Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Skeletal Radiol. 2020 Feb;49(2):257-262. doi: 10.1007/s00256-019-03279-w. Epub 2019 Jul 20.
The purpose of this study is first to determine the clinical utility of the postprocedure scan in detecting postinterventional complications after CT-guided musculoskeletal biopsies, and second to evaluate the contribution to the radiation dose of the postprocedural CT scan.
Retrospective analysis of 500 consecutive CT-guided musculoskeletal biopsies over an 18-month period from 29 March 2017 to 28 September 2018, where spiral postprocedure scans were obtained in every case. To assess the clinical utility of postinterventional CT scans, it was determined whether immediate post-procedural complications were detected on the postprocedural scans only or were also seen on the procedural images. To evaluate the relative radiation exposure of postprocedural scans, a ratio was obtained of the dose-length product (DLP) of the postprocedural scan compared with the total DLP of each case.
A total of 397 bone biopsies and 103 soft-tissue biopsies were performed in 471 patients. The immediate postprocedural complication rate was 0.4% (2 out of 500) in all procedures. Both complications were minor (small hematomas) and detected only on postinterventional CT scans. The average total DLP for the procedures was 383.5 mGycm. The average DLP of the postprocedural scan was 64.0 mGycm. The average radiation dose contribution of the postprocedural CT scans toward the total DLP was 17.4%.
Immediate postprocedural complications in CT-guided musculoskeletal interventions are rare. When complications do occur, they are usually minor. To substantially reduce radiation dose, postinterventional CT scans should not be performed routinely.
本研究的目的首先是确定 CT 引导下肌肉骨骼活检后，术后扫描在检测介入后并发症方面的临床实用性，其次是评估术后 CT 扫描对辐射剂量的贡献。
回顾性分析了 2017 年 3 月 29 日至 2018 年 9 月 28 日期间连续 500 例 CT 引导下肌肉骨骼活检，其中在每种情况下均获得螺旋术后扫描。为评估术后 CT 扫描的临床实用性，确定术后扫描是否仅检测到即刻介入后并发症，还是也在程序图像中观察到这些并发症。为评估术后扫描的相对辐射暴露，获得了术后扫描的剂量长度乘积（DLP）与每个病例的总 DLP 的比值。
在 471 名患者中进行了 397 例骨活检和 103 例软组织活检。所有手术的即时术后并发症发生率为 0.4%（500 例中有 2 例）。两种并发症均为轻微（小血肿），仅在介入后 CT 扫描中检测到。手术的平均总 DLP 为 383.5 mGycm。术后扫描的平均 DLP 为 64.0 mGycm。术后 CT 扫描对总 DLP 的平均辐射剂量贡献为 17.4%。
CT 引导下肌肉骨骼介入术后的即刻并发症罕见。当并发症确实发生时，它们通常是轻微的。为了显著降低辐射剂量，不应常规进行术后 CT 扫描。
