MR引导下乳腺穿刺活检机器人研究进展

乳腺癌是目前发病率最高的恶性肿瘤之一。早期诊断及治疗乳腺癌对改善预后具有重要意义。随着机器人技术发展成熟,MR引导下乳腺穿刺活检机器人技术可能成为早期诊治乳腺癌的理想方式之一。本文对近年来MR引导下乳腺穿刺活检机器人研发及应用进展进行综述。     

超声造影在肺周围病变穿刺活检中的应用

目的探讨CEUS在肺部周围病变穿刺活检中的应用价值。方法将53例肺部周围病变患者随机分成研究组（n=31）和对照组（n=22）。研究组在CEUS引导下进行穿刺活检,对照组直接在超声引导下进行穿刺活检。对比两组穿刺标本的阳性诊断率及并发症的发生率。结果研究组与对照组的平均穿刺针数分别为1.19针、1.86针,穿刺标本的阳性诊断率分别为100%（31/31）及86.36%（19/22）,并发症发生率分别为0及4.55%（1/22）,差异均有统计学意义（P均〈0.05）。结论 CEUS引导下穿刺活检肺部周围病变能明显提高穿刺活检获取标本的阳性诊断率,降低并发症,具有临床推广价值。     

高场强MR引导下精准穿刺抽吸治疗多房性脑脓肿

目的观察高场强MR引导下经皮精准穿刺抽吸治疗多房性脑脓肿的有效性及安全性。方法回顾性分析9例接受1.0T高场强MR引导经皮穿刺抽吸治疗的多房性脑脓肿患者,记录手术时间、并发症及随访结果。结果对9例共接受25次高场强MR引导下脓腔穿刺抽吸,其中2例行2次、7例行3次穿刺抽吸,技术成功率100%(25/25);手术时间40～100 min,平均75 min。抽吸脓液细菌培养8例呈阳性。1例术中出现少量硬膜下出血,无严重并发症。术后随访6个月,症状均显著好转;影像学随访显示脓腔皆完闭塞或肉芽肿形成,有效率100%(9/9)。结论高场强MR引导下经皮精准穿刺抽吸治疗多房性脑脓肿安全、有效。     

实时CEUS在经皮盆腔肿块穿刺活检中的应用价值

目的探讨实时CEUS穿刺活检技术在经皮盆腔肿块中的应用价值。方法将40例邻近腹壁的盆腔肿块随机分为2组,造影组(20例,行实时CEUS穿刺活检)、非造影组(20例,行常规超声引导直接穿刺),比较两组穿刺的成功率及确诊率。结果造影组的穿刺成功率与确诊率分别为100%(20/20)、100%(20/20),非造影组的穿刺成功率与确诊率分别为80.00%(16/20)、75.00%(15/20),造影组与非造影组的穿刺成功率与确诊率分别对比,差异均有统计学意义(P均0.05)。结论实时CEUS能区分肿块内坏死与活性区域,准确引导穿刺获得病灶内活性组织,可为临床正确诊治疾病提供重要信息。     

CT引导下穿刺活检在脊柱病变诊断中的应用

目的　探讨CT引导下经皮穿刺活检对脊椎病变的诊断价值。方法　对 4 2例影像学不能确诊的病例实施CT引导下经皮穿刺细胞学检查和活检术 ,包括颈、胸、腰共 5 2个椎节。结果　全部病例一次穿刺取材成功 ,无一例出现并发症。 39例一次穿刺确诊率 92 8%。确诊病例包括 :孤立性浆细胞瘤 1例 ,转移癌 2 4例 ,结核 5例 ,多发性骨髓瘤 4例 ,恶性淋巴瘤 2例 ,骨感染 3例 ,3例误诊。结论　CT引导下经皮穿刺细胞学检查和活检是诊断脊柱占位性病变安全、有效的方法。     

CT引导下穿刺活检在寰枢椎病变诊断中的应用

目的 应用ＣＴ引导下穿刺活检对寰枢椎闰变作定性诊断并探讨其在确定治疗方案中的作用。方法 对２２例寰枢椎病变行ＣＴ引志下穿刺活检,男７例,女１５例,侧方及后外侧进针,局麻下操作。结果 ２２例中,结核７例,转移笥肿瘤４例,骨巨细胞瘤、骨髓瘤、低度恶性组织细胞瘤各２例,脊索瘤、嗜酸性肉芽肿、神经纤维瘤、软骨肉瘤各１例,纤维及坏死组织１例。活检阳性率９５．４％,假阴性率４．６％。手术治疗１０例,手术后病理     

