Cone beam CT in percutaneous biopsies of the musculoskeletal system
Abstract
Background: Percutaneous biopsies have become an indispensable part in the diagnostics of musculoskeletal lesions owing to current technological advances in imaging control and performance. The newest technology used for percutaneous biopsies of musculoskeletal lesions is C-arm cone-beam computed tomography (CT) combined with a computer navigation system for needle guidance.
Methods: 28 patients who underwent computer-guided percutaneous biopsies of the musculoskeletal system using cone-beam CT (Phillips Allura ND20) with the XperGuide needle-navigation system were included in the study in order to determine the feasibility and diagnostic accuracy of computer-guided percutaneous biopsies and to evaluate the method’s success rate, its safety, and patient irradiation exposure.
Results: Technical and histological success rates were 90 % and 89.3 %, respectively. The highest histological success rate was observed for lesions in the pelvis and in the lower extremities. Specificity and sensitivity for determining benign and malignant lesions were 100 % and 83.3 %, respectively. Mean patient effective dose was 13.4 mSv.
Conclusion: The results of our study confirm that C-arm cone-beam CT combined with a computer navigation system for needle guidance has proven to be a safe, sensitive and accurate method, with lower patient irradiation and complication rate compared to conventional CT. It is a good alternative to CT-guided percutaneous biopsies.
Downloads
References
Maybody M, Stevenson C, Solomon SB. Overview of navigation systems in image-guided interventions. Tech Vasc Interv Radiol. 2013 Sep;16(3):136–43. https://doi.org/10.1053/j.tvir.2013.02.008 PMID:23993075
Kagadis GC, Katsanos K, Karnabatidis D, Loudos G, Nikiforidis GC, Hendee WR. Emerging technologies for image guidance and device navigation in interventional radiology. Med Phys. 2012 Sep;39(9):5768–81. https://doi.org/10.1118/1.4747343 PMID:22957641
Davies A, Sundaram M, James S. Imaging of bone tumors and tumor-like lesions. Berlin: Springer-Verlag; 2009. https://doi.org/10.1007/978-3-540-77984-1.
Le HB, Lee ST, Munk PL. Image-guided musculoskeletal biopsies. Semin Intervent Radiol. 2010 Jun;27(2):191–8. https://doi.org/10.1055/s-0030-1253517 PMID:21629408
Mitsuyoshi G, Naito N, Kawai A, Kunisada T, Yoshida A, Yanai H, et al. Accurate diagnosis of musculoskeletal lesions by core needle biopsy. J Surg Oncol. 2006 Jul;94(1):21–7. https://doi.org/10.1002/jso.20504 PMID:16788939
Rimondi E, Staals EL, Errani C, Bianchi G, Casadei R, Alberghini M, et al. Percutaneous CT-guided biopsy of the spine: results of 430 biopsies. Eur Spine J. 2008 Jul;17(7):975–81. https://doi.org/10.1007/s00586-008-0678-x PMID:18463900
Fenton DS, Peterson JJ. Procedural similarities. In: Peterson JJ, Fenton DS, Czervionke LF, editors. Image-guided musculoskeletal intervention. 1st ed. Philadelphia: Saunders/Elsevier; 2008. pp. 1–15. https://doi.org/10.1016/B978-1-4160-2905-2.50008-2.
Le HB, Lee ST, Munk PL. Image-guided musculoskeletal biopsies. Semin Intervent Radiol. 2010 Jun;27(2):191–8. https://doi.org/10.1055/s-0030-1253517 PMID:21629408
Becker C, Nikolaou K. Multislice CT. Dordrecht: Springer; 2008.
Braak S. Cone-beam CT-guidance in Interventional Radiology [Ph.D]. Univerza v Utrechtu, Nizozemska; 2012.
