Image Guidance and Planning

  • Ramon Go
  • Jeffrey PrinsellJr.


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.


Retroperitoneal nerve plexus Splanchnic nerve block Imaging guidance Cancer patient Celiac Splanchnic Superior hypogastric 


  1. 1.
    Fujita Y, Sari A. Max Kappis and the celiac plexus block. Anesthesiology. 1997;86(2):508.CrossRefGoogle Scholar
  2. 2.
    Popper HL. Acute pancreatitis; an evaluation of the classification, symptomatology, diagnosis and therapy. Am J Dig Dis. 1948;15(1):1–4.CrossRefGoogle Scholar
  3. 3.
    Bridenbaugh LD, Moore DC, Campbell DD. Management of upper abdominal cancer pain: treatment with celiac plexus block with alcohol. JAMA. 1964;190:877–80.CrossRefGoogle Scholar
  4. 4.
    Jacobs JB, Jackson SH, Doppman JL. A radiographic approach to celiac ganglion block. Radiology. 1969;92(6):1373–3.CrossRefGoogle Scholar
  5. 5.
    Wiersema MJ, Wiersema LM. Endosonography-guided celiac plexus neurolysis. Gastrointest Endosc. 1996;44(6):656–62.CrossRefGoogle Scholar
  6. 6.
    Loukas M, Klaassen Z, Merbs W, Tubbs RS, Gielecki J, Zurada A. A review of the thoracic splanchnic nerves and celiac ganglia. Clin Anat. 2010;23(5):512–22.CrossRefGoogle Scholar
  7. 7.
    Zhang XM, Zhao QH, Zeng NL, et al. The celiac ganglia: anatomic study using MRI in cadavers. AJR Am J Roentgenol. 2006;186(6):1520–3.CrossRefGoogle Scholar
  8. 8.
    Yoshioka K, Niinuma H, Ehara S, Nakajima T. MR angiography and CT angiography of the artery of Adamkiewicz: state of the art. Radiographics. 2006;26(1):S63–73.CrossRefGoogle Scholar
  9. 9.
    Kieffer E, Fukui S, Chiras J, Koskas F, Bahnini A, Cormier E. Spinal cord arteriography: a safe adjunct before descending thoracic or thoracoabdominal aortic aneurysmectomy. J Vasc Surg. 2002;35(2):262–8.CrossRefGoogle Scholar
  10. 10.
    Wang PJ, Shang MY, Qian Z, Shao CW, Zhao XH. CT-guided percutaneous neurolytic celiac plexus block technique. Abdom Imaging. 2006;31(6):710–8.CrossRefGoogle Scholar
  11. 11.
    Kambadakone A, Thabet A, Gervais D, Mueller P, Arellano R. CT-guided celiac plexus neurolysis: a review of anatomy, indications, technique, and tips for successful treatment. Radiographics. 2011;31:1599–621.CrossRefGoogle Scholar
  12. 12.
    Haaga JR, Reich NE, Havrilla TR, Alfidi RJ. Interventional CT scanning. Radiol Clin N Am. 1977;15(3):449–56.PubMedGoogle Scholar
  13. 13.
    Haaga JR, Kori SH, Eastwood DW, Borkowski GP. Improved technique for CT-guided celiac ganglia block. AJR Am J Roentgenol. 1984;142(6):1201–4.CrossRefGoogle Scholar
  14. 14.
    Hol PK, Kvarstein G, Viken O, Smedby O, Tonnessen TI. MRI-guided celiac plexus block. J Magn Reson Imaging. 2000;12(4):562–4.CrossRefGoogle Scholar
  15. 15.
    De Cicco M, Matovic M, Balestreri L, Fracasso A, Morassut S, Testa V. Single-needle celiac plexus block: is needle tip position critical in patients with no regional anatomic distortions? Anesthesiology. 1997;87(6):1301–8.CrossRefGoogle Scholar
  16. 16.
    Rathmell J. Atlas of image-guided intervention in regional anesthesia and pain medicine. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 135–45.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ramon Go
    • 1
  • Jeffrey PrinsellJr.
    • 1
  1. 1.Pain ManagementMemorial Sloan Kettering Cancer CenterNew YorkUSA

Personalised recommendations