0.23T开放式MRI结合光学导航引导头颈部病变穿刺活检临床应用价值

0.23T open MRI combined with i Path 200 optical navigation for guiding percutaneous puncture biopsy of cephalocervical lesions

目的评价采用0.23T开放式MRI结合ipath 200光学导航导引,经皮穿刺活检头颈部病变的有效性和安全性。方法回顾性分析77例接受0.23T开放式MRI结合ipath 200光学导航引导头颈部病变经皮穿刺活检的患者77例(男51例,女26例;平均年龄43岁)。平均病变直径为3 cm(范围1.0~7.8 cm)。病变定位采用快速自旋回波T2WI和或增强扫快速自旋回波T1WI;完全平衡稳态(CBASS 3D)序列快速采集头颈部区域高分辨率图像,并清晰显示穿刺针,用于持续性引导穿刺针至靶病变区。23例病变穿刺过程中静脉注射钆对比剂。病理组织学取样:Chiba细针抽吸19例,同轴活检枪组织切割58例。记录并评估穿刺技术成功率、诊断准确性、手术时间和并发症。结果全部77例患者,均获得足够量的组织样本用于病理学诊断分析,结果为41例恶性病变和36例良性病变。42例通过手术得到最终病理诊断结果;35例通过随后至少1年的影像学和临床随访证实了最终诊断。0.23T开放式MRI结合ipath 200光学导航引导头颈部病变活检的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为93.2%,100%,100%,91.7%和96%。手术时间为平均为29 min(15~47 min)。未观察到严重并发症。结论 0.23T开放式MRI结合光学导航引导头颈部病变穿刺活检可以帮助临床医师准确诊断头颈部肿块,安全有效。

Objective To evaluate the efficacy and safety of 0.23 T open MRI combined with i Path200 optical navigation in guiding percutaneous puncture biopsy of cephalocervical lesions. Methods The clinical data of 77 patients with cephalocervical lesions, who received percutaneous puncture biopsy under the guidance of 0.23 T open MRI combined with i Path 200 optical navigation were retrospectively analyzed.The patients included 51 males and 26 females, with an average age of 43 years. The average diameter of lesion was 3 cm(ranging from 1 cm to 7.8 cm). Fast spin echo T2 WI and enhanced scan fast spin echo T1 WI were used to locate the lesion. CBASS 3 D sequence was used to quickly collect high resolution images of cephalocervical region and to clearly display the puncture needle so as to continuously guide the puncture needle to reach the target lesion site. In 23 patients intravenous injection of gadolinium contrast agent was adopted during the process of puncturing. Pathological histology sampling was performed with Chiba fine needle aspiration(n=19) or coaxial biopsy gun tissue cutting(n=58). The technical success rate of puncture,the diagnostic accuracy, the time spent for procedure and the complications were recorded and evaluated.Results Sufficient amount of tissue samples for pathological examination were obtained in all 77 patients.Pathological diagnoses included 41 malignant lesions and 36 benign lesions. Among the 77 patients, the final diagnosis was obtained by surgical pathology in 42 and by over one year imaging and clinical follow-up evidence in 35. The sensitivity, specificity, positive predictive rate, negative predictive rate, and diagnostic accuracy of percutaneous puncture biopsy of cephalocervical lesions guided by 0.23 T open MRI combined with iPath 200 optical navigation were 93.2%, 100%, 100%, 91.7% and 96%, respectively. The mean time spent for procedure was 29 minutes(15-47 minutes). No serious complications occurred. Conclusion Percutaneous puncture biopsy guided by 0.23 T open MRI combined with iPath 200 optical navigation can help clinicians evaluate cephalocervical lesions with higher diagnostic accuracy. This technique is clinically safe and effective.