Image Guidance and Planning

Abstract

The concept of being able to isolate an abdominal or retroperitoneal nerve plexus percutaneously using a needle technique provided a less invasive approach to “blocking” nociceptive impulses. Popper et al. described the use of splanchnic nerve block as a diagnostic tool to differentiate between somatic and visceral abdominal pains (Popper HL. Am J Dig Dis 15(1):1–4, 1948). The risks associated with previous “blind” techniques eventually led to the use of imaging guidance. Fluoroscopic guidance was first introduced in the 1950s followed by CT guidance and eventually ultrasound guidance in the 1990s (Wiersema MJ, Wiersema LM. Gastrointest Endosc 44(6):656–62, 1996). The most commonly used imaging modalities include ultrasound, MRI, fluoroscopy, and CT scan. While each modality possesses individual benefits and limitations which will be discussed below, it is important to understand patient-specific characteristics, such as optimal patient positioning. Moreover, each cancer patient will require imaging for their workup, which is invaluable to determine the “approach” using the most anatomically appropriate interventional modality. Various plexus blocks and neurolyses, such as celiac, splanchnic, superior hypogastric, and lumbar sympathetic, have become an essential therapeutic option in the management of cancer-related abdominal and pelvic pain.