Department of Imaging, Hospital A C Camargo, São Paulo, Brazil.
Br J Radiol. 2012 Jul;85(1015):e339-42. doi: 10.1259/bjr/16118679. Epub 2011 Sep 21.
The adrenal glands are an important site of both primary and secondary disease processes. Image-guided percutaneous biopsy of the adrenal gland is an accurate and safe alternative to surgical biopsy. This procedure is most often performed in patients with a suspicion of metastatic disease where an accurate pathological diagnosis plays an important role in disease staging and defining therapy. There are many different approaches to performing adrenal biopsy under CT guidance such as anterior transhepatic/transpancreatic, lateral transhepatic/transplenic or posterior transpulmonary/transpleural/paravertebral. We describe a technique in which the adrenal gland was biopsied using a CT-guided percutaneous paravertebral approach with the use of a hydrodissection manoeuver. 13 CT-guided adrenal gland percutaneous biopsies using this technique were performed at our institution between April 2009 and July 2010. All biopsies yielded sufficient material for pathological analysis and there were no complications reported after the procedure. Saline injection can expand the posterior paravertebral space and facilitate a posterior extrapleural approach with high accuracy and low complication rates, and we believe that this may be the best approach for adrenal gland biopsy.
肾上腺是原发性和继发性疾病的重要部位。在影像引导下经皮穿刺活检肾上腺是一种安全有效的替代手术活检的方法。这种方法主要用于怀疑转移疾病的患者，因为准确的病理诊断对疾病分期和确定治疗方案非常重要。在 CT 引导下，有许多不同的方法可以进行肾上腺活检，如经肝/胰前入路、经肝/脾侧入路或经肺/胸膜后/椎旁入路。我们描述了一种使用 CT 引导下经皮椎旁入路和水分离技术进行肾上腺活检的技术。2009 年 4 月至 2010 年 7 月，我们机构共进行了 13 例 CT 引导下经皮肾上腺活检。所有活检均获得足够的病理分析材料，且术后无并发症报告。盐水注射可以扩大后椎旁间隙，以高精度和低并发症率进行后胸膜外入路，我们认为这可能是肾上腺活检的最佳方法。
