Department of Internal Medicine - Division of Radiology, King Khalid University, 7887 Alfara street, Abha 62529, Saudi Arabia; Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States of America.
Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States of America.
Clin Imaging. 2024 Sep;113:110236. doi: 10.1016/j.clinimag.2024.110236. Epub 2024 Jul 20.
To compare the indications, specimen quality, and cost of CT versus non-image guided bone marrow aspirate and biopsy (BMAB).
All CT and non-image guided BMAB performed from January 2013-July 2022 were studied. Body-mass-index (BMI), skin-to-bone distance, aspirate, and core specimen quality, and core sample length were documented. Indications for CT guided BMAB were recorded. Categorical variables were compared using chi-squared test and continuous variables using Mann-Whitney test. Analysis of per-biopsy factors used linear mixed-effect models to adjust for clustering. Cost of CT and non-image guided BMAB was taken from patient billing data.
There were 301 CT and 6535 non-image guided BMABs studied. All CT guided BMAB were studied. A subset of 317 non-image guided BMAB was selected randomly from the top ten CT BMAB referrers. BMI (kg/m) and skin-to-bone distance (cm) was higher in the CT versus the non-image guided group; 34.4 v 26.8, p < 0.0001; 4.8 v 2.5, p < 0.0001, respectively. Aspirate and core sample quality were not different between groups, p = 0.21 and p = 0.12, respectively. CT guided core marrow samples were longer, p < 0.0001. The most common CT BMAB referral indications were large body habitus (47.7 %), failed attempt (18.8 %) and not stated (17.4 %). Cost of a CT guided BMAB with conscious sedation was $3945 USD versus $310 USD for non-image guided.
CT guided BMAB are commonly performed in patients with large body habitus and failed attempt. However, the cost is 12.7 fold higher with no increase in specimen quality. These findings can help referrers be cost conscious.
比较 CT 引导与非影像引导骨髓抽吸和活检（BMAB）的适应证、标本质量和成本。
研究了 2013 年 1 月至 2022 年 7 月期间进行的所有 CT 和非影像引导 BMAB。记录了体重指数（BMI）、皮肤到骨骼的距离、抽吸和核心标本质量以及核心样本长度。记录了 CT 引导 BMAB 的适应证。使用卡方检验比较分类变量，使用曼-惠特尼检验比较连续变量。使用线性混合效应模型分析每例活检的因素，以调整聚类。CT 和非影像引导 BMAB 的成本来自患者计费数据。
共研究了 301 例 CT 引导和 6535 例非影像引导 BMAB。所有 CT 引导 BMAB 均进行了研究。从前 10 位 CT BMAB 推荐者中随机选择了非影像引导 BMAB 的一个子集，共 317 例。CT 组与非影像引导组的 BMI（kg/m）和皮肤到骨骼的距离（cm）更高，分别为 34.4 v 26.8，p<0.0001；4.8 v 2.5，p<0.0001。两组间抽吸和核心标本质量无差异，p=0.21 和 p=0.12。CT 引导的骨髓核心样本更长，p<0.0001。最常见的 CT BMAB 转诊指征为体型大（47.7%）、尝试失败（18.8%）和未说明（17.4%）。有清醒镇静的 CT 引导 BMAB 费用为 3945 美元，而非影像引导的费用为 310 美元。
CT 引导 BMAB 常用于体型大且尝试失败的患者。然而，成本增加了 12.7 倍，标本质量却没有提高。这些发现可以帮助转诊医生更具成本意识。
