Technical Feasibility of Electromagnetic US/CT Fusion Imaging and Virtual Navigation in the Guidance of Spine Biopsies

Abstract

Purpose To test the technical feasibility of electromagnetic computed tomography (CT) + ultrasound fusion (US)-guided bone biopsy of spinal lesions.

Materials and Methods This retrospective study included 14 patients referred for biopsy of spinal bone lesions without cortical disruption or intervertebral disc infection. Lesions were located in the sacrum (n = 4), lumbar vertebral body (n = 7) or intervertebral disc (n = 3). Fusion technology matched a pre-procedure CT scan with real-time ultrasound. The first six procedures were performed under both standard CT and CT + US fusion guidance (group 1). In the last eight procedures, the needle was positioned under fusion imaging guidance alone, and CT was only used at the end of needle placement to confirm correct positioning (group 2). Additionally, we retrieved 8 patients (controls) with location-matched lesions as group 2, which were biopsied in the past with the standard CT-guided technique. The procedure duration and number of CT passes were recorded.

Results Mean procedure duration and median CT pass number were significantly higher in group 1 vs. group 2 (45 ± 5 vs. 26 ± 3 minutes, p = 0.002 and 7; 5.25–8.75 vs. 3; 3–3.25, p = 0.001). In controls, the mean procedure duration was 47 ± 4 minutes (p = 0.001 vs. group 2; p = 0.696 vs. group 1) and the number of CT passes was 6.5 (5–8) (p = 0.001 vs. group 2; p = 0.427 vs. group 1). No complications occurred and all specimens were adequate overall. In one case in group 2, the needle position was modified according to CT assessment before specimen withdrawal.

Conclusion Electromagnetic CT+US fusion-guided bone biopsy of spinal lesions is feasible and safe. Compared to conventional CT guidance, it may reduce procedural time and the number of CT passes.

Zusammenfassung

Ziel Prüfung der technischen Machbarkeit der elektromagnetischen Computertomografie (CT) + Ultraschallfusion (US)-gesteuerten Knochenbiopsie von Wirbelsäulenläsionen.

Material und Methoden Diese retrospektive Studie schloss 14 Patienten ein, die überwiesen wurden zur Biopsie von Wirbelsäulen-Knochenläsionen ohne kortikale Störung oder Bandscheibeninfektion. Die Läsionen befanden sich im Kreuzbein (n = 4), im Lendenwirbelkörper (n = 7) oder in der Bandscheibe (n = 3). Die Fusionstechnologie verwendete ein CT-Scan vor der Prozedur und Echtzeit-Ultraschall. Die ersten 6 Eingriffe wurden sowohl unter Standard-CT als auch unter CT + US-Fusionsführung durchgeführt (Gruppe 1). Bei den letzten 8 Eingriffen wurde die Nadel nur unter Führung der Fusionsbildgebung positioniert, und das CT wurde nach erfolgter Nadelplatzierung zur Bestätigung der korrekten Positionierung verwendet (Gruppe 2). Zusätzlich riefen wir 8 Patienten mit lokal übereinstimmenden Läsionen wie bei Gruppe 2 auf (Kontrollen), die in der Vergangenheit mit der CT-gesteuerten Standardtechnik biopsiert wurden. Die Dauer des Eingriffs und die Anzahl der CT-Durchgänge wurden aufgezeichnet.

Ergebnis Die mittlere Eingriffsdauer war in Gruppe 1 signifikant höher als in Gruppe 2 (45 ± 5 vs. 26 ± 3 Minuten; p = 0,002), ebenso die mediane Anzahl der CT-Durchläufe (7; 5,25–8,75 vs. 3; 3–3,25; p = 0,001). Bei den Kontrollen betrug die mittlere Eingriffsdauer 47 ± 4 Minuten (p = 0,001 vs. Gruppe 2; p = 0,696 vs. Gruppe 1) und die Anzahl der CT-Durchgänge 6,5 (5–8; p = 0,001 vs. Gruppe 2; p = 0,427 vs. Gruppe 1). Es traten keine Komplikationen auf und alle Proben waren insgesamt geeignet. In einem Fall in Gruppe 2 wurde die Nadelposition entsprechend der CT-Beurteilung vor der Probenentnahme modifiziert.

Schlussfolgerung Die elektromagnetische CT+US-fusionsgesteuerte Knochenbiopsie von Wirbelsäulenläsionen ist durchführbar und sicher. Im Vergleich zur konventionellen CT-Steuerung kann sie die Dauer des Eingriffs und die Anzahl der CT-Durchgänge reduzieren.

Key words

biopsy - bone - fusion - spine - ultrasound

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