Sainani Nisha I, Schlett Christopher L, Hahn Peter F, Gervais Debra A, Mueller Peter R, Arellano Ronald S
Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA,
Abdom Imaging. 2014 Jun;39(3):633-44. doi: 10.1007/s00261-014-0089-x.
The purpose of this study was to evaluate the efficacy of CT-guided percutaneous biopsy of isoattenuating liver lesions using anatomic landmarks (ALs) to guide needle placement and added value of intravenous (IV) contrast.
An interventional radiology database was reviewed to identify patients with CT-guided percutaneous biopsy of isoattenuating focal liver lesions using ALs to guide needle placement. The cohort was further divided into two groups: lesions biopsied using ALs only and lesions biopsied using ALs and intravenous contrast (AL+IV). Pathology results or follow-up imaging served as reference standard. Sensitivity and accuracy were calculated, Student's t test and Fisher's exact test were used for statistical comparison between the two groups.
Between January 2000 and December 2011, CT-guided percutaneous biopsy of 133 isoattenuating focal liver lesions was performed in 133 patients. The AL group included 54 patients (M:F = 29:25) with 54 lesions (size range 7-90 mm, mean 32.1 ± 18.1) and AL+IV group included 79 patients (M:F = 44:35) with 79 lesions (size range 7-100 mm, mean 25.6 ± 15.0). AL group included 23 (43%) benign and 31 (57%) malignant lesions; AL+IV group included 31 (39%) benign and 48 (61%) malignant lesions. Sensitivity and accuracy for CT-guided biopsy of focal isoattenuating liver lesions were, overall 94% and 96%, AL group 97% and 98% and AL+IV group 92% and 94%, with no statistical significant difference between the AL and AL+IV groups (P = 0.88-1.00).
Accurate planning and utilizing of internal reference ALs is successful in yielding a diagnostic sample for CT-guided percutaneous biopsy of isoattenuating focal liver lesion. The confidence of accurate targeting can be enhanced by administering IV contrast, however, since the visualization provided by IV contrast can be short-lived; use of IV contrast does not obviate the need for precise planning based on ALs.
本研究旨在评估在CT引导下利用解剖标志（ALs）引导针穿刺对等密度肝病变进行经皮活检的有效性以及静脉注射（IV）造影剂的附加价值。
回顾介入放射学数据库，以确定在CT引导下利用ALs引导针穿刺对等密度局灶性肝病变进行经皮活检的患者。该队列进一步分为两组：仅使用ALs进行活检的病变组和使用ALs及静脉造影剂进行活检的病变组（AL+IV）。病理结果或随访影像作为参考标准。计算敏感性和准确性，采用学生t检验和Fisher精确检验对两组进行统计学比较。
2000年1月至2011年12月期间，对133例患者的133个等密度局灶性肝病变进行了CT引导下经皮活检。AL组包括54例患者（男：女=29：25），有54个病变（大小范围7-90mm，平均32.1±18.1）；AL+IV组包括79例患者（男：女=44：35），有79个病变（大小范围7-100mm，平均25.6±15.0）。AL组包括23个（43%）良性病变和31个（57%）恶性病变；AL+IV组包括31个（39%）良性病变和48个（61%）恶性病变。CT引导下对等密度局灶性肝病变进行活检的总体敏感性和准确性分别为94%和96%，AL组为97%和98%，AL+IV组为92%和94%，AL组和AL+IV组之间无统计学显著差异（P=0.88-1.00）。
准确规划和利用内部参考ALs成功地为CT引导下经皮穿刺活检等密度局灶性肝病变获取了诊断样本。静脉注射造影剂可增强准确靶向的信心，然而，由于静脉注射造影剂提供的可视化可能是短暂的；使用静脉注射造影剂并不能消除基于ALs进行精确规划的必要性。
