuclei. This appearance is diagnostic of chondroblastoma. (Hematoxylin-eosin stain; original magnification, x200.) (d) Follow-up frontal radiograph of the right hip obtained 4 years after treatment. The osteolytic lesion (arrow) is indistinct and partially filled with bone. The patient is asymptomatic.
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Figure 1d. (a) Frontal radiograph of the right hip demonstrates a round osteolytic lesion of the femoral head, measuring 8 mm in diameter and surrounded by a thin zone of sclerosis (arrow). (b) Transverse CT scan of the femoral head with the electrode in place demonstrates that despite the slightly eccentric location of the electrode, the entire tumor is within the 5-mm effective range of treatment (arrow). (c) Photomicrograph of the biopsy specimen reveals immature-appearing eosinophilic chondroid matrix and adjacent mononuclear cells (arrow) with eccentrically located, reniform nuclei. This appearance is diagnostic of chondroblastoma. (Hematoxylin-eosin stain; original magnification, x200.) (d) Follow-up frontal radiograph of the right hip obtained 4 years after treatment. The osteolytic lesion (arrow) is indistinct and partially filled with bone. The patient is asymptomatic.
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The patient was discharged the same day and experienced relief of pain. The final results of the histopathologic examination indicated that the lesion was a chondroblastoma rather than an osteoid osteoma (Fig 1c). Shortly after the procedure, the patient experienced complete relief of her pain and resumed normal activities. A radiograph of the hip obtained 4 years after the procedure demonstrated healing of the lesion (Fig 1d). The patient remains asymptomatic at this writing.
Case 2.—A 17-year-old adolescent boy developed sharp right knee pain on flexion and extension and had difficulty walking. He was initially treated with NSAIDs for a presumed hamstring injury. The pain returned on discontinuation of NSAIDs and was severe enough that the patient developed a flexion contracture. MR imaging 6 months later revealed a possible cartilaginous neoplasm in the proximal tibia. The patient underwent knee arthroscopy at an outside institution, but the lesion was not visualized. When MR imaging performed 3 months after arthroscopy showed interval growth of the lesion, the patient was referred to our institution for further evaluation. An open biopsy was performed, and results were not diagnostic. The biopsy was followed by a third MR imaging examination, which showed increased bone marrow edema in the posterior medial tibial epiphysis with involvement of the adjacent soft tissue (Fig 2a). CT-guided biopsy of this region revealed chondroblastoma (Fig 2b).
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Figure 2a. (a) Sagittal T1-weighted MR image (repetition time msec/echo time msec, 700/16) through the knee shows the relationship of the tumor (white arrow) to the growth plate (black arrow). (b) Photomicrograph of the biopsy specimen reveals immature-appearing eosinophilic chondroid matrix and adjacent mononuclear cells with eccentrically located, reniform nuclei (arrow). This appearance is diagnostic of chondroblastoma. (Hematoxylin-eosin stain; original magnification, x200.) (c) Two transverse CT scans through the proximal tibial plateau demonstrate a round osteolytic lesion of the posterior-medial tibia (black arrow) containing faint calcifications (arrowhead). There is a large amount of periosteal soft-tissue edema (white arrow). (d) Transverse CT scan through the proximal tibia obtained 3 years after radio-frequency treatment shows almost complete healing of the bone (arrow).
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Figure 2b. (a) Sagittal T1-weighted MR image (repetition time msec/echo time msec, 700/16) through the knee shows the relationship of the tumor (white arrow) to the growth plate (black arrow). (b) Photomicrograph of the biopsy specimen reveals immature-appearing eosinophilic chondroid matrix and adjacent mononuclear cells with eccentrically located, reniform nuclei (arrow). This appearance is diagnostic of chondroblastoma. (Hematoxylin-eosin stain; original magnification, x200.) (c) Two transverse CT scans through the proximal tibial plateau demonstrate a round osteolytic lesion of the posterior-medial tibia (black arrow) containing faint calcifications (arrowhead). There is a large amount of periosteal soft-tissue edema (white arrow). (d) Transverse CT scan through the proximal tibia obtained 3 years after radio-frequency treatment shows almost complete healing of the bone (arrow).
