Acute multiple trauma: Analysis of the spectrum of radiologic workup and time requirement

As part of a prospective study of 140 patients who had sustained multiple trauma and were treated in the emergency department, we recorded the times needed for conventional radiography, sonography, and/or computed tomography (CT) for each patient, including the diagnostic-free intervals comprising the times for transporting and moving the patient and for waiting. Conventional radiography (on average, 8.5 radiographic films per patient) was performed in 98.6% of the patients, sonography in 78.6%, and CT in 67.8%. The average duration was 20.3 minutes (range, 1–80 minutes) for conventional radiography, 6.5 minutes (range, 2–15 minutes) for sonography, and 16.9 minutes (range, 12–135 minutes) for CT. The average cumulative total time consumed for diagnostic imaging in the emergency department was 78.4 minutes for all modalities (including CT) and 49.1 minutes for conventional radiography and sonography (excluding CT). The cumulative diagnostic-free time (i.e., time passing without actual performance of the imaging procedure) for all imaging modalities (including CT) was 31.9 minutes and for conventional radiography and sonography (without CT) 19.2 minutes of the total time. The average time for transporting the patient to and from the CT scanner and for positioning the patient for the CT examination was 14.5 minutes. When CT is added to the workup in the emergency department, transportation and waiting considerably prolong the time needed for diagnostic imaging.     

Clearing the cervical spine in multiple trauma victims: A time-effective protocol using helical computed tomography

This study was performed to evaluate helical computed tomography (HCT) as the primary method of initial cervical spine assessment in multiple trauma victims. Prospective evaluation of the cervical spine using HCT and plain film radiography (PFR) was performed in 800 patients with suspected multisystem injuries. With HCT, an average of 32 slices were obtained at 5-mm intervals from the base of the skull to T1 using helical acquisition and a bone algorithm. HCT was performed following cross-table lateral radiographs of the cervical spine in all patients. We compared HCT and PFR for detection of abnormalities and duration of examination and also compared HCT with conventional CT in a subset of patients (N=20) for image quality/lesion detectability. Sixty-eight fractures were identified in 46 patients. HCT prospectively identified 67 fractures (98.5%), and plain films demonstrated 29 fractures (43%). No difference in image quality/lesion detectability was encountered when comparing HCT to conventional CT. HCT of the cervical spine could be completed in 4.5 minutes and added an average of only 8 minutes to the stay of the patient in the CT room. During the time of the study, the overall patient disposition time from the trauma resuscitation area was reduced from 6.5 to 4.5 hours. Rapid and accurate evaluation of the cervical spine is possible with HCT and is recommended as part of the initial imaging protocol in multiple trauma patients.     

16层螺旋CT导引下孤立性肺结节穿刺活检

目的:评价并比较16层螺旋CT与单螺旋CT导引下孤立性肺结节穿刺活检的诊断价值及应用的安全性。方法:在16层螺旋CT、单螺旋CT导引下分别对50例肺孤立性结节穿刺活检,对采集的标本行细胞学或病理学检查,术后行CT扫描明确是否有气胸、出血等并发症,分析操作时间、取材准确性及并发症出现率。结果:16层CT穿刺活检组50例中取得满意组织并确诊46例,穿刺平均时间22.8min,并发症出现率8%;单螺旋组50例中取得满意组织并确诊37例,穿刺平均时间35.6min,并发症出现率12%;在不同CT导引下穿刺取材时间及取材准确性比较有统计学意义(P<0.05),并发症出现率无统计学意义(P>0.05)。结论:16层螺旋CT为穿刺定位取材提供了更多信息,16CT定位下的穿刺活检成功率和准确率较高,可作为孤立性肺结节定性诊断的首选方法。     

Diagnostic Yield of Computed Tomography-Guided Coaxial Core Biopsy of Undetermined Masses in the Free Retroperitoneal Space: Single-Center Experience

