CT guided vertebral body biopsy

Congress:

ECR 2019

Poster Number:

C-2206

Type:

Educational Exhibit

Keywords:

Musculoskeletal spine, Bones, Interventional non-vascular, CT, PET-CT, MR, Biopsy, Cancer, Infection, Metastases

Authors:

A. N. Murphy¹, B. Buckley², P. J. MacMahon¹, S. J. Eustace¹, E. C. Kavanagh¹; ¹Dublin/IE, ²Galway/IE

DOI:

10.26044/ecr2019/C-2206

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-2206

Fig. 1: This patient with metastatic breast cancer developed multiple new FDG avid...

Fig. 3: MRI displays an expansile bony lesion in T8 (A) with STIR hyperintensity (B)....

Fig. 4: MRI shows a 3.8cm T1 hypointense (A) , T2 hyperintense (B) mass centred on the...

Fig. 5: 39 year old female with thoracic spine pain. Bone scan (A) and SPECT CT (B)...

Learning objectives

This educational exhibit will review: Indications for vertebral body biopsy, Technique and complications, How to best choose a biopsy site, Diagnostic yield.

Background

The spine is the most common site of osseous metastatic disease; up to 70% of patients with cancer will develop bone metastases1. This is due to the abundant red marrow in the vertebral bodies and the communication of deep veins with valve-less vertebral venous plexuses1. Common malignancies that metastasize to the bones include: breast, prostate, lung and renal cell cancer1. Image guided vertebral biopsy is a safe, accurate and relatively inexpensive technique that can be performed in the outpatient setting under fluoroscopic or CT-guided technique....

Findings and procedure details

How besttochoose a biopsy site: Carefully review indication, history and imaging, ensuring there are no contraindications to biopsy. It is important to interrogate all available imaging for the most amenable lesion and if not already performed, consider PET, MR or bone scan to identify target sites for bestbiopsy route (See Fig. 1). Technique: Localization of lesion: A preliminary scout CT is performed followed by placement of radio-opaque markers on the skin over the target lesion and marking of the skin (See Fig. 2). The procedure...

Conclusion

Percutaneous vertebral body biopsy under local anesthesia is an important tool in the evaluation of vertebral body lesions, and can be performed with minimal morbidity and a high diagnostic yield. It is a relatively inexpensive technique and can be performed in theoutpatient setting6. It is important to use all available imaging to identify a suitable biopsy site. In patients with multiple bonelesions, all available imaging should be first interrogated for the mostappropriate lesion and if not performed, consider PET, MR or bone scan to identify...

Personal information

Dr Alexandra N. Murphy; third year radiology resident. Dr Bryan Buckley; first year radiology resident. Professor Peter J.MacMahon; Musculoskeletal and General Radiologist. Professor Stephen K. Eustace; Musculoskeletal and General Radiologist. Professor Eoin C. Kavanagh; Musculoskeletal and General Radiologist. Dublin, Ireland.

References

1 Filippiadis D, Mazioti A, Kelekis A. Percutaneous, Imaging-Guided Biopsy of Bone Metastases.Diagnostics (Basel). 2018;8(2):25. Published 2018 Apr 18. doi:10.3390/diagnostics8020025 2. WCG Peh, FRCP, FRCR CT-guided percutaneous biopsy of spinal lesionsBiomed Imaging Interv J. 2006 Jul-Sep; 2(3): e25. Published online 2006 Jul 1.doi:10.2349/biij.2.3.e25 3.Wu JS,Goldsmith JD,Horwich PJ,et al. Bone and soft-tissue lesions: what factors affect diagnostic yield of image-guided core-needle biopsy?Radiology.2008Sep;248(3):962-70.doi: 10.1148/radiol.2483071742. 4.Cohen MG,McMahon CJ,Kung JW,et al. Comparison of Battery-Powered and Manual Bone Biopsy Systems for Core Needle Biopsy of Sclerotic Bone Lesions.AJR Am J...