Background/Objectives: Spinal metastases are a frequent and serious complication in cancer patients, often causing severe pain, instability, and neurological deficits. Thermal ablation techniques such as radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CA) have emerged as minimally invasive treatments. These techniques rely on precise imaging guidance to effectively target lesions while minimizing complications. This systematic review aims to compare the efficacy of different imaging modalities—computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, and mixed techniques—in guiding thermal ablation for spinal metastases, focusing on success rates and complications. Methods: A systematic literature search was conducted across PubMed, OVID, Google Scholar, and Web of Science databases, yielding 3733 studies. After screening, 51 studies met the eligibility criteria. Data on success rates, tumor recurrence, complications, and patient outcomes were extracted. Success was defined as no procedure-related mortality, tumor recurrence or expansion, or nerve injury. This systematic review followed PRISMA guidelines and was registered with PROSPERO (ID: CRD42024567174). Results: CT-guided thermal ablation demonstrated high success rates, especially with RFA (75% complete success). Although less frequently employed, MRI guidance showed lower complication rates and improved soft-tissue contrast. Fluoroscopy-guided procedures were effective but had a higher incidence of nerve injury and incomplete tumor control. Mixed imaging techniques, such as CBCT-MRI fusion, showed potential for reducing complications and improving targeting accuracy. Conclusions: CT remains the most reliable imaging modality for guiding thermal ablation in spinal metastases, while MRI provides enhanced safety in complex cases. Fluoroscopy, although effective for real-time guidance, presents limitations in soft-tissue contrast. Mixed imaging techniques like CBCT-MRI fusion offer promising solutions by combining the advantages of both CT and MRI, warranting further exploration in future studies.
**背景/目的：** 脊柱转移瘤是癌症患者常见且严重的并发症，常导致剧烈疼痛、脊柱不稳和神经功能缺损。射频消融、微波消融和冷冻消融等热消融技术已成为微创治疗手段。这些技术依赖于精确的影像引导，以有效靶向病灶并最大限度减少并发症。本系统综述旨在比较不同影像引导方式——计算机断层扫描、磁共振成像、透视以及混合技术——在引导脊柱转移瘤热消融中的疗效，重点关注成功率和并发症。 **方法：** 在PubMed、OVID、Google Scholar和Web of Science数据库中进行系统性文献检索，共获得3733项研究。经筛选后，51项研究符合纳入标准。提取了关于成功率、肿瘤复发、并发症和患者结局的数据。成功定义为无手术相关死亡、肿瘤复发或扩大、或神经损伤。本系统综述遵循PRISMA指南，并在PROSPERO注册。 **结果：** CT引导的热消融显示出较高的成功率，尤其是射频消融。虽然应用较少，但MRI引导显示出较低的并发症发生率，并改善了软组织对比度。透视引导的手术有效，但神经损伤和肿瘤控制不完全的发生率较高。混合成像技术，如CBCT-MRI融合，显示出减少并发症和提高靶向准确性的潜力。 **结论：** CT仍然是引导脊柱转移瘤热消融最可靠的影像学方式，而MRI在复杂病例中提供了更高的安全性。透视尽管能提供实时引导，但在软组织对比度方面存在局限。CBCT-MRI融合等混合成像技术结合了CT和MRI的优势，提供了有前景的解决方案，值得在未来研究中进一步探索。
肿瘤(癌症)患者之家