超声引导下胃肠道病变穿刺活检

目的探讨超声引导下胃肠道病变穿刺活检的临床应用价值。方法对30例经肠镜、CT或MRI检查发现但未能明确诊断的胃肠道病变(胃来源2例、小肠4例、结肠4例、直肠18例、肛管2例)进行超声引导下穿刺活检,总结活检方法、成功率及相关并发症。结果 30例中,经腹穿刺10例,经直肠穿刺16例,经肛周穿刺4例。标本取材满意29例,目标病灶穿刺成功率96.67%(29/30)。29例取材成功者中,活检病理提示良性病变11例,恶性病变18例,其中7例手术切除,6例活检病理与手术病理相符,1例活检病理不能鉴别未分化癌与间皮瘤,手术病理证实为未分化癌,其余病例与随访结果相符。穿刺后随访1~18个月,所有患者均未出现穿刺相关并发症。结论对于胃肠道病变,尤其是内镜活检困难或无效的病变,超声引导穿刺活检是安全、有效的诊断方法。     

超声造影在肝占位性病变穿刺活检中的应用

目的探讨超声造影在经皮肝占位性病变穿刺活检中的应用。方法对32例常规超声检查诊断的肝占位性病变进行超声造影,根据病灶内微灌注情况,对其中31例进行常规超声引导下穿刺活检,穿刺标本送病理科行组织学检查。取材量满足病理诊断为取材成功。结果常规超声检查提示32例肝占位性病变病灶内坏死、液化3例,超声造影提示病灶内坏死、液化10例;肝多发占位病灶4例,其中1例（2个病灶）1灶造影剂呈＂快进快出＂,另1灶造影三期与肝实质呈同步等增强,其余3例多发病灶超声造影均呈＂快进快出＂;6例常规超声检查病灶未显示血流,5例超声造影检查有不同程度增强,1例病灶三期均呈无增强,考虑局灶性坏死结节未行穿刺活检。31例肝占位性病变于超声造影动脉期增强区取材,平均穿刺2.13次（66/31）,取材成功率100%（31/31）,确诊率96.80%（30/31）。结论超声造影可敏感地反映肝占位病变微灌注情况,准确分辨肝占位病变坏死、液化区,初步判断病变的良、恶性,指导常规超声准确进行定位取材,在肝占位病变穿刺活检中有重要的临床价值。     

超声造影联合穿刺活检在肺周围型病变定性诊断中的应用

目的探讨CEUS联合穿刺活检在肺周围型病变定性诊断中的应用价值。方法对158例肺周围型病变患者行经皮穿刺活检术,其中97例术前行CEUS检查(试验组),61例术前仅行常规超声检查(对照组)。比较两组穿刺次数、诊断阳性率及并发症情况。绘制CEUS时间-强度曲线(TIC),比较试验组中良性与恶性病变TIC的上升时间(RT)、达峰时间(TTP)、曲线上升斜率(WIS)及峰值强度(PI)。观察并记录良恶性病变的增强特征。结果试验组和对照组穿刺病理诊断阳性率分别为94.85%(92/97)和83.61%(51/61),差异有统计学意义(P=0.02);平均穿刺次数分别为(2.11±0.48)次和(2.20±0.44)次,两组间差异无统计学意义(P=0.18);并发症发生率分别为2.06%(2/97)和4.92%(3/61),差异无统计学意义(P=0.32)。RT、WIS及PI在良恶性病变间差异有统计学意义(P均0.05),TTP差异无统计学意义(P=0.08)。试验组良恶性病变均以不均匀增强为主,良性病变中占77.50%(31/40),恶性病变中占88.46%(46/52),其增强特征差异无统计学意义(P=0.16)。结论 CEUS在肺周围型病变的定性诊断中具有一定价值,对经皮肺穿刺活检具有指导意义。     

超声引导下肺外周占位病变穿刺活检技术方法探讨

超声引导下经皮穿刺活检技术现已成为获取肺外周占位病变组织标本的主要手段,但只有熟练掌握该穿刺技巧才能提高手术的成功率。本研究探讨超声引导下肺外周占位病变穿刺活检术的技术方法及并发症的防范。     

MR三维颅脑容积成像增强扫描诊断内听道区病变

目的探讨MR三维颅脑容积成像(3D-BRAVO)增强扫描诊断内听道区病变的价值。方法对81例内听道区病变患者(116个病灶)行3D-BRAVO增强扫描及常规增强MR检查,对比两种方法诊断内听道区病变的敏感度。结果常规增强扫描发现阳性病灶86个,诊断敏感度71.55%(83/116),漏诊率28.45%(33/116);3D-BRAVO增强扫描检出全部116个阳性病灶,诊断敏感度100%(116/116);3D-BRAVO增强扫描诊断敏感度高于常规增强扫描(Z=-3.74,P<0.001)。结论3D-BRAVO增强扫描可敏感检出内听道区病变,为临床诊疗提供影像学证据。     

