Flat detector cone-beam CT-guided percutaneous needle biopsy of mediastinal lesions: preliminary experience

Percutaneous CT Fluoroscopy-Guided Core Needle Biopsy of Mediastinal Masses: Technical Outcome and Complications of 155 Procedures during a 10-Year Period

PURPOSE

To evaluate technical outcome, diagnostic yield and safety of computed tomographic fluoroscopy-guided percutaneous core needle biopsies in patients with mediastinal masses.

METHODS

Overall, 155 CT fluoroscopy-guided mediastinal core needle biopsies, performed from March 2010 to June 2020 were included. Size of lesion, size of needle, access path, number of success, number of biopsies per session, diagnostic yield, patient's position, effective dose, rate of complications, tumor localization, size of tumor and histopathological diagnosis were considered. Post-interventional CT was performed, and patients observed for any complications. Complications were classified per the Society of Interventional Radiology (SIR).

RESULTS

148 patients (age, 54.7 ± 18.2) underwent 155 CT-fluoroscopy-guided percutaneous biopsies with tumors in the anterior (114; 73.5%), middle (17; 11%) and posterior (24; 15.5%) mediastinum, of which 152 (98%) were technically successful. For placement of the biopsy needle, in 82 (52.9%) procedures a parasternal trajectory was chosen, in 36 (23.3%) a paravertebral access, in 20 (12.9%) through the lateral intercostal space and in 17 (11%) the thoracic anterior midline, respectively. A total of 136 (89.5%) of the biopsies were considered adequate for a specific histopathologic analysis. Total DLP (dose-length product) was 575.7 ± 488.8 mGy*cm. Mean lesion size was 6.0 ± 3.3 cm. Neoplastic pathology was diagnosed in 115 (75.7%) biopsies and 35 (23%) biopsy samples showed no evidence of malignancy. Minor complications were observed in 18 (11.6%) procedures and major pneumothorax requiring drainage insertion in 3 interventions (1.9%).

CONCLUSION

CT fluoroscopy-guided percutaneous core needle biopsy of mediastinal masses is an effective and safe procedure for the initial assessment of patients with mediastinal tumors.

Percutaneous bone biopsy using a flat-panel cone beam computed tomography virtual navigation system

Objectives

To assess the clinical role of flat-panel cone beam CT (CBCT) in performing percutaneous needle biopsy (PNB) of bone lesions. Flat-panel cone beam CT systems have been used as a guidance tool for performing percutaneous biopsy. Real-time fluoroscopy and virtual navigation systems help simplify needle path planning and shorten procedure times.

Methods

From March 2012 to March 2016, 80 patients with 80 bone lesions were retrospectively enrolled in the study in Zhengzhou city of China. Technical success, diagnostic accuracy, puncture performance, procedure time, complications, and effective radiation exposure were calculated.

Results

All biopsies were technically successful (100%). Sufficient tissue for histopathological analysis was obtained in 75 of 80 cases. The sensitivity of PNB of bone lesions was 95.5%, the specificity was 83.3%, and accuracy was 93.7%. The mean scoring of puncture performance was 3.9 ± 1.3. The mean total procedure time was 13.20 ± 4.4 min, resulting in a mean exposure dose of 11.3 ± 5.1 mSv. The complication rate was 8.7%.

Conclusion

Percutaneous bone biopsy using CBCT is a safe and effective method that simplifies needle path planning and shortens procedure times.

Clinical role of guidance by C-arm CT for 125I brachytherapy on pulmonary tumors

PURPOSE

To evaluate the clinical value of C-arm CT (CACT)-guided interstitial iodine-125 (¹²⁵I) brachytherapy on pulmonary tumors.

MATERIALS AND METHODS

30 patients with 40 solid pulmonary tumors were enrolled to undergo CACT-guided interstitial ¹²⁵I brachytherapy between November 2011 and November 2014. The needle path was planned on a CACT virtual navigation and real-time fluoroscopy system. Technical success, puncture score, procedure time, local control rate (LCR), radiation exposure, complications and survival were investigated.

RESULTS

The technical success of interstitial ¹²⁵I brachytherapy under CACT guidance was 40/40 (100%). The performance score was 4.7 ± 0.5 with a mean total procedure time of 17.7 ± 5.6 min. LCR in small (≤2.0 cm), intermediate (2.1-4.9 cm) and large (≥5.0 cm) pulmonary tumors was 100, 89.5 and 72.7% at the 4-month follow-up, respectively. The mean effective dose was 10.1 ± 2.8 mSv. Major complications occurred in four patients (13.3%). The mean survival time was 28.4 ± 2.3 months.

CONCLUSION

CACT can provide virtual navigation and real-time fluoroscopy synchronously for interstitial ¹²⁵I seed implantation on pulmonary tumors.

Flat detector cone beam CT-guided nephrostomy using virtual navigation in patients with iatrogenic ureteral injury

PURPOSE

To evaluate the feasibility of flat detector cone beam computed tomography (CBCT)-guided nephrostomy using virtual navigation in patients with iatrogenic ureteral injury.

MATERIALS AND METHODS

A retrospective review of percutaneous nephrostomy (PN) revealed the use of CBCT with 3D virtual navigation guidance in 42 procedures (40 patients) for patients with iatrogenic ureteral injury. All procedures were shown as second-line interventions after failed ultrasound-guided nephrostomy. Data on technical success rate, procedure time, puncture performance, radiation exposure, complications, and clinical success were collected.

RESULTS

The technical success rate was 95.2% (40/42). The mean puncture performance score was 4.4 ± 1.0, and the procedure time was 25.2 ± 3.1 min, resulting in a mean effective exposure dose of 5.9 ± 2.3 mSv. There were no serious complications. During the mean follow-up periods of 11.4 months (range 6-19), clinical success rates following drainage were 72.5% (29/40), and ten cases (25%) had secondary surgical treatments.

CONCLUSION

CBCT with 3D virtual navigation is a feasible technique for PN with reasonable exposure dose and can serve as a second-line intervention after failed ultrasound guidance.