Wallace MJ, Kuo MD, Glaiberman C, Binkert CA, Orth RC, Soulez G; Technology Assessment Committee of the Society of Interventional Radiology. Three-dimensional C-arm cone-beam CT: applications in the interventional suite. J Vasc Interv Radiol. 2008 Jun;19(6):799–813. https://doi.org/10.1016/j.jvir.2008.02.018 PMID:18503893
Braak SJ, van Strijen MJ, van Leersum M, van Es HW, van Heesewijk JP. Real-Time 3D fluoroscopy guidance during needle interventions: technique, accuracy, and feasibility. AJR Am J Roentgenol. 2010 May;194(5):W445-51. https://doi.org/10.2214/AJR.09.3647 PMID:20410392
Spelle L, Ruijters D, Babic D, Homan R, Mielekamp P, Guillermic J, et al. First clinical experience in applying XperGuide in embolization of jugular paragangliomas by direct intratumoral puncture. Int J CARS. 2009 Nov;4(6):527–33. https://doi.org/10.1007/s11548-009-0370-6 PMID:20033329
Tam AL, Mohamed A, Pfister M, Chinndurai P, Rohm E, Hall AF, et al. C-arm cone beam computed tomography needle path overlay for fluoroscopic guided vertebroplasty. Spine. 2010 May;35(10):1095–9. https://doi.org/10.1097/BRS.0b013e3181bc39c6 PMID:20139803
Orth RC, Wallace MJ, Kuo MD; Technology Assessment Committee of the Society of Interventional Radiology. C-arm cone-beam CT: general principles and technical considerations for use in interventional radiology. J Vasc Interv Radiol. 2008 Jun;19(6):814–20. https://doi.org/10.1016/j.jvir.2008.02.002 PMID:18503894
Racadio JM, Babic D, Homan R, Rampton JW, Patel MN, Racadio JM, et al. Live 3D guidance in the interventional radiology suite. AJR Am J Roentgenol. 2007 Dec;189(6):W357-64. https://doi.org/10.2214/AJR.07.2469 PMID:18029850
Tselikas L, Joskin J, Roquet F, Farouil G, Dreuil S, Hakimé A, et al. Percutaneous bone biopsies: comparison between flat-panel cone-beam CT and CT-scan guidance. Cardiovasc Intervent Radiol. 2015 Feb;38(1):167–76. https://doi.org/10.1007/s00270-014-0870-9 PMID:24627161
Davies A, Sundaram M, James S. Imaging of bone tumors and tumor-like lesions. Berlin: Springer-Verlag; 2009. https://doi.org/10.1007/978-3-540-77984-1.
Braak SJ, Zuurmond K, Aerts HC, van Leersum M, Overtoom TT, van Heesewijk JP, et al. Feasibility study of needle placement in percutaneous vertebroplasty: cone-beam computed tomography guidance versus conventional fluoroscopy. Cardiovasc Intervent Radiol. 2013 Aug;36(4):1120–6. https://doi.org/10.1007/s00270-013-0598-y PMID:23511990
Busser WM, Hoogeveen YL, Veth RP, Schreuder HW, Balguid A, Renema WK, et al. Percutaneous radiofrequency ablation of osteoid osteomas with use of real-time needle guidance for accurate needle placement: a pilot study. Cardiovasc Intervent Radiol. 2011 Feb;34(1):180–3. https://doi.org/10.1007/s00270-010-9950-7 PMID:20668850
Carrafiello G, Fontana F, Mangini M, Ierardi AM, Cotta E, Floridi C, et al. Initial experience with percutaneous biopsies of bone lesions using XperGuide cone-beam CT (CBCT): technical note. Radiol Med (Torino). 2012 Dec;117(8):1386–97. https://doi.org/10.1007/s11547-012-0788-1 PMID:22327915
Suzuki S, Furui S, Yamaguchi I, Yamagishi M, Watanabe A, Abe T, et al. Effective dose during abdominal three-dimensional imaging with a flat-panel detector angiography system. Radiology. 2009 Feb;250(2):545–50. https://doi.org/10.1148/radiol.2502080695 PMID:19188322
