Dual-angled CT-guided biopsy

Difficult biopsy and drainage: just say yes

Abdominal radiologists are often asked to perform difficult percutaneous chest, abdomen, and pelvis biopsies and drainages with imaging guidance. Many of these procedures involve small target lesions far from the skin surface, in close proximity to critical structures. Organ location is changeable due to respiration, peristalsis, and pulsation, further complicating the planning process. High-level three-dimensional spatial awareness is critical to mastery of complex image-guided procedures. A comprehensive grasp of anatomy and expected changes can be exploited in certain cases to target lesions within a solid organ or to avoid injury to sensitive structures during biopsy, drain placement, or thermal ablation. In this article, we will use illustrative cases to explore the use of anatomic knowledge and the ability to synthesize this three-dimensional data dynamically during planning and execution of difficult CT- and ultrasound-guided procedures. We will discuss unusual biopsy requests-such as bowel biopsies-and the benefits of using ultrasound guidance for certain procedures in the chest. Additionally, we will describe multiple special techniques, including out of standard plane angulation and endocavitary techniques, in order to maximize chances of success.

Interventional radiology procedures in the liver. Biopsy, drainage, and ablation

Radiologically guided interventional procedures in the liver have continually increased, in number and variety, over the years. Factors promoting these advances include new technology, innovative ideas, and growing acceptance by clinicians and patients. Percutaneous biopsy and drainage procedures are firmly established techniques with low complication rates. Ablation by injected substances is useful for treating certain tumor types. The most exciting development is the introduction of percutaneous thermal techniques for tumor ablation. Although more experience is needed to optimize the use of focal thermal ablation, early results seem promising.

Artificial paravertebral widening for percutaneous CT-guided adrenal biopsy

A percutaneous adrenal biopsy under CT guidance is described. The biopsy was performed after injection of physiologic saline solution into the paravertebral space, creating a wider pathway for needle insertion. This technique has been previously reported for biopsy of thoracic lesions, but in our case it was used for biopsy of a relatively inaccessible adrenal lesion. This artificial window that is formed by displacing the pleura laterally allows a direct and potentially safer access route to the retroperitoneum, avoiding puncture of pleura, diaphragm, and abdominal structures.