开放式MR引导肺周围型病变穿刺活检的应用价值及并发症相关因素分析

Application value of 1.0T open MR-guided percutaneous peri-pulmonary lesion biopsy and analysis of complications related factors from 405 cases

目的探讨1.0T开放式MR引导下肺周围型病变穿刺活检术的诊断准确性、安全性及并发症相关因素。方法回顾性分析我科所行MR引导下405例肺周围型病变穿刺活检术,应用Fisher’s精确检验比较直径不同的两组(≤2cm和>2cm)病例的诊断准确率。计算气胸、咯血、血胸等并发症发生率,并分析各种并发症的相关因素。结果 MR引导经皮肺周围型病变穿刺活检在诊断恶性肿瘤的准确性、特异性和敏感性分别为96.30%、100%、95.13%。≤2cm(n=178)及>2cm(n=227)病灶的诊断准确性、特异性和敏感性分别为95.51%、100%、92.92%及96.92%、100%、96.17%。平均穿刺时间为(25±7)min(范围17~40min)。穿刺活检相关的并发症:气胸发生率为7.6%;肺内出血的发生率为23%,咯血为4.7%,血胸为0.2%,无其他严重并发症的发生。肺实质内较长穿刺路径(≥4cm)的患者气胸率显著增高,病灶大小≤2cm及穿刺路径≥4cm的患者肺内出血率显著增高。结论 1.0T开放式MR引导下经皮肺周围型病变穿刺活检术是一种准确、安全的诊断技术,肺实质内较长穿刺路径(≥4cm)是术后气胸及肺内出血的主要相关因素,病灶直径较小(≤2cm)是肺内出血的相关因素。

Objective To retrospectively evaluate the feasibility, safety and accuracy of 1. 0 T open magnetic resonance ima-ging （ MRI）-guided percutaneous cutting needle biopsy of peripheral pulmonary lesions. Methods We retrospectively analyzed 405 cases underwent MR-guided percutaneous biopsy of peripheral pulmonary lesions in our department. Using Fisher＇s exact test, we compared the diagnostic accuracy of two different groups （≤2 cm and 〉2 cm） in different diameters, calculated the incidence of complications such as pneumothorax, hemoptysis, hemothorax, and analyzed the related factors of various complications. Re-sults The accuracy, specificity and sensitivity of MR guided percutaneous percutaneous biopsy in the diagnosis of malignant tumors were 96. 30%, 100% and 95. 13%, respectively. The diagnostic accuracy, specificity and sensitivity of the lesions were 95. 51%, 100%, 92. 92% and 96. 92%, 100% and 96. 17% respectively in the two groups. There was no statistically signifi-cant difference （ P 〉0. 05）. The average puncture time was （25 ± 7） minutes （range 17~40 minutes）. MR-guided percutane-ous lung biopsy-related complications：the incidence of pneumothorax was 7. 6%, closed thoracic drainage was 1. 5%; the inci-dence of intra-pulmonary hemorrhage was 23%, hemoptysis was 4. 7%, blood chest was 0. 2%, no other serious complications occurred. Long pulmonary parenchymal puncture path （≥4 cm） was the related risk factor of pneumothorax, and small lesion size （≤2 cm） and long puncture path （≥4 cm） were the related risk factors of pulmonary hemorrhage. Conclusion 1. 0 T open MR-guided percutaneous biopsy is an accurate and safe diagnostic technique for the diagnosis of peripheral pulmonary le-sions. Long puncture path is the related risk factor of pneumothorax, and small lesion size and long puncture path are the related risk factors of pulmonary hemorrhage and hemoptysis.