Abi-Jaoudeh Nadine, Fisher Teresa, Jacobus John, Skopec Marlene, Radaelli Alessandro, Van Der Bom Imramsjah Martijn, Wesley Robert, Wood Bradford J
Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland.
Division of Radiation Safety, Office of Research Services, National Institutes of Health, Bethesda, Maryland.
J Vasc Interv Radiol. 2016 Sep;27(9):1342-1349. doi: 10.1016/j.jvir.2016.05.034. Epub 2016 Jul 25.
To compare cone-beam computed tomography (CT) navigation vs conventional CT image guidance during biopsies.
Patients scheduled for image-guided biopsies were prospectively and randomly assigned to conventional CT guidance vs cone-beam CT navigation. Radiation dose, accuracy of final needle position, rate of histopathologic diagnosis, and number of needle repositions to reach the target (defined as pullback to adjust position) were compared.
A total of 58 patients (mean age, 57 y; 62.1% men) were randomized: 29 patients underwent 33 biopsies with CT guidance and 29 patients with 33 lesions underwent biopsy with cone-beam CT navigation. The average body mass index (BMI) was similar between groups, at 28.8 kg/m(2) ± 6.55 (P = .18). There was no difference between groups in terms of patient and lesion characteristics (eg, size, depth). The average lesion size was 29.1 ± 12.7mm for CT group vs 32.1mm ±16.8mm for cone-beam CT group (P < 0.59). Location of lesions was equally divided between the 2 groups, 20 lung lesions, 18 renal lesions and 20 other abdominal lesions. Mean number of needle repositions in the cone-beam CT group was 0.3 ± 0.5, compared with 1.9 ± 2.3 with conventional CT (P < .001). The average skin entry dose was 29% lower with cone-beam CT than with conventional CT (P < .04 accounting for BMI). The average estimated effective dose for the planning scan from phantom data was 49% lower with cone-beam CT vs conventional CT (P = .018). Accuracy, defined as the difference between planned and final needle positions, was 4.9 mm ± 4.1 for the cone-beam CT group, compared with 12.2 mm ± 8.1 for conventional CT (P < .001). Histopathologic diagnosis rates were similar between groups, at 90.9% for conventional CT and 93.9% for cone-beam CT (P = .67).
Cone-beam CT navigation for biopsies improved targeting accuracy with fewer needle repositions, lower skin entry dose, and lower effective dose for planning scan, and a comparable histopathologic diagnosis rate.
比较锥形束计算机断层扫描（CT）导航与传统CT图像引导在活检过程中的应用。
将计划进行图像引导活检的患者前瞻性随机分为传统CT引导组和锥形束CT导航组。比较辐射剂量、最终针位置的准确性、组织病理学诊断率以及到达目标所需的针重新定位次数（定义为回拉以调整位置）。
共58例患者（平均年龄57岁；男性占62.1%）被随机分组：29例患者在CT引导下进行了33次活检，29例有33个病灶的患者接受了锥形束CT导航活检。两组间平均体重指数（BMI）相似，为28.8kg/m²±6.55（P = 0.18）。患者和病灶特征（如大小、深度）在两组间无差异。CT组平均病灶大小为29.1±12.7mm，锥形束CT组为32.1mm±16.8mm（P < 0.59）。病灶位置在两组间平均分布，20个肺部病灶、18个肾脏病灶和20个其他腹部病灶。锥形束CT组平均针重新定位次数为0.3±0.5次，传统CT组为1.9±2.3次（P < 0.001）。锥形束CT的平均皮肤入口剂量比传统CT低29%（考虑BMI后P < 0.04）。根据体模数据，锥形束CT计划扫描的平均估计有效剂量比传统CT低49%（P = 0.018）。定义为计划针位置与最终针位置差值的准确性，锥形束CT组为4.9mm±4.1，传统CT组为12.2mm±8.1（P < 0.001）。两组间组织病理学诊断率相似，传统CT组为90.9%，锥形束CT组为93.9%（P = 0.67）。
锥形束CT导航活检提高了靶向准确性，减少了针重新定位次数，降低了皮肤入口剂量和计划扫描的有效剂量，且组织病理学诊断率相当。