The purpose of this study was to evaluate the diagnostic yield of core biopsy in coaxial technique under guidance of computed tomography (CT) for retroperitoneal masses. We performed a retrospective analysis of CT-guided coaxial core biopsies of undetermined masses in the non-organ-bound retroperitoneal space in 49 patients. In 37 cases a 15-G guidance needle with a 16-G semiautomated core biopsy system, and in 12 cases a 16-G guidance needle with an 18-G biopsy system, was used. All biopsies were technically successful. A small hematoma was seen in one case, but no relevant complication occurred. With the coaxial technique, up to 4 specimens were obtained from each lesion (mean, 2.8). Diagnostic accuracy in differentiation between malignant and benign diseases was 95.9%. A specific histological diagnosis could be established in 39 of 42 malignant lesions (92.9%). Correct subtyping of malignant lymphoma according to the WHO classification was possible in 87.0%. Benign lesions were correctly identified in seven cases, although a specific diagnosis could only be made in conjunction with clinical and radiological information. In conclusion, CT-guided coaxial core biopsy provides safe and accurate diagnosis of retroperitoneal masses. A specific histological diagnosis, which is essential for choosing the appropriate therapy, could be established in most cases of malignancy.     

Cone-Beam Computed Tomography Fusion and Navigation for Real-Time Positron Emission Tomography–guided Biopsies and Ablations: A Feasibility Study

PurposeTo describe a novel technique for multimodality positron emission tomography (PET) fusion–guided interventions that combines cone-beam computed tomography (CT) with PET/CT before the procedure.Materials and MethodsSubjects were selected among patients scheduled for a biopsy or ablation procedure. The lesions were not visible with conventional imaging methods or did not have uniform uptake on PET. Clinical success was defined by adequate histopathologic specimens for molecular profiling or diagnosis and by lack of enhancement on follow-up imaging for ablation procedures. Time to target (time elapsed between the completion of the initial cone-beam CT scan and first tissue sample or treatment), total procedure time (time from the moment the patient was on the table until the patient was off the table), and number of times the needle was repositioned were recorded.ResultsSeven patients underwent eight procedures (two ablations and six biopsies). Registration and procedures were completed successfully in all cases. Clinical success was achieved in all biopsy procedures and in one of the two ablation procedures. The needle was repositioned once in one biopsy procedure only. On average, the time to target was 38 minutes (range 13–54 min). Total procedure time was 95 minutes (range 51–240 min, which includes composite ablation). On average, fluoroscopy time was 2.5 minutes (range 1.3–6.2 min).ConclusionsAn integrated cone-beam CT software platform can enable PET-guided biopsies and ablation procedures without the need for additional specialized hardware.     

Musculoskeletal biopsies using computed tomography fluoroscopy

OBJECTIVE: To determine the diagnostic yield, accuracy, and safety of computed tomography (CT) fluoroscopy guidance for musculoskeletal biopsies. MATERIALS AND METHODS: A retrospective analysis of musculoskeletal biopsies performed with CT fluoroscopy guidance over a 2-year period was made. Data collected were biopsy sites, CT fluoroscopic times, and biopsy results. Results were categorized as the following: positive, negative (but diagnostic), or nondiagnostic. Reference standard consisted of 5 years of follow-up to verify results. RESULTS: Ninety-five CT fluoroscopy-guided musculoskeletal biopsies were performed. Bone biopsies comprised 83% (79/95), and soft tissue biopsies comprised 17% (16/95). The mean age was 54 years (range, 16-90 years); 40.0% (38/95) were male subjects, and 60.0% (57/95) were female subjects. For all subjects, CT fluoroscopic times ranged from 2 to 310 seconds, with a mean time of 63 seconds and a median time of 34 seconds. The diagnostic yield was 96% (91/95), with a nondiagnostic result in 4% (4/95) of subjects. Diagnostic biopsy specimens showed a positive result in 63% (60/95) of subjects and a negative but diagnostic result in 33% (31/95) of subjects. There were no major complications. CONCLUSIONS: Computed tomography fluoroscopic-guided musculoskeletal biopsies show a high diagnostic yield and are accurate and safe. The biopsy results are similar or superior to other published reports using conventional CT guidance with only a small overall fraction being nondiagnostic. The benefits of real-time imaging are at the cost of operator exposure to ionizing radiation and the risk of potentially high exposures to both patient and operator. The impact on indications for which lesions are most amenable to percutaneous biopsy using CT fluoroscopy and procedure time has yet to be determined.     

