开放式MRI导航系统导引行肺病变穿刺活检137例

Open MRI navigation system guided needle biopsy of lung lesions： experience with 137 cases

目的 探讨MRI导引下肺穿刺活检术的可行性、准确性及其临床应用价值.方法 应用配备iPath 200光学追踪系统的低场开放式MR仪,对137例肺内结节或肿物患者行穿刺活检术,其中肺内孤立性结节或肿物103例,肺内多发病灶34例;病灶最大径≥3.5 cm的57例、1.5～3.4 cm的71例、≤1.4 cm的9例.结果 病灶最大径≥3.5 cm组、1.5～3.4 cm组、≤1.4 cm组及总的穿刺成功率分别为100.0%（57/57）、98.6%（70/71）、77.8%（7/9）、97.8%（134/137）;穿刺组织病理检查诊断恶性肿瘤98例,良性39例;MRI导引肺穿刺活检的敏感度为94.2%（98/104）,特异度为100.0%（33/33）,准确性为95.6%（131/137）,阳性预测值为100.0%（98/98）,阴性预测值为84.6%（33/39）.结论 开放式MRI导引肺穿刺活检术具有较高的安全性、准确性和有效性,值得在临床进一步推广和应用.

Objective To evaluate the feasibility, accuracy and its clinical value of MRI-guided needle biopsy of lung lesions. Methods A total of 137 patients with pulmonary nodules or masses underwent lung biopsy in low-field open MRI equipped with iPath 200 optical tracking systems. Among them, 103 cases had solitary pulmonary lesion; the other 34 cases had multiple foci. The maximum diameter of the lesion was not smaller than 3.5 cm （ ≥ 3.5 cm） in 57 patients, between 1.5 cm and 3.4 cm（ 1.5-3.4 cm） in 71 patients, not greater than 1.4 cm （ ≤ 1.4 cm） in 9 patients. Results The puncture success rate was 100.0% （57/57） for lesions ≥3.5 cm, 98.6% （70/71） for lesions 1.5-3.4 cm,77.8% （7/9） for lesions ≤1.4 cm and 97. 8% （134/137） for total cases, respectively. According to the pathological results, pulmonary lesions were malignant in 98 cases and benign in 39 cases. The sensitivity,specificity, accuracy, positive predictive value and negative predictive value of MRI-guided lung biopsy were 94.2%（98/104）, 100.0% （33/33）, 95.6% （131/137）, 100.0% （98/98） and 84.6% （33/39）,respectively. Conclusion MRI-guided needle biopsy of lung lesion can be performed precisely in a lowfield open MRI with a low risk of complications. As a supplement to US or CT-guided biopsy, it is worth further promotion and application.