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Figure 2c. (a) Sagittal T1-weighted MR image (repetition time msec/echo time msec, 700/16) through the knee shows the relationship of the tumor (white arrow) to the growth plate (black arrow). (b) Photomicrograph of the biopsy specimen reveals immature-appearing eosinophilic chondroid matrix and adjacent mononuclear cells with eccentrically located, reniform nuclei (arrow). This appearance is diagnostic of chondroblastoma. (Hematoxylin-eosin stain; original magnification, x200.) (c) Two transverse CT scans through the proximal tibial plateau demonstrate a round osteolytic lesion of the posterior-medial tibia (black arrow) containing faint calcifications (arrowhead). There is a large amount of periosteal soft-tissue edema (white arrow). (d) Transverse CT scan through the proximal tibia obtained 3 years after radio-frequency treatment shows almost complete healing of the bone (arrow).
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Figure 2d. (a) Sagittal T1-weighted MR image (repetition time msec/echo time msec, 700/16) through the knee shows the relationship of the tumor (white arrow) to the growth plate (black arrow). (b) Photomicrograph of the biopsy specimen reveals immature-appearing eosinophilic chondroid matrix and adjacent mononuclear cells with eccentrically located, reniform nuclei (arrow). This appearance is diagnostic of chondroblastoma. (Hematoxylin-eosin stain; original magnification, x200.) (c) Two transverse CT scans through the proximal tibial plateau demonstrate a round osteolytic lesion of the posterior-medial tibia (black arrow) containing faint calcifications (arrowhead). There is a large amount of periosteal soft-tissue edema (white arrow). (d) Transverse CT scan through the proximal tibia obtained 3 years after radio-frequency treatment shows almost complete healing of the bone (arrow).
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Because surgical resection could have resulted in extensive damage to the articular surface, radio-frequency heat ablation was suggested as primary treatment. After obtaining informed consent from the patient and his parents, ablation was performed with a probe with a 5-mm exposed tip, which resulted in a sphere of thermal necrosis measuring approximately 1 cm in diameter. At the time of treatment, the lesion measured 1.8 x 1.9 cm on transverse CT scans (Fig 2c). Therefore, three separate treatments were performed during a single session to encompass the entire lesion. At each location the lesion was heated to 90°C for 6 minutes.
The patient was discharged on the same day, experiencing considerable relief of pain. At the time of his most recent follow-up, more than 3 years after treatment, the patient was entirely free of symptoms. His flexion contracture and joint effusion were gone, and CT showed complete healing of the lesion (Fig 2d).
Case 3.—A 10-year-old boy presented with intermittent right knee pain of several years duration. The pain had markedly increased over several weeks and limited the patient’s movement. Radiography and CT revealed a 1.5-cm osteolytic lesion, surrounded by a thin, sclerotic border, at the medial aspect of the lateral femoral condyle, immediately deep to the subarticular bone plate at the origin of the anterior cruciate ligament (ACL). There was no internal matrix mineralization, and the presumed diagnosis was chondroblastoma. Informed consent was obtained from the patient and his mother. Heat ablation of the lesion was performed with an 8-mm probe. The electrode was initially advanced through the distal cortical surface into the intercondylar notch for one treatment, heating to 90°C for only 1 minute, to prevent damage to the ACL (Fig 3a). The tumor was then heated to 90°C for 6 minutes in six different locations; overlapping fields encompassed the entire tumor (Fig 3b). A CT-guided biopsy was performed, and results of the frozen section histopathologic examination confirmed the diagnosis (Fig 3c).
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Figure 3a. (a) Transverse CT scan shows placement of the electrode to the edge of the lesion in the intracondylar notch (arrow). The effective treatment zone is indicated by the circle. Note that the expected area of therapeutic necrosis extends slightly into the medullary bone of the femur. (b) A second transverse CT scan obtained after pulling the electrode back to treat the more peripheral portions of the tumor (arrow). Again, the expected zone of thermal ablation is indicated by a circle. (c) Photomicrograph of the biopsy specimen reveals mononuclear cells morphologically consistent with chondroblasts and positive for S-100 at immunohistochemical analysis. (Hematoxylin-eosin; original magnification, x100.) (d) Transverse CT scan obtained 2 months after treatment. The lesion appears slightly smaller, and a zone of sclerosis (arrows) consistent with the anticipated therapeutic zone has developed in the adjacent femur. (e) Transverse CT scan obtained approximately 2 years after treatment. The lesion is much improved; its former location is indicated by tiny residual lucencies (arrow).