Intravascular Ultrasound-Guided Transvenous Biopsy of Abdominal and Pelvic Targets Difficult to Access by Percutaneous Needle Biopsy: Technique and Initial Clinical Experience

PurposeTo report initial clinical experience with intravascular ultrasound (US)-guided transvenous biopsy (TVB) for perivascular target lesions in the abdomen and pelvis using side-viewing phased-array intracardiac echocardiography catheters.Materials and MethodsIn this single-institution, retrospective study, 48 patients underwent 50 intravascular US-guided TVB procedures for targets close to the inferior vena cava or iliac veins deemed difficult to access by conventional percutaneous needle biopsy (PNB). In all procedures, side-viewing phased-array intracardiac echocardiography intravascular US catheters and transjugular liver biopsy sets were inserted through separate jugular or femoral vein access sheaths, and 18-gauge core needle biopsy specimens were obtained under real-time intravascular US guidance. Diagnostic yield, diagnostic accuracy, and complications were analyzed.ResultsIntravascular US-guided TVB was diagnostic of malignancy in 40 of 50 procedures for a diagnostic yield of 80%. There were 5 procedures in which biopsy was correctly negative for malignancy, with a per-procedure diagnostic accuracy of 90% (45/50). Among the 5 false negatives, 2 patients underwent repeat intravascular US-guided TVB, which was diagnostic of malignancy for a per-patient diagnostic accuracy of 94% (45/48). There were 1 (2%) mild, 2 (4%) moderate, and 1 (2%) severe adverse events, with 1 moderate severity adverse event (venous thrombosis) directly attributable to the intravascular US-guided TVB technique.ConclusionsIntravascular US-guided TVB performed on difficult-to-approach perivascular targets in the abdomen and pelvis resulted in a high diagnostic accuracy, similar to accepted thresholds for PNB. Complication rates may be slightly higher but should be weighed relative to the risks of difficult PNB, surgical biopsy, or clinical management without biopsy.     

CT fluoroscopy-guided cutting needle biopsy of focal pure ground-glass opacity lung lesions: diagnostic yield in 83 lesions

Objective

The objective of our study was to retrospectively determine the diagnostic yield of CT fluoroscopy-guided cutting needle biopsy of focal pure ground-glass opacity lung lesions.

Materials and methods

Biopsies were performed using 20-G coaxial cutting needles for 83 focal pure ground-glass opacity lung lesions (mean lesion size, 12.1 mm). After excluding the lesions for which biopsy specimens were unobtainable and final diagnoses were undetermined, the diagnostic yield, including sensitivity and specificity for a diagnosis of malignancy and accuracy, was calculated. The lesions were then divided into 2 groups: the diagnostic failure group, comprising lesions with false-negative results and for which a biopsy specimen was unobtainable; and the diagnostic success group, comprising lesions with true-negative results and true-positive results. Various variables were compared between the 2 groups by univariate analysis.

Results

Biopsy specimens were obtained from 82 lesions, while specimens could not be obtained from 1 lesion. Final diagnosis was undetermined in 16 lesions. The sensitivity and specificity for a diagnosis of malignancy were 95% (58/61) and 100% (5/5), respectively. Diagnostic accuracy was 95% (63/66). The 4 lesions in diagnostic failure group were smaller, deeper, and more likely to be located in the lower lobe and further, for those lesions, number of specimens obtained was smaller, compared with 63 lesions in diagnostic success group. However, none of the differences were statistically significant.

Conclusion

CT fluoroscopy-guided cutting needle biopsy provided high diagnostic yield for focal pure ground-glass opacity lung lesions.     

