REGULAR CONTENT
Final ID
615
Type
Educational Exhibit-Poster Only
Authors
S Sundararajan1, M Oselkin1, B Pukenas1
Institutions
1Hospital of the University of Pennsylvania, Philadelphia, PA
Purpose
Image-guided calvarial biopsy is challenging. Notable risks include traversing meninges, brain injury, infection, and hemorrhage (1). CT can be used to characterize osseous matrix, detect cortical erosions, and plan biopsy tracks (2). Core biopsy and FNA are often employed in visceral and bone sampling (3,4). Drill systems have been used for osseous biopsy, though their implementation in the calvarium is infrequent (1). We reviewed our experience with CT-guided techniques and devices employed during calvarial biopsies performed at our institution.
Materials & Methods
Retrospective review from 2012 to 2016 of 10 patients was performed under IRB approval. 3 techniques used: biplane fluoroscopy with cone-beam CT (1 patient), CT-fluoroscopy with pre- and post-biopsy CT (6 patients), and dose-conscientious CT-fluoroscopy with pre-biopsy CT exclusion (3 patients). 7 cases conducted with needle/spring-loaded co-axial technique (18-20G needle/spring loaded core & 22G FNA). 3 cases performed with drill systems (14G Bonopty® & 11G OnControl®). Bilateral frontal-parietal and non-skull base temporal-occipital surfaces sampled. Lesions ranged in size, with erosion of the entire calvarium, isolated outer/inner table mass, or focal diploic lysis/sclerosis.
Results
Dose from fluoroscopic biopsy measured >1Gy due to cone-beam CT confirmation of needle position and sampling under fluoroscopy. CT-biopsies with high-gauge co-axial and drill-based systems provided comparable operator comfort and device stability. 1 pass with drill-based systems was sufficient for histologic and molecular diagnosis. Average 2-4 passes with higher-gauge co-axial systems needed for cytometry, with histologic diagnosis insufficient in 2 of 6 patients. Elimination of pre-planning CT and adjusting kV/mA produced an average DLP decrease from 300 to 30 mGy-cm. No procedural complications.
Conclusions
Calvarial biopsy with the Bonopty® & OnControl® is safe and feasible. These drill systems reliably provide diagnostic quality specimens with 1 time biopsy, thereby minimizing risks from repetitive calvarial sampling. Elimination of pre-biopsy CT and modifying side table dose parameters further contributes up to a 10-fold reduction in radiation exposure.
Final ID
615
Type
Educational Exhibit-Poster Only
Authors
S Sundararajan1, M Oselkin1, B Pukenas1
Institutions
1Hospital of the University of Pennsylvania, Philadelphia, PA
Purpose
Image-guided calvarial biopsy is challenging. Notable risks include traversing meninges, brain injury, infection, and hemorrhage (1). CT can be used to characterize osseous matrix, detect cortical erosions, and plan biopsy tracks (2). Core biopsy and FNA are often employed in visceral and bone sampling (3,4). Drill systems have been used for osseous biopsy, though their implementation in the calvarium is infrequent (1). We reviewed our experience with CT-guided techniques and devices employed during calvarial biopsies performed at our institution.
Materials & Methods
Retrospective review from 2012 to 2016 of 10 patients was performed under IRB approval. 3 techniques used: biplane fluoroscopy with cone-beam CT (1 patient), CT-fluoroscopy with pre- and post-biopsy CT (6 patients), and dose-conscientious CT-fluoroscopy with pre-biopsy CT exclusion (3 patients). 7 cases conducted with needle/spring-loaded co-axial technique (18-20G needle/spring loaded core & 22G FNA). 3 cases performed with drill systems (14G Bonopty® & 11G OnControl®). Bilateral frontal-parietal and non-skull base temporal-occipital surfaces sampled. Lesions ranged in size, with erosion of the entire calvarium, isolated outer/inner table mass, or focal diploic lysis/sclerosis.
Results
Dose from fluoroscopic biopsy measured >1Gy due to cone-beam CT confirmation of needle position and sampling under fluoroscopy. CT-biopsies with high-gauge co-axial and drill-based systems provided comparable operator comfort and device stability. 1 pass with drill-based systems was sufficient for histologic and molecular diagnosis. Average 2-4 passes with higher-gauge co-axial systems needed for cytometry, with histologic diagnosis insufficient in 2 of 6 patients. Elimination of pre-planning CT and adjusting kV/mA produced an average DLP decrease from 300 to 30 mGy-cm. No procedural complications.
Conclusions
Calvarial biopsy with the Bonopty® & OnControl® is safe and feasible. These drill systems reliably provide diagnostic quality specimens with 1 time biopsy, thereby minimizing risks from repetitive calvarial sampling. Elimination of pre-biopsy CT and modifying side table dose parameters further contributes up to a 10-fold reduction in radiation exposure.