Magnetic resonance imaging-guided percutaneous biopsy of musculoskeletal lesions
Magnetic resonance imaging-guided percutaneous biopsy of musculoskeletal lesions
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DOI：
10.2106/jbjs.f.01230
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发表时间：
2007-10-01
影响因子：
5.3
通讯作者：
Winalski, Carl S.
中科院分区：
文献类型：
--
作者：
Carrino, John A.;Khurana, Bharti;Winalski, Carl S.
背景：磁共振成像通常可以很好地显示骨、软组织和关节病变。我们的目标是评估磁共振成像引导的活检对选定的肌肉骨骼病变的诊断性能。方法：在这个回顾性病例系列中，在具有实时引导系统的开放式中场 0.5-T 介入磁共振成像设备中进行了 45 次连续活检。在二十个骨头、十八个关节外软组织和七个关节内软组织部位进行活组织检查。使用磁共振成像引导的主要原因是与其他成像方式相比需要提高病灶的显见性、需要在病灶内进行特定部位的定位以及需要实时引导。通过细针抽吸、空心针活检或这些技术的组合来获取样本。使用独立的参考标准来确认最终诊断。诊断性能根据诊断率（活检产生足够的病理评估材料的比例）和诊断准确性（敏感性、特异性、阳性预测值和阴性预测值）进行评估。还确定了并发症。 结果：总体诊断率为 91%（45 次活检中的 41 次获得了足够的诊断材料），骨病变为 95%（20 次中的 19 次），关节外软组织病变为 94%（18 次中的 17 次），关节内软组织病变为 71%（7 次中的 5 次）。就诊断准确性而言，整个组的敏感性为0.86，特异性为1.00，阳性预测值为1.00，阴性预测值为0.76。骨病变的值分别为0.92、1.00、1.00和0.86；关节外软组织病变为0.77、1.00、1.00和0.57；关节内软组织病变为1.00、1.00、1.00、1.00。有一个并发症：与周围神经鞘肿瘤活检相关的神经性疼痛加剧。结论：磁共振成像引导下的经皮肌肉骨骼病变活检对于其他成像方式可能不足的情况总体上具有良好的诊断性能。对于骨病变，该性能非常好，对于关节外软组织病变，性能中等，对于关节内软组织病变，性能一般。证据级别：诊断级别 II。有关证据级别的完整描述，请参阅作者须知。
Background: Bone, soft-tissue, and articular lesions are often well visualized by magnetic resonance imaging. Our goal was to evaluate the diagnostic performance of magnetic resonance imaging-guided biopsies of selected musculoskeletal lesions.Methods: In this retrospective case series, forty-five consecutive biopsies were performed in an open mid-field 0.5-T interventional magnetic resonance imaging unit with a real-time guidance system. The biopsies were performed at twenty bone, eighteen extra-articular soft-tissue, and seven intra-articular soft-tissue sites. The main reasons for using magnetic resonance imaging guidance were the need to improve lesion conspicuity compared with that provided by other imaging modalities, the need for site-specific targeting within the lesion, and the need for real-time guidance. Samples were obtained with fine-needle aspiration, core-needle biopsy, or a combination of these techniques. An independent reference standard was used to confirm the final diagnosis. Diagnostic performance was evaluated on the basis of the diagnostic yield (the proportion of biopsies yielding sufficient material for pathological evaluation) and diagnostic accuracy (sensitivity, specificity, positive predictive value, and negative predictive value). Complications were identified as well.Results: The diagnostic yield was 91% (forty-one of forty-five biopsies yielded sufficient material for a diagnosis) overall, 95% (nineteen of twenty) for the bone lesions, 94% (seventeen of eighteen) for the extra-articular soft-tissue lesions, and 71% (five of seven) for the intra-articular soft-tissue lesions. With regard to the diagnostic accuracy, the sensitivity was 0.86, the specificity was 1.00, the positive predictive value was 1.00, and the negative predictive value was 0.76 in the overall group. The respective values were 0.92, 1.00, 1.00, and 0.86 for the bone lesions; 0.77, 1.00, 1.00, and 0.57 for the extra-articular soft-tissue lesions; and 1.00, 1.00, 1.00, and 1.00 for the intra-articular soft-tissue lesions. There was one complication: exacerbation of neuropathic pain related to a biopsy of a peripheral nerve sheath tumor.Conclusions: Magnetic resonance imaging-guided percutaneous biopsies of musculoskeletal lesions for which other imaging modalities might be inadequate have a good diagnostic performance overall. The performance can be very good for bone lesions, moderate for extra-articular soft-tissue lesions, and fair for intra-articular soft-tissue lesions.Level of Evidence: Diagnostic Level II. See Instructions to Authors for a complete description of levels of evidence.