Zlevor Annie M, Kisting Meridith A, Couillard Allison B, Rossebo Annika E, Szczykutowicz Timothy P, Mao Lu, White James K, Hartung Michael P, Gettle Lori Mankowski, Hinshaw J Louis, Pickhardt Perry J, Ziemlewicz Timothy J, Foltz Marcia L, Lee Fred T
Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin.
Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
J Vasc Interv Radiol. 2023 May;34(5):910-918. doi: 10.1016/j.jvir.2023.01.024. Epub 2023 Feb 1.
To compare electromagnetic navigation (EMN) with computed tomography (CT) fluoroscopy for guiding percutaneous biopsies in the abdomen and pelvis.
A retrospective matched-cohort design was used to compare biopsies in the abdomen and pelvis performed with EMN (consecutive cases, n = 50; CT-Navigation; Imactis, Saint-Martin-d'Hères, France) with those performed with CT fluoroscopy (n = 100). Cases were matched 1:2 (EMN:CT fluoroscopy) for target organ and lesion size (±10 mm).
The population was well-matched (age, 65 vs 65 years; target size, 2.0 vs 2.1 cm; skin-to-target distance, 11.4 vs 10.7 cm; P > .05, EMN vs CT fluoroscopy, respectively). Technical success (98% vs 100%), diagnostic yield (98% vs 95%), adverse events (2% vs 5%), and procedure time (33 minutes vs 31 minutes) were not statistically different (P > .05). Operator radiation dose was less with EMN than with CT fluoroscopy (0.04 vs 1.2 μGy; P < .001), but patient dose was greater (30.1 vs 9.6 mSv; P < .001) owing to more helical scans during EMN guidance (3.9 vs 2.1; P < .001). CT fluoroscopy was performed with a mean of 29.7 tap scans per case. In 3 (3%) cases, CT fluoroscopy was performed with gantry tilt, and the mean angle out of plane for EMN cases was 13.4°.
Percutaneous biopsies guided by EMN and CT fluoroscopy were closely matched for technical success, diagnostic yield, procedure time, and adverse events in a matched cohort of patients. EMN cases were more likely to be performed outside of the gantry plane. Radiation dose to the operator was higher with CT fluoroscopy, and patient radiation dose was higher with EMN. Further study with a wider array of procedures and anatomic locations is warranted.
比较电磁导航（EMN）与计算机断层扫描（CT）透视引导腹部和盆腔经皮活检的效果。
采用回顾性匹配队列设计，比较使用EMN（连续病例，n = 50；CT导航；Imactis，法国圣马丁德埃雷）进行的腹部和盆腔活检与使用CT透视（n = 100）进行的活检。病例按目标器官和病变大小（±10 mm）1:2（EMN:CT透视）进行匹配。
两组人群匹配良好（年龄，65岁对65岁；目标大小，2.0 cm对2.1 cm；皮肤到目标距离，11.4 cm对10.7 cm；P >.05，分别为EMN组与CT透视组）。技术成功率（98%对100%）、诊断率（98%对95%）、不良事件（2%对5%）和操作时间（33分钟对31分钟）无统计学差异（P >.05）。EMN组术者辐射剂量低于CT透视组（0.04对1.2 μGy；P <.001），但由于EMN引导期间螺旋扫描更多（3.9次对2.1次；P <.001），患者剂量更高（30.1对9.6 mSv；P <.001）。CT透视平均每例进行29.7次轻拍扫描。3例（3%）CT透视检查采用了机架倾斜，EMN组病例的平均平面外角度为13.4°。
在匹配的患者队列中，EMN和CT透视引导的经皮活检在技术成功率、诊断率、操作时间和不良事件方面密切匹配。EMN病例更有可能在机架平面外进行。CT透视对术者的辐射剂量更高，而EMN对患者的辐射剂量更高。有必要对更广泛的手术和解剖部位进行进一步研究。
