开放式MR引导下经皮胰腺占位性病变粗针穿刺活检的临床应用

Clinical application of open-type MR-guided percutaneous coaxial cutting needle biopsy in diagnosing pancreatic space-occupying lesions

目的探讨光学导航辅助0.4T开放式MR引导下胰腺占位性病变经皮粗针穿刺活检的安全性和有效性。方法回顾性分析2019年1月至2021年1月116例行胰腺穿刺活检患者的临床资料。术前增强CT或MRI评估,根据术前是否行PET-CT检查分为2组,行PET-CT检查组56例,未行PETCT检查组60例。0.4T开放式磁共振成像仪结合光学导航仪系统,采用17 G同轴穿刺针和18 G全自动活检枪行胰腺肿瘤穿刺活检术。术后送病理检查,记录腹痛、出血等并发症,通过手术或临床随访至少6个月确定最终诊断。结果所有病例准确穿刺至拟定靶点,一次成功率为100%,准确率为96.6%。3例发生穿刺后腹痛,2例出现腹腔出血,并发症发生率为4.2%。术前有PET-CT组的准确率和并发症率分别为98.3%和3.4%,无PET-CT组准确率和并发症率分别为94.6%和5.0%(P>0.05)。结论磁共振导航引导下胰腺占位性病变粗针穿刺活检术准确、安全,是一项值得推广的临床技术。

Objective To assess the safety and efficacy of optical navigation assisted 0.4-T open-type MR-guided percutaneous coaxial cutting needle biopsy in diagnosing pancreatic space-occupying lesions.Methods The clinical data of 116 patients,who received pancreatic puncture biopsy between January 2019and January 2021,were retrospectively analyzed.Preoperative enhanced CT or MRI to evaluate the lesions was performed in all patients,and based on whether a preoperative PET-CT examination was adopted or not the patients were divided into PET-CT group(n=56)and non-PET-CT group(n=60).0.4-T open-type MRI scanning was performed,with the help of optical navigation the percutaneous pancreatic mass biopsy by using 17G coaxial puncture needle and 18G automatic biopsy gun was carried out.The tissues obtained from the biopsy were send for pathological examination.The complications such as abdominal pain,bleeding,etc.were recorded,and the final diagnosis was confirmed by surgery or by clinical follow-up for at least 6 months.Results Accurate puncture of the scheduled target point was achieved in all patients.The success rate with single procedure was 100%and the accuracy rate was 96.6%.Post-puncture abdominal pain occurred in 3patients and abdominal cavity bleeding in 2 patients.The incidence of complications was 4.2%.The accuracy rate and complication incidence in the PET-CT group were 98.3%and 3.4%respectively,which in the nonPET-CT group were 94.6%and 5%respectively,the differences between the two groups were not statistically significant(P>0.05).Conclusions For diagnosing pancreatic space-occupying lesions,optical navigation assisted 0.4-T open-type MR-guided percutaneous coaxial cutting needle biopsy is accurate and safe.Therefore,it is a technology worthy of promotion in clinical practice.(J Intervent Radiol,2022,31:1065-1068)