Technical and nidus-specific factors associated with adequacy of intraprocedural biopsy samples preceding radiofrequency ablation of osteoid osteoma

PurposeTo examine the diagnostic yield of intraprocedural percutaneous biopsy performed at the time of radiofrequency ablation of suspected Osteoid Osteoma (OO) and identify technical and nidus-specific factors associated with diagnostic adequacy.Materials and methodsFollowing IRB approval, a total of 42 patients (male: 28, female: 14; mean age: 29 years) who underwent intraprocedural biopsy immediately prior to RFA between June 2010 and June 2017 were retrospectively identified. The nidi were located in various locations. The nidi had a mean size of 6.3 mm (range: 3–11 mm, Standard deviation (SD): 2.26). Core biopsies were performed by one of 15 operators. Biopsies were performed with two needle types ranging from 11-G to 15-G with a mean number of samples of 1.8 (range: 1–5, SD: 1.01). Electronic records and imaging were reviewed for demographics, nidus characteristics, biopsy details and diagnostic yield. Multivariate logistic regression of nidus-specific and biopsy-specific factors was performed.ResultsA total of 22/42 (52.3%) of the biopsies were adequate for histological diagnosis of OO. For the two experienced operators, the diagnostic yield was 67% (6/9) and 80% (8/10). Biopsy adequacy was significantly correlated with presence of an osteoid matrix (p = 0.03), obtaining >1 core sample (p = 0.03), the needle track passing through the nidus (p = 0.0003) and thinner (2.5 mm) intraprocedural CT slices (p = 0.03). On multivariate analysis, use of thinner intraprocedural CT slices was found to be associated with adequate biopsy (p = 0.02).ConclusionIntraprocedural percutaneous biopsy samples of nidi highly-suspected to be OO at the time of RFA were diagnostic in 52% of patients. Multivariate analysis shows thinner intraprocedural CT slices to be a significantly associated with biopsy adequacy.     

CT引导下穿刺活检及介入治疗的临床应用(附56例分析)

目的：探讨ＣＴ引导下穿刺活检及介入治疗的临床应用价值。方法：ＣＴ引导下行诊断目的２９例,治疗目的１７例,诊断及治疗双目的的１０例病人。穿刺部位包括胸部１７例,腹部２７例,躯干及四肢１２例,共５６例６０个病灶。ＣＴ扫描确定穿刺点、角度及深度。局麻进针后,ＣＴ再次扫描确认针尖到达预定位置再进行活检取材或介入治疗。结果：６０ 个病灶穿刺６１针次,穿刺一次成功率１００％ ,确诊率９７．４％ ,治疗有效率８８．９％ ,并发症５．４％ 。结论：ＣＴ引导下穿刺活检及介入治疗属微创伤性技术,简便易行,安全有效,成功率高,并发症少。     

CT导引下胸部病变穿刺活检的临床分析

目的：评价CT导引下穿刺活检在胸部病变诊断中的价值。方法：有手术病理或临床随诊的胸部病变CT穿刺活检223例，其中125例133次活检为传统CT导引下活检，其余98例105次CT穿刺活检应用激光导引装置。结果：223例胸部病变中212例有临床诊断结果，CT穿刺活检诊断正确率为82．1％（174／212），对恶性病变的敏感率86．2％（131／152），特异性100％、对良性病变明确诊断率为71．7％（43／60）。并发症包括13．0％（31／238）发生气胸，1．3％（3／238）需要放胸腔引流管，5．0％（1／238）发生肺实质少量出血，0．8％（2／238）出现少量咳血。激光导引下CT穿刺活检诊断正确率为88．4％（84／95），明显高于传统CT导引下活检76．9％（90／117）的诊断正确率，两者在气胸发生率、每次活检平均胸膜穿刺次数方面无统计学差异。结论：CT导引下胸部病变穿刺活检是一种安全、准确、有效的诊断及鉴别诊断方法。激光导引装置在胸部CT穿刺活检中有较高的应用价值，尤其对于小病灶和中心性病变。与传统CT导引下活检相比激光导引下CT活检可提高诊断证确率、缩短活检时间。     

