CT导引下经皮肌肉骨骼病变穿刺活检

CT-guided percutaneous biopsy of musculoskeletal lesions

目的探讨 CT 导引下经皮穿刺活检在肌肉骨骼病变诊断的价值,评估激光导引装置在肌肉骨骼病变 CT 穿刺活检中的作用。方法 165例 CT 引导下肌肉骨骼穿刺活检病例(其中36例使用 Pinpoint 激光引导系统),骨骼穿刺活检142例,软组织穿刺活检23例。149例有手术病理、切开活检病理或临床随访资料。结果 165例肌肉骨骼病变的穿刺活检总正确率为75.2%(124/165)。其中骨骼病变穿刺活检的正确率为73.2%(104/142),肌肉软组织病变穿刺活检的正确率为87.0%(20/23)。Pinpoint 激光导引下 CT 穿刺活检的诊断正确率为80.6%(29/36)。使用骨钻针穿刺诊断正确率73.8%(96/130),使用抽吸针穿刺诊断正确率80.0%(28/35)。大病灶(直径>3 cm)穿刺活检诊断正确率80.6%(79/98),小病灶(直径≤3 cm)穿刺活检诊断正确率67.2%(45/67),二者之间差异有统计学意义(P<0.05)。结论 CT 导引下经皮骨骼肌肉活检是一种安全、简便、有效的诊断和鉴别诊断方法。对大病灶的诊断正确率优于较小病灶,在小病灶中,使用 Pinpoint 激光导引装置有助于提高诊断正确率。

Objective To evaluate the clinical applications of CT-guided percutaneous fine needle aspiration biopsy of mnsculoskeletal lesions and the role of laser-guided device for CT biopsy in mnsculoskeletal lesions. Methods There were 165 cases with CT-guided percutaneous fine needle aspiration biopsy of musculoskeletal lesions including 142 cases of bone lesions and 23 cases of soft tissue lesions. 149 cases were proved pathologically by surgery, open biopsy or had clinical follow-up information. Results The accuracy of CT-guided fine needle aspiration biopsy was 75.2% （124/165）. The accuracy rates for bone and soft tissue biopsies were 73. 2% （104/142） and 87. 0% （20/23） respectively. The accuracy rate for laser-guided biopsy was 80.6% （ 29/36 ） . The biopsy accuracy rates were 73.8% （ 96/130 ） with Ackermann needle and 80. 0% （ 28/35 ） with fine needle aspiration （ FNA）. The accuracy rates for big lesions （diameter 〉 3 cm） and small lesions （ diameter ≤ 3 cm） were 80. 6% （79/98） and 67. 2% （45/67）, respectively （P 〈 0. 05）. Conclusion CT-guided percutaneons fine needle aspiration biopsy is a safe, simple and effective method for the diagnosis and differential diag^nosis of mnsculoskeletal lesions. The biopsy for the big lesion is superior to the small one. The diagnostic accuracy can be improved with laserguided CT biopsy for small lesions.