From the Department of Radiology (A.T.), University of Southern California, Los Angeles, California
Mallinckrodt Institute of Radiology (T.J.H., J.W.J.), St. Louis, Missouri.
AJNR Am J Neuroradiol. 2019 Feb;40(2):309-312. doi: 10.3174/ajnr.A5949. Epub 2019 Jan 17.
Although percutaneous musculoskeletal biopsies are routinely performed in the axial and appendicular skeleton, there are no published data on the systematic evaluation of the feasibility, safety, and diagnostic accuracy of percutaneous skull biopsy. In certain clinical encounters such as patients with primary skull tumors or patients with known cancer and isolated skull lesions suspected of calvarial metastasis or synchronous primary tumor, percutaneous skull biopsy may be considered a viable option. The purpose of this study was to evaluate the feasibility, safety profile, and diagnostic yield of percutaneous CT-guided skull biopsy.
Percutaneous CT-guided skull biopsy was performed in 14 patients. Patient demographics, cancer history, indication for initial imaging, imaging technique of diagnosis, skull tumor anatomic location, and final histologic diagnosis were documented. Preprocedural imaging of each skull lesion was reviewed to determine tumor size and characteristics. Procedural notes were reviewed to determine the total conscious sedation time or anesthesia time, type of biopsy needle, and the number and length of obtained core specimens. Procedure-related complications were also documented according to the Society of Interventional Radiology classification.
All CT-guided percutaneous skull biopsy procedures were performed as preoperatively planned and were technically successful. Procedures were performed with the patient under conscious sedation in 93% (13/14) of cases. Definitive histologic diagnosis was achieved in 86% (12/14) of cases. There were no acute or delayed procedure-related complications.
The results of this retrospective initial study suggest that percutaneous CT-guided skull biopsy is feasible with an excellent safety profile, affords a high diagnostic yield for histologic characterization, and may obviate more invasive open skull biopsies.
虽然经皮肌肉骨骼活检在轴性和附肢骨骼中常规进行，但目前尚无关于经皮颅骨活检的可行性、安全性和诊断准确性的系统评估的发表数据。在某些临床情况下，如原发性颅骨肿瘤患者或已知患有癌症且孤立颅骨病变疑似颅骨转移或同步原发性肿瘤的患者，经皮颅骨活检可能是一种可行的选择。本研究旨在评估经皮 CT 引导颅骨活检的可行性、安全性和诊断率。
对 14 例患者进行了经皮 CT 引导颅骨活检。记录了患者的人口统计学资料、癌症史、初始影像学检查的指征、诊断的影像学技术、颅骨肿瘤的解剖位置和最终的组织学诊断。对每个颅骨病变的术前影像学进行评估，以确定肿瘤的大小和特征。回顾手术记录以确定总镇静时间或麻醉时间、活检针的类型以及获得的核心标本的数量和长度。根据介入放射学学会的分类，还记录了与手术相关的并发症。
所有 CT 引导下的经皮颅骨活检均按术前计划进行，并取得了技术上的成功。93%（13/14）的病例在患者清醒镇静下进行了手术。86%（12/14）的病例获得了明确的组织学诊断。无急性或迟发性与手术相关的并发症。
这项回顾性初步研究的结果表明，经皮 CT 引导颅骨活检是可行的，具有极好的安全性，对组织学特征具有较高的诊断率，并可能避免更具侵袭性的开放性颅骨活检。