Comparison of computed with conventional tomography in the evaluation of temporomandibular joint disease: a study of autopsy specimens

Autopsy specimens were examined both radiographically and macroscopically to compare direct computed tomography (CT) with conventional tomography (CVT) for their diagnostic yield of the structural bone changes in the temporomandibular joint (TMJ). Fifteen specimens were examined with corrected sagittal and 12 with corrected frontal tomography. Five joints showed bone exposure and/or disc perforation macroscopically and all of them were correctly diagnosed by both CT and CVT (sensitivity 1.0). However, false-positive diagnoses were also made, resulting in values for specificity which were somewhat lower for CT than for CVT. Frontal images did not reveal any additional 'true' findings compared with sagittal CT or CVT. For single areas of the joints the average sensitivity was low, 0.28 for CT and 0.47 for CVT, but the specificity for the joint as a whole was high with both methods (0.91 and 0.94 respectively). We conclude that CVT is superior to CT in the diagnosis of single structural bone changes but comparable for comprehensive diagnosis of TMJ disease.     

Computed-tomography-guided percutaneous core needle biopsies of suspected malignant lymphomas: impact of biopsy, lesion, and patient parameters on diagnostic yield

PURPOSE: To investigate the diagnostic yield of core needle biopsy in patients with malignant lymphoma. MATERIAL AND METHODS: Computed-tomography-guided core needle biopsies in patients with malignant lymphoma performed in the period 1996 to 2001 were evaluated retrospectively. A biopsy was considered as "fully diagnostic" if a histological diagnosis, including the histologic subtype in the event of malignant lymphoma, was achieved and the clinical course and CT follow-up of at least 6 months confirmed the biopsy results. A biopsy was regarded as "partly diagnostic" if histological work-up defined malignant lymphoma but not the histological subtype, and if histological diagnosis bore therapeutic relevance. Diagnostic yield was correlated with features such as size of specimen, location and depth of the target lesion, and experience of the investigator. RESULTS: 45 biopsies were performed in 40 patients. With respect to definite histopathological diagnosis, 31 biopsies (68.9%) were diagnostic and 14 (31.1%) non-diagnostic. In 4 cases (8.8%), biopsies yielded partly diagnostic results, since therapy could be scheduled after biopsy without final sub-classification. Statistical analysis of biopsy parameters revealed that sample sizes were significantly larger in the diagnostic group. CONCLUSION: CT-guided biopsy can be considered as an alternative for lymphoma diagnosis and should be the first interventional procedure. The most important parameter for diagnostic success is the size of the specimen.     

Stereotactic 11-gauge vacuum-assisted breast biopsy: influence of number of specimens on diagnostic accuracy

PURPOSE: To determine whether number of specimens obtained at stereotactic 11-gauge vacuum-assisted breast biopsy with the patient prone influences diagnostic accuracy and to determine whether this number varies depending on mammographic appearance of lesions as masses or microcalcifications. MATERIALS AND METHODS: Biopsy was prospectively performed in 100 patients (median age, 55 years; range, 31-81 years) with 100 lesions that were mammographically evident as masses (n = 50) and microcalcifications (n = 50) with standardized protocol to acquire 20 specimens per lesion in three 360 degrees probe rotations at one skin entry site. Specimens were histologically evaluated sequentially, and findings were compared with results of surgical excision or of mammographic follow-up for at least 24 months. Differences in diagnostic yield after each probe rotation and differences in diagnostic yield between masses and microcalcifications were determined with chi(2) test. RESULTS: Up to 12 specimens harvested within two 360 degrees probe rotations were necessary to yield correct diagnosis in 96% of patients with masses and 92% of patients with microcalcifications. Diagnostic yield was not improved with more than 12 specimens for masses or microcalcifications. In two (4%) of 47 patients with lesions that were eventually diagnosed as cancer, results at stereotactic biopsy indicated they were benign. Underestimation of diagnosis of lesions as atypical ductal hyperplasia and ductal carcinoma in situ occurred in two (50%) of four and two (17%) of 12 lesions, respectively. With 20 specimens harvested during three probe rotations, there was no statistically significant difference in diagnostic yield between patients with masses and those with microcalcifications (P =.68). CONCLUSION: At 11-gauge vacuum-assisted biopsy, highest diagnostic yield was achieved with 12 specimens per lesion, independent of mammographic appearance of the lesion. Even with standardized retrieval of 20 specimens per lesion, underestimation of disease still occurs.     