Leschka SC, Babic D, El Shikh S, Wossmann C, Schumacher M, Taschner CA. C-arm cone beam computed tomography needle path overlay for image-guided procedures of the spine and pelvis. Neuroradiology. 2012 Mar;54(3):215–23. https://doi.org/10.1007/s00234-011-0866-y PMID:21476020
Tsalafoutas IA, Tsapaki V, Triantopoulou C, Gorantonaki A, Papailiou J. CT-guided interventional procedures without CT fluoroscopy assistance: patient effective dose and absorbed dose considerations. AJR Am J Roentgenol. 2007 Jun;188(6):1479–84. https://doi.org/10.2214/AJR.06.0705 PMID:17515365
Cardella JF, Bakal CW, Bertino RE, Burke DR, Drooz A, Haskal Z, et al.; Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for image-guided percutaneous biopsy in adults. J Vasc Interv Radiol. 2003 Sep;14(9 Pt 2):S227–30. PMID:14514823
Omary RA, Bettmann MA, Cardella JF, Bakal CW, Schwartzberg MS, Sacks D, et al.; Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for the reporting and archiving of interventional radiology procedures. J Vasc Interv Radiol. 2003 Sep;14(9 Pt 2):S293–5. https://doi.org/10.1097/01.RVI.0000094601.83406.e1 PMID:14514836
Jelinek JS, Murphey MD, Welker JA, Henshaw RM, Kransdorf MJ, Shmookler BM, et al. Diagnosis of primary bone tumors with image-guided percutaneous biopsy: experience with 110 tumors. Radiology. 2002 Jun;223(3):731–7. https://doi.org/10.1148/radiol.2233011050 PMID:12034942
Motamedi K, Levine BD, Seeger LL, McNitt-Gray MF. Success rates for computed tomography-guided musculoskeletal biopsies performed using a low-dose technique. Skeletal Radiol. 2014 Nov;43(11):1599–603. https://doi.org/10.1007/s00256-014-1892-8 PMID:24788453
Lis E, Bilsky MH, Pisinski L, Boland P, Healey JH, O’malley B, et al. Percutaneous CT-guided biopsy of osseous lesion of the spine in patients with known or suspected malignancy. AJNR Am J Neuroradiol. 2004 Oct;25(9):1583–8. PMID:15502142
Puri A, Shingade VU, Agarwal MG, Anchan C, Juvekar S, Desai S, et al. CT-guided percutaneous core needle biopsy in deep seated musculoskeletal lesions: a prospective study of 128 cases. Skeletal Radiol. 2006 Mar;35(3):138–43. https://doi.org/10.1007/s00256-005-0038-4 PMID:16391943
Maciel MJ, Tyng CJ, Barbosa PN, Bitencourt AG, Matushita Junior JP, Zurstrassen CE, et al. Computed tomography-guided percutaneous biopsy of bone lesions: rate of diagnostic success and complications. Radiol Bras. 2014 Sep-Oct;47(5):269–74. https://doi.org/10.1590/0100-3984.2013.0004 PMID:25741100
Hau A, Kim I, Kattapuram S, Hornicek FJ, Rosenberg AE, Gebhardt MC, et al. Accuracy of CT-guided biopsies in 359 patients with musculoskeletal lesions. Skeletal Radiol. 2002 Jun;31(6):349–53. https://doi.org/10.1007/s00256-002-0474-3 PMID:12073119
Kim S, Park H, Lee S, Chung E, Park H, Kook S, et al. Initial Experience with Percutaneous Needle Aspiration of Paraspinal Lesions Using XperGuide Cone-Beam CT. J Korean Soc Radiol. 2013;68(3):245. https://doi.org/10.3348/jksr.2013.68.3.245.
Dupuy DE, Rosenberg AE, Punyaratabandhu T, Tan MH, Mankin HJ. Accuracy of CT-guided needle biopsy of musculoskeletal neoplasms. AJR Am J Roentgenol. 1998 Sep;171(3):759–62. https://doi.org/10.2214/ajr.171.3.ajronline_171_3_001 PMID:9725312
Copyright (c) 2018 Slovenian Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
