REGULAR CONTENT
Final ID
613
Type
Educational Exhibit-Poster Only
Authors
A DeFoe1, D Slater1, J McBride2, A Heckman2, T Donovan1, C Vargo2
Institutions
1University of Nebraska Medical Center, Omaha, NE, 2N/A, Omaha, NE
Purpose
1. Identify techniques for CT-guided biopsy to help avoid crossing critical structures.2. Identify techniques for CT-guided biopsy to help displace critical structures.3. Identify structures that can safely be traversed for percutaneous biopsy.4. Identify other useful techniques for successful CT-guided percutaneous biopsy.
Materials & Methods
Interventional radiologists are called on to biopsy myriad lesions throughout the body. While many biopsies are straightforward with image guidance, some lesions pose a greater challenge. This may be due to intervening organs or blood vessels one does not which to cross. One may employ techniques for successful and safe CT-guided percutaneous biopsy of such lesions.
Results
Avoiding structures can be accomplished with patient positioning and changing the CT gantry angle. This can aid in vertebral body lesion biopsy by visualizing the pedicle in a single slice. Additionally, a craniocaudal gantry angle can delineate a safe path not seen on standard axial images. Patient positioning can also be used to accentuate the scan angle (1). For adrenal lesions, positioning the patient lesion side down compresses lung so that it need not be crossed (2).Hydrodissection is a useful technique to displace structures and create a safe path. This has been routinely used with thermal ablation to displace bowel (1,2). Additionally, hyrdodissection can aid in retrocrural lymph node or posterior mediastinal biopsy to avoid traversing lung. Bowel may also be displaced with use of a blunt cannula, or simply removing the sharp stylet.Certain structures in the way may be safely crossed. A transgastric route for pancreatic lesions is safe, as this route is often used for pancreatic pseduocyst drainage (3). The IVC can safely be crossed with a 19 G guide needle to obtain 20 G cores of retroperitoneal masses. Bowel may be safely crossed with 22G needles, though limiting this approach to fine needle aspiration (2,3). A transosseous approach can be used, including transsternal or transiliac (4).Especially mobile masses/lymph nodes can be 'fixed' in place with use of a second, smaller needle.
Conclusions
Multiple techniques exist to aid in successful CT-guided biopsy of difficult lesions.
Final ID
613
Type
Educational Exhibit-Poster Only
Authors
A DeFoe1, D Slater1, J McBride2, A Heckman2, T Donovan1, C Vargo2
Institutions
1University of Nebraska Medical Center, Omaha, NE, 2N/A, Omaha, NE
Purpose
1. Identify techniques for CT-guided biopsy to help avoid crossing critical structures.2. Identify techniques for CT-guided biopsy to help displace critical structures.3. Identify structures that can safely be traversed for percutaneous biopsy.4. Identify other useful techniques for successful CT-guided percutaneous biopsy.
Materials & Methods
Interventional radiologists are called on to biopsy myriad lesions throughout the body. While many biopsies are straightforward with image guidance, some lesions pose a greater challenge. This may be due to intervening organs or blood vessels one does not which to cross. One may employ techniques for successful and safe CT-guided percutaneous biopsy of such lesions.
Results
Avoiding structures can be accomplished with patient positioning and changing the CT gantry angle. This can aid in vertebral body lesion biopsy by visualizing the pedicle in a single slice. Additionally, a craniocaudal gantry angle can delineate a safe path not seen on standard axial images. Patient positioning can also be used to accentuate the scan angle (1). For adrenal lesions, positioning the patient lesion side down compresses lung so that it need not be crossed (2).Hydrodissection is a useful technique to displace structures and create a safe path. This has been routinely used with thermal ablation to displace bowel (1,2). Additionally, hyrdodissection can aid in retrocrural lymph node or posterior mediastinal biopsy to avoid traversing lung. Bowel may also be displaced with use of a blunt cannula, or simply removing the sharp stylet.Certain structures in the way may be safely crossed. A transgastric route for pancreatic lesions is safe, as this route is often used for pancreatic pseduocyst drainage (3). The IVC can safely be crossed with a 19 G guide needle to obtain 20 G cores of retroperitoneal masses. Bowel may be safely crossed with 22G needles, though limiting this approach to fine needle aspiration (2,3). A transosseous approach can be used, including transsternal or transiliac (4).Especially mobile masses/lymph nodes can be 'fixed' in place with use of a second, smaller needle.
Conclusions
Multiple techniques exist to aid in successful CT-guided biopsy of difficult lesions.