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Figure 3b. (a) Transverse CT scan shows placement of the electrode to the edge of the lesion in the intracondylar notch (arrow). The effective treatment zone is indicated by the circle. Note that the expected area of therapeutic necrosis extends slightly into the medullary bone of the femur. (b) A second transverse CT scan obtained after pulling the electrode back to treat the more peripheral portions of the tumor (arrow). Again, the expected zone of thermal ablation is indicated by a circle. (c) Photomicrograph of the biopsy specimen reveals mononuclear cells morphologically consistent with chondroblasts and positive for S-100 at immunohistochemical analysis. (Hematoxylin-eosin; original magnification, x100.) (d) Transverse CT scan obtained 2 months after treatment. The lesion appears slightly smaller, and a zone of sclerosis (arrows) consistent with the anticipated therapeutic zone has developed in the adjacent femur. (e) Transverse CT scan obtained approximately 2 years after treatment. The lesion is much improved; its former location is indicated by tiny residual lucencies (arrow).
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Figure 3c. (a) Transverse CT scan shows placement of the electrode to the edge of the lesion in the intracondylar notch (arrow). The effective treatment zone is indicated by the circle. Note that the expected area of therapeutic necrosis extends slightly into the medullary bone of the femur. (b) A second transverse CT scan obtained after pulling the electrode back to treat the more peripheral portions of the tumor (arrow). Again, the expected zone of thermal ablation is indicated by a circle. (c) Photomicrograph of the biopsy specimen reveals mononuclear cells morphologically consistent with chondroblasts and positive for S-100 at immunohistochemical analysis. (Hematoxylin-eosin; original magnification, x100.) (d) Transverse CT scan obtained 2 months after treatment. The lesion appears slightly smaller, and a zone of sclerosis (arrows) consistent with the anticipated therapeutic zone has developed in the adjacent femur. (e) Transverse CT scan obtained approximately 2 years after treatment. The lesion is much improved; its former location is indicated by tiny residual lucencies (arrow).
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Figure 3d. (a) Transverse CT scan shows placement of the electrode to the edge of the lesion in the intracondylar notch (arrow). The effective treatment zone is indicated by the circle. Note that the expected area of therapeutic necrosis extends slightly into the medullary bone of the femur. (b) A second transverse CT scan obtained after pulling the electrode back to treat the more peripheral portions of the tumor (arrow). Again, the expected zone of thermal ablation is indicated by a circle. (c) Photomicrograph of the biopsy specimen reveals mononuclear cells morphologically consistent with chondroblasts and positive for S-100 at immunohistochemical analysis. (Hematoxylin-eosin; original magnification, x100.) (d) Transverse CT scan obtained 2 months after treatment. The lesion appears slightly smaller, and a zone of sclerosis (arrows) consistent with the anticipated therapeutic zone has developed in the adjacent femur. (e) Transverse CT scan obtained approximately 2 years after treatment. The lesion is much improved; its former location is indicated by tiny residual lucencies (arrow).
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Figure 3e. (a) Transverse CT scan shows placement of the electrode to the edge of the lesion in the intracondylar notch (arrow). The effective treatment zone is indicated by the circle. Note that the expected area of therapeutic necrosis extends slightly into the medullary bone of the femur. (b) A second transverse CT scan obtained after pulling the electrode back to treat the more peripheral portions of the tumor (arrow). Again, the expected zone of thermal ablation is indicated by a circle. (c) Photomicrograph of the biopsy specimen reveals mononuclear cells morphologically consistent with chondroblasts and positive for S-100 at immunohistochemical analysis. (Hematoxylin-eosin; original magnification, x100.) (d) Transverse CT scan obtained 2 months after treatment. The lesion appears slightly smaller, and a zone of sclerosis (arrows) consistent with the anticipated therapeutic zone has developed in the adjacent femur. (e) Transverse CT scan obtained approximately 2 years after treatment. The lesion is much improved; its former location is indicated by tiny residual lucencies (arrow).
