开放式磁共振导引胸腰椎体病变骨钻活检的应用价值  

The application value of open MRI guided bone drill biopsy of thoracic and lumbar spine

作　　者：朱统寅[1] 李成利[2] 柳明[2] 何祥萌[2] 黄杰[2] 于静[2] 

机构地区：[1]山东大学医学院山东省医学影像学研究所,山东济南250021 [2]山东大学山东省医学影像学研究所,山东济南250021

出　　处：《医学影像学杂志》2013年第2期305-309,共5页Journal of Medical Imaging

摘　　要：目的探讨0.23T开放式磁共振介入系统导引胸腰椎病变穿刺活检的可行性、安全性及准确性。方法利用0.23T开放式磁共振联合iPath 200光学导航系统经椎弓根入路对34例胸、腰椎椎体病变患者行经皮穿刺活检术,穿刺胸椎病变13例,腰椎病变21例。将经皮穿刺活检得到的病理结果与外科手术的病理和/或临床随访12个月以上的最终结果进行比较,计算磁共振导引经皮胸、腰椎体穿刺活检的准确率。结果所有患者均一次穿刺成功并取得足量标本,穿刺组织病理检查诊断为恶性病变18例,良性病变14例,性质不明的2例;外科手术病理及临床随访的最终结果为恶性病变20例,良性病变14例。开放式磁共振导引胸、腰椎体病变穿刺活检的敏感度为90%(18/20),特异度为100%(14/14),准确度为94.1%(32/34),阳性预测值为100%(18/18),阴性预测值为87.5%(14/16)。所有患者均未出现严重并发症。结论 0.23T开放式磁共振导航系统导引经椎弓根穿刺活检胸、腰椎椎体病变是一种安全、准确的诊断方法。Objective To evaluate the feasibility,safety and accuracy of open 0.23 T MRI-guided percutaneous bone drill hiopsy of thoracic and lumbar spine. Methods A total of 34 procedures of thoracic or lumbar lesions underwent percutane- ous transpedicular spine biopsy in low-field open MRI mounted with iPath 200 optical tracking systems, Among them, 13 cases were located in thoracic spine, and the other cases in lumbar spine. The biopsy specimens were evaluated with histol- ogy. The final diagnosis was confirmed by histologic samples from surgery or by clinical follow-up of 12 months minimum- ly. The diagnostic accuracy, sensitivity and specificity were calculated. Results All cases were successfully punctured and obtained adequate tissues. Histological examination of biopsy revealed 18 malignant lesions, 14 benign and 2 for unidenti- fied pathology. The final diagnoses from surgery or clinical follow-up were 20 malignant lesions and 14 benign. The sensi- tivity, specificity, accuracy, positive predictive value and negative predictive value of MRI guided biopsy of thoracic and lumbar spine wereg0G（18/20）, 100G（14/14）, 94.1G（32/34）, 100%（18/18）, 87.5G（14/16）, respectively. No seri- ous complications occurred in the group. Conclusion MRI-guided percutaneous transpedicular biopsy is an accurate and safe diagnostic technique in the evaluation of thoracic and lumbar spine lesions.

关 键 词：磁共振成像 介入性 椎体病变 活组织检查 经椎弓根 

分 类 号：R681.5[医药卫生—骨科学] R445.2[医药卫生—外科学]