Experimentally induced small-bowel tumor in rabbits: US-guided percutaneous 18-gauge core biopsy

PURPOSE: To evaluate the safety and diagnostic yield of percutaneous 18-gauge core biopsy for an experimentally induced small-bowel tumor in a rabbit model. MATERIALS AND METHODS: Small-bowel tumors were induced by injecting VX2 tumor into 20 rabbits. After 3 weeks, the small bowel was filled with 100 mL of 2% diluted contrast agent containing methylene blue by using a 5-F catheter. Fifty biopsy firings for small-bowel tumor were performed with ultrasonographic (US) guidance by using an 18-gauge automatic gun. Computed tomography (CT) was performed before and immediately after biopsy. Any procedure-related complications, including leakage of air or fluid, hematoma, and perforation as seen at CT and identified at laparotomy, which was performed 48 hours after biopsy, were evaluated. White blood cell (WBC), red blood cell, and platelet counts; hemoglobin and hematocrit levels; and erythrocyte sedimentation rate were also obtained before and 48 hours after biopsy. Comparison was performed with paired t test. The diagnostic yield was calculated, and the specimen was evaluated whether fragments of mucosa were included or not. RESULTS: No contrast agent leakage or pneumoperitoneum suggesting perforation was identified at CT or laparotomy. Fluid leakage was observed with manual squeezing at two biopsy sites (4%). In two rabbits, hemoperitoneum was observed at CT or laparotomy. Hematoma larger than 3 cm was observed in six rabbits. WBC count and erythrocyte sedimentation rate slightly increased, and red blood cells, hemoglobin, hematocrit, and platelets counts had decreased slightly after biopsy but were not significant (P >.05). Definitive histologic diagnosis of tumor was obtained in 44 (88%) of 50 biopsy sites. Fragments of mucosa were observed in 13 (28%) specimens of 10 rabbits. CONCLUSION: Core biopsies of small-bowel tumor can be performed safely with an 18-gauge gun without severe complications and allow histologic diagnosis of small-bowel tumor with a good diagnostic yield.     

Mediastinal lymphadenopathy: diagnostic yield of transbronchial mediastinal lymph node biopsy with CT fluoroscopic guidance-initial experience

PURPOSE: To determine whether the use of computed tomographic (CT) fluoroscopy to guide transbronchial needle aspiration (TBNA) of mediastinal lymph nodes can improve the diagnostic yield. MATERIALS AND METHODS: CT fluoroscopy was used to guide TBNA in 12 consecutive patients with mediastinal lymphadenopathy who had previously undergone nondiagnostic conventional TBNA. CT fluoroscopy was used to confirm the location of the biopsy needle by using a "quick-check" technique (ie, fluoroscopy was performed sparingly after needle insertion). The location of each needle, the total procedural and fluoroscopic times, and any complications were recorded. RESULTS: All CT fluoroscopic procedures were performed in less than 1 hour, and a tissue diagnosis was established in all patients. Eighteen lymph nodes with a diameter of 0.8-2.4 cm were sampled with 116 needle passes. CT fluoroscopy documented inadequate positioning in 48 of the 116 (41.3%) needle passes. Eighteen (15.5%) needles did not fully penetrate the tracheobronchial tree. Six needles (5.2%) were placed into the great vessels. Malignant disease was diagnosed in nine patients, and benign disease was diagnosed in three. The mean fluoroscopic exposure time was 20.5 seconds +/- 12.7. No pneumothoraces or substantial hemorrhage were observed. CONCLUSION: CT fluoroscopic guidance for TBNA procedures is a safe and efficient means of providing diagnostic material and should be considered for patients who have previously undergone nondiagnostic blinded TBNA.     

