De Filippo M, Onniboni M, Rusca M, Carbognani P, Ferrari L, Guazzi A, Casalini A, Verardo E, Cataldi V, Tiseo M, Sverzellati N, Chiari G, Rabaiotti E, Corsi A, Cacciani G, Sommario M, Ardizzoni A, Zompatori M
Dipartimento di Scienze Cliniche, Sezione di Scienze Radiologiche, Università degli Studi di Parma, Parma, Italy.
Radiol Med. 2008 Oct;113(7):945-53. doi: 10.1007/s11547-008-0325-y. Epub 2008 Sep 25.
This study aimed to assess the usefulness of multiplanar reformations (MPR) during multidetector-row computed tomography (MDCT)-guided percutaneous needle biopsy of lung lesions difficult to access with the guidance of the native axial images alone owing to overlying bony structures, large vessels or pleural fissures.
MDCT-guided transthoracic needle biopsy (TNB) was performed on 84 patients (55 men and 29 women; mean age 65 years) with suspected lung neoplasm by using a spiral MDCT scanner with the simultaneous acquisition of six slices per rotation. We determined the site of entry of the 22-gauge Chiba needle on native axial images and coronal or sagittal MPR images. We took care to ensure the shortest needle path without overlying large vessels, main bronchi, pleural fissures or bony structures; access to the lung parenchyma as perpendicular as possible to the pleural plane; and sampling of highly attenuating areas of noncalcified tissue within the lesion.
Diagnostic samples were obtained in 96% of cases. In 73 patients, lesions appeared as a solid noncalcified nodule <2 cm; 11 lesions were mass-like. In 22, the biopsy required MPR guidance owing to overlying ribs (18), fissures (2) or hilar-mediastinal location (2).
MDCT MPR images allowed sampling of pulmonary lesions until now considered unreachable with axial MDCT guidance because of overlying bony structures (ribs, sternum and scapulae) or critical location (hilar-mediastinal, proximity to the heart or large vessels). Compared with the conventional procedure, the use of MPR images does not increase the rate of pneumothorax or the procedure time.
本研究旨在评估在多排螺旋计算机断层扫描（MDCT）引导下，对因存在重叠骨质结构、大血管或胸膜裂而仅依靠原始轴位图像难以引导穿刺的肺部病变进行经皮穿刺活检时，多平面重组（MPR）的作用。
使用每旋转同时采集6层图像的螺旋MDCT扫描仪，对84例疑似肺部肿瘤患者（55例男性，29例女性；平均年龄65岁）进行MDCT引导下经胸针吸活检（TNB）。我们在原始轴位图像以及冠状或矢状MPR图像上确定22G千叶针的进针点。我们注意确保针道最短，且不经过大血管、主支气管、胸膜裂或骨质结构；尽可能垂直于胸膜平面进入肺实质；并对病变内非钙化组织的高衰减区域进行取样。
96%的病例获得了诊断性样本。73例患者的病变表现为直径<2 cm的实性非钙化结节；11例为肿块样病变。22例患者因存在重叠肋骨（18例）、裂（2例）或肺门纵隔位置（2例），活检需要MPR引导。
MDCT的MPR图像能够对肺部病变进行取样，这些病变以往因存在重叠骨质结构（肋骨、胸骨和肩胛骨）或关键位置（肺门纵隔、靠近心脏或大血管），在轴位MDCT引导下被认为无法取样。与传统方法相比，使用MPR图像不会增加气胸发生率或操作时间。
