Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
Skeletal Radiol. 2023 Jun;52(6):1119-1126. doi: 10.1007/s00256-022-04226-y. Epub 2022 Nov 10.
Image-guided percutaneous needle biopsies are essential in the workup of musculoskeletal (MSK) lesions. While helical CT (HCT) is well established, intermittent CT fluoroscopy (iCTF) is an increasingly used alternative. The purpose of this study is to establish whether differences in subject radiation exposure, procedure time, yield, or adverse events exist between HCT and iCTF guidance.
This retrospective cohort study included consecutive MSK needle biopsies performed on a single-CT scanner over a 12-month period at a tertiary academic center. Subject demographics, radiation dose, and outcomes were abstracted from the medical record. Comparisons between the two cohorts were performed using Student's t-test for continuous data and using Fisher's exact test for categorical data and a two-tailed p value less than 0.05 was considered significant.
Two hundred sixteen adults (115 (53.2%) females) with a mean age of 58.8 ± 18.4 years, underwent 216 biopsies (109 (50.5%) HCT guided, 107 (49.5%) iCTF guided) between June 2017 and June 2018. Dose-length product (DLP) and volume CT dose index (CTDIvol) were significantly higher for the HCT cohort (HCT 698.9 ± 400.8 mGycm vs iCTF 312.8 ± 170.8 mGycm; p < 0.005 and HCT 19.1 mGy ± 8.8 vs iCTF 6.9 mGy ± 1.5, p < 0.001). No significant difference in diagnostic yield, procedure time, or adverse event rate was identified.
For CT-guided MSK needle biopsies, iCTF decreases subject radiation dose compared to HCT without negatively affecting outcomes. iCTF should be strongly considered by radiologists performing MSK biopsies given the reduced patient radiation exposure.
在肌肉骨骼（MSK）病变的检查中，影像引导经皮穿刺活检至关重要。虽然螺旋 CT（HCT）已得到广泛应用，但间歇性 CT 透视（iCTF）是一种越来越常用的替代方法。本研究旨在确定 HCT 和 iCTF 引导下的患者放射暴露量、手术时间、产量或不良事件是否存在差异。
本回顾性队列研究纳入了在一家三级学术中心的单台 CT 扫描仪上进行的连续 MSK 穿刺活检，时间为 12 个月。从病历中提取患者人口统计学、辐射剂量和结果。使用学生 t 检验对连续数据进行比较，使用 Fisher 确切检验对分类数据进行比较，双侧 p 值<0.05 被认为具有统计学意义。
216 名成年人（115 名（53.2%）女性），平均年龄 58.8±18.4 岁，在 2017 年 6 月至 2018 年 6 月期间接受了 216 次活检（109 次（50.5%）HCT 引导，107 次（49.5%）iCTF 引导）。HCT 组的剂量长度乘积（DLP）和容积 CT 剂量指数（CTDIvol）明显高于 iCTF 组（HCT 698.9±400.8 mGycm 与 iCTF 312.8±170.8 mGycm；p<0.005 和 HCT 19.1 mGy±8.8 与 iCTF 6.9 mGy±1.5，p<0.001）。诊断产量、手术时间或不良事件发生率无显著差异。
对于 CT 引导的 MSK 穿刺活检，iCTF 与 HCT 相比可降低患者的放射剂量，而不会对结果产生负面影响。鉴于患者的放射暴露减少，放射科医生在进行 MSK 活检时应强烈考虑使用 iCTF。