Multislice CT fluoroscopy: technical principles, clinical applications and dosimetry

PURPOSE: The aim of this study is describing fluoroscopic techniques with multislice CT during interventional procedures. We emphasize the technical principles of the multislice CT fluoroscopy and the relative advantages in clinical application, in comparison to single slice fluoroCT and conventional CT guided procedures. Other topics are dosimetry and patient's and operator's radioprotection. MATERIALS AND METHODS: We describe our experience in 60 cases of interventional procedures performed with CT fluoroscopy array for the TOSHIBA AQUILION-MULTI TSX-101A scanner that allows a real-time 3 slices simultaneous representation of the target: middle target slice, superior and inferior slices. Thirty nine biopsies, 5 abscess drainage, 12 shoulder arthrocentesis previous to arthro-MR and 4 hepatic neoplasm ablations have been performed during the last 9 months. For each procedure questionnaires have been used to evaluate: target organs, scan parameters, fluoroscopy techniques (continuous or spot) and total time of fluoroCT. Basing on these data and on the measurements made on a body phantom we calculated patient's and operator's radiation dose rate. RESULTS AND DISCUSSION: The real-time simultaneous representation of the middle target slice and the adjacent superior and inferior slices has always allowed an immediate identification of the needle tip and direction. The use of a needle holder has been determined by the needle type, the fluoroscopy technique (continuous or spot), the type of interventional procedure and the target. In our experience freehand spot fluoroscopy approach was easier, faster and with less radiation dose rate. 24 seconds were the mean fluoroscopy time for all different CT fluoroscopy modalities and procedures. The mean absorbed equivalent dose rate to patient's skin was 5300 microSv/s while the dose to operator's body and hand was respectively 0.3 microSv/s and 30 microSv/s. CONCLUSIONS: Multislice CT fluoroscopy, specially if performed by spot technique, leads to an acceptable radiation dose rate to patient and operator, is user friendly and guides interventional procedures with rapidity.     

多层螺旋CT在经皮穿刺肺组织活检中的应用价值

目的探讨多层螺旋CT(MSCT)引导下经皮穿刺肺组织活检的技术方法,并评价MSCT在经皮穿刺肺组织活检中的应用价值。资料与方法对42例患者的42个肺部病灶进行MSCT引导下经皮穿刺肺活检。结果42个病灶均成功穿刺(成功率为100%)。肺外周小病灶的一次穿刺成功率为88.2%(15/17),肺门部病灶的一次穿刺成功率为86.7%(13/15)。病理检出40例,诊断成功率和活检准确率均为95.2%。术后并发肺出血2例,发生率为4.8%;气胸2例,发生率为4.8%。结论MSCT引导不仅能提高经皮穿刺肺外周部小病灶和肺门部病灶的技术成功率、诊断成功率和活检准确性,而且能减少并发症的发生。     

CT透视引导下的纵隔小病灶穿刺活检的临床价值

目的探讨CT引导下纵隔小病灶穿刺活检技术及诊断价值。方法42例纵隔小病灶(小于3cm)在CT引导下采用自动切割式活检针穿刺活检。结果42例纵隔肿块穿刺活检病灶取材成功率97.65(41/42)。纵隔肿块穿刺活检的诊断准确率92.3%(39/42),对于恶性病变诊断准确率96.3%(26/ 27),良性病变为86.7%(13/15)。并发气胸2例(4.8%),纵隔少量出血1例(2.3%)。结论CT引导下穿刺活检是安全、有效的诊断手段,对于纵隔病变诊断的准确率高,CT引导下纵隔小病灶穿刺活检对纵隔病变的诊断和治疗具有重要意义。