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The patient was discharged on the same day. He experienced pain relief immediately, and he became asymptomatic over the next few weeks. Follow-up CT of the lesion 2 months after treatment showed that the lesion had decreased in size and that a sclerotic zone had developed surrounding it (Fig 3d). Follow-up CT 21 months later showed interval healing of the lesion (Fig 3e). There was no evidence of cortical disruption or ACL injury. The patient remains free of symptoms 2 years after treatment.
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Discussion
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These three patients represent our total experience with percutaneous radio-frequency treatment of typical chondroblastoma. We believe that this approach can be an effective joint-sparing alternative to surgical intervention in some cases. With periods of follow-up ranging from 2 to 4 years, there has been no evidence of recurrence.
The radio-frequency method has proven to be a safe and effective treatment for more than 200 patients with osteoid osteoma (6). Osteoid osteomas are well suited to radio-frequency ablation because they are small, are benign, and have finite growth. There have been no major complications due to the procedure. The success rate (approximately 90% of patients are permanently cured after a single treatment) has been similar to that of surgery (7).
Unlike osteoid osteoma, chondroblastoma has the potential for continued growth and a small risk of malignant transformation (8,9). Surgery involving curettage and packing with polymethylmethacrylate or bone graft has been the preferred treatment due to the potential for progression. However, the lesions may be difficult to treat surgically because they are small and epiphyseal, frequently requiring an intraarticular approach for proper visualization (10). Less invasive treatment with arthroscopic resection has also been described in chondroblastoma of the knee (11).
On radiographs, chondroblastoma appears as a well-defined, osteolytic lesion with a thin sclerotic rim located in the epiphysis or apophysis of a long bone. CT demonstrates similar findings, although endosteal changes and cortical penetration are more apparent (2,3). MR imaging may show peripheral lobulation on T2-weighted images (12). Periosteal reaction may be seen at radiography or CT in about half of the cases, whereas MR imaging demonstrates bone marrow edema and/or periosteal reaction in a high percentage of cases. This feature helps distinguish chondroblastoma (and osteoid osteoma) from other lesions that may be found in the epiphysis, such as enchondroma, chondromyxoid fibroma, and giant cell tumor.
Histologically, chondroblastoma typically consists of round or polyhedral chondroblasts with eccentric, often reniform or cleft nuclei, islands of cartilage or chondroid matrix, scattered multinucleated osteoclast-type giant cells, and fine, lace-like calcifications deposited at the periphery of the chondroblasts, resulting in a "chicken-wire" pattern (13,14). The microscopic appearance of chondroblastoma is distinct from that of other cartilage-containing tumors, and these tumors may resemble more aggressive benign neoplasms such as giant cell tumor or aneurysmal bone cyst (15). Vascular invasion and malignant disease may occur, and death may result in a small percentage of cases of chondroblastoma (16). Despite these occasional outcomes, the tumor is typically not highly invasive and tends not to infiltrate beyond the apparent margin seen on imaging studies.
If the diagnosis is in doubt, percutaneous treatment may be inappropriate. We advocate biopsy and radio-frequency ablation as a single intervention rather than two separate procedures. The procedure requires general anesthesia because of the pain involved and the typically young age of the patients. Because the radio-frequency method is minimally destructive to adjacent tissues and is indifferent to tissue type, we believe it is appropriate to perform a single-step procedure if the lesion is small and if the differential diagnosis does not include a substantial question of malignancy. There should be diagnostic agreement between the orthopedic surgeon and the radiologist based on clinical and radiologic criteria. In the event that the final results of the pathologic examination differ from the frozen section diagnosis, we see no potential consequences from ablation that would interfere with or alter a subsequent surgical procedure. Because of the potential for progression, careful follow-up imaging is required.
The technique of radio-frequency ablation in bone lesions has previously been described in articles on the treatment of osteoid osteoma (6,7). Although we often use general anesthesia for this procedure, it is usually performed on an outpatient basis. The electrodes used for treatment of osteoid osteoma produce an area of thermal necrosis that extends 5–6 mm from the exposed tip, resulting in destruction of a spherical region 1.0–1.2 cm in diameter for each 6-minute treatment, regardless of tissue type. A single treatment is adequate for most osteoid osteomas because of their small size. Necrotic bone has the same mechanical function as normal bone (17,18). However, some weakening of the bone may be expected during the resorptive phase of healing. Therefore we advise patients to avoid strenuous athletics during this time. We have seen no case of fracture or osteochondral injury in over 200 patients treated for osteoid osteoma.
Chondroblastomas are generally small enough to be amenable to percutaneous therapy with this approach, but several overlapping or contiguous heat treatments may need to be performed to treat the entire tumor, as was done for the patients in cases 2 and 3. The patient in case 1, who had an 8-mm lesion, was successfully treated with a single radio-frequency ablation procedure. Equipment powerful enough to ablate larger tissue volumes has been developed for treatment of hepatic and renal tumors (19,20); however, greater precision is possible with overlapping small fields rather than a single large field (18). We believe that this permits treatment of subarticular lesions with minimal damage to the joint. There is no evidence of degenerative arthritis in our three patients at the time of this writing.
Local recurrence of chondroblastoma occurs in 8%–20% of surgically treated patients. Adjuvant treatments such as cryosurgery or phenol cauterization have been developed, with varying rates of success (21,22). The most common site of recurrence is the proximal femur, a region easily accessible under CT guidance. Therefore, percutaneous treatment with radio-frequency ablation may also be beneficial in treating recurrence of chondroblastoma and may provide a less invasive, more effective option for maintaining local control.
Percutaneous radio-frequency ablation is a safe and effective first-line treatment for chondroblastoma. The technique is minimally invasive and can apparently be curative. Patients with small initial or recurrent lesions are ideal candidates, although multiple treatments during a single session may be necessary for larger lesions. Further clinical experience and prospective studies are needed to determine the exact role of radio-frequency ablation in the treatment of chondroblastoma.
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FOOTNOTES
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Abbreviations: ACL = anterior cruciate ligament,
NSAID = nonsteroidal anti-inflammatory drug
Author contributions: Guarantor of integrity of entire study, D.I.R.; study concepts and design, D.I.R.; literature research, J.K.E., D.I.R.; clinical and experimental studies, D.I.R.; data acquisition and analysis/interpretation, J.K.E., D.I.R.; manuscript preparation, J.K.E., D.I.R.; manuscript definition of intellectual content, editing, revision/review, and final version approval, all authors.
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R. Suneja, R. J. Grimer, M. Belthur, L. Jeys, S. R. Carter, R. M. Tillman, and A. M. Davies
Chondroblastoma of bone: LONG-TERM RESULTS AND FUNCTIONAL OUTCOME AFTER INTRALESIONAL CURETTAGE
J Bone Joint Surg Br,
July 1, 2005;
87-B(7):
974 - 978.
[Abstract]
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N. Anis, N. Chawki, and K. Antoine
Use of Radio-Frequency Ablation for the Palliative Treatment of Sacral Chordoma
AJNR Am. J. Neuroradiol.,
October 1, 2004;
25(9):
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[Abstract]
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J. M. Lee, G. Y. Jin, S. N. Goldberg, Y. C. Lee, G. H. Chung, Y. M. Han, S. Y. Lee, and C. S. Kim
Percutaneous Radiofrequency Ablation for Inoperable Non-Small Cell Lung Cancer and Metastases: Preliminary Report
Radiology,
January 1, 2004;
230(1):
125 - 134.
[Abstract]
[Full Text]
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P O'Donnell and P O'Donnell
Evaluation of focal bone lesions: basic principles and clinical scenarios
Imaging,
December 1, 2003;
15(4):
298 - 323.
[Abstract]
[Full Text]
[PDF]
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TOP
ABSTRACT
INTRODUCTION