MRI引导下乳腺病灶真空辅助穿刺活检术的应用

目的探讨MRI引导真空辅助穿刺活检术在BI-RADS 4类乳腺病变中的应用价值。方法对9例MRI诊断为BI-RADS 4类乳腺病变的患者行MR引导真空辅助穿刺活检术。采用1.5T MR仪,8通道专用乳腺MR活检线圈,乳腺适度加压后固定于定位装置内;定位扫描采用矢状位3D动态增强扫描,将数据传至乳腺活检专用定位工作站,由工作站自动计算活检位置及进针深度。以14.5cm、8G真空辅助活检针进行穿刺。结果 9例中,8例病灶准确定位,并成功取得组织病理结果;1例因病灶位置表浅、工作站不能定位而终止活检。每例取组织6~20条,共取96条;每例操作时间为30~65min。组织病理学结果:乳腺浸润性导管癌2例,腺病3例,导管内乳头状瘤1例,硬化性腺病合并导管扩张1例,腺病伴不典型增生1例。结论 MR引导下乳腺病变真空抽吸活检术用于BI-RADS 4类乳腺病变安全可行,能够取得足够的组织用于病理学评估。     

Endorectal magnetic resonance imaging and spectroscopy for the detection of tumor foci in men with prior negative transrectal ultrasound prostate biopsy

Purpose

We determined the ability of combined endorectal magnetic resonance imaging (MRI) and magnetic resonance spectroscopic imaging (MRSI) to detect prostate cancer foci prospectively in men with prior negative transrectal ultrasound (TRUS) prostate biopsy.

Materials and Methods

Endorectal MRI with spectroscopy was performed in 24 consecutive patients with 1 or more prior negative TRUS prostatic biopsies for persistently increased prostate specific antigen and/or abnormal digital rectal examination. All studies were interpreted by a dedicated radiologist who reported areas of interest in the peripheral zone as normal, equivocal or suspicious on MRI and MRSI separately. Equivocal and suspicious areas were then correlated with a 3-dimensional prostate model. All patients underwent a standard TRUS 10-core peripheral zone biopsy with up to 4 additional biopsies targeted at the equivocal or suspected sites.

Results

Prostate cancer was detected in 7 of 24 subjects (29.2%). Considering the equivocal category as test negative the sensitivity, specificity, positive and negative predictive values, and the accuracy of MRI, MRSI and combined MRI/MRSI for the detection of prostate cancer were 57.1%, 57.1% and 100.0%, 88.2%, 82.4% and 70.6%, 66.7%, 57.1% and 58.3%, 83.3%, 82.1% and 100%, and 79.2%, 75.0% and 79.2%, respectively. The site of positive biopsy correlated correctly in 50% and 28.6% of MRI and MRSI labeled suspicious cores, respectively.

Conclusions

MRI and MRSI have the potential to identify cancer foci and direct TRUS in patients with a previous negative TRUS biopsy. Further, larger studies are required to quantify the amount of benefit.     

MRI定位联合经直肠超声引导下经会阴穿刺诊断前列腺癌

目的观察MRI引导目标穿刺活检(TB)诊断前列腺癌(PCa)的临床应用价值。方法对120例临床疑诊PCa患者行MRI,而后在经直肠超声(TRUS)引导下,分别采用系统穿刺(SB)与MRI定位行经会阴前列腺目标穿刺术(MRI-TB)。根据穿刺病理结果统计SB、MRI-TB及SB+MRI-TB对PCa检出率和穿刺阳性针率。结果病理诊断78例PCa,42例良性病变。SB、MRI-TB对PCa的漏诊率分别为23.08%(18/78)、8.97%(7/78),差异有统计学意义(P=0.048)。SB、MRI-TB及SB+MRI-TB对PCa的检出率分别为50.00%(60/120)、59.17%(71/120)和65.00%(78/120),SB+MRI-TB高于SB和MRI-TB(P均0.05)。SB、MRI-TB及SB+MRI-TB的阳性针率分别为31.17%(374/1 200)、59.58%(286/480)及35.14%(538/1 531),MRI-TB高于SB和SB+MRI-TB(P均0.001)。结论采用MRI-TB方案可提高穿刺阳性针率,减少穿刺点数,降低重复穿刺和并发症风险;联合应用SB+MRI-TB可提高PCa检出率。     

Comparison of endorectal magnetic resonance imaging, guided prostate biopsy and digital rectal examination in the preoperative anatomical localization of prostate cancer

PURPOSE: We compared the accuracy of endorectal magnetic resonance imaging (erMRI), transrectal ultrasound (TRUS) guided biopsy and digital rectal examination (DRE) for detecting the location of cancer in the prostate gland and seminal vesicles. MATERIALS AND METHODS: This is a retrospective study of 106 consecutive patients with prostate cancer who were referred for erMRI before radical prostatectomy. Step-section pathological data and erMRI were available in 90 patients, DRE data were available on 86 and individually labeled sextant core biopsies were available in 45. T1 and T2-weighted erMRI was interpreted by a single reader, who scored the likelihood of tumor on a 5-point scale in each seminal vesicle and in 12 locations in the prostate gland. MR spectroscopy data were not used for erMRI interpretation. One pathologist reviewed whole mount serial sections of radical prostatectomy specimens. The area under ROC curves was used to evaluate accuracy. RESULTS: The area under ROC curves for tumor localization was higher for erMRI than for DRE at the prostatic apex (0.72 vs 0.66), mid gland (0.80 vs 0.69) and base (0.83 vs 0.69). It was likewise higher for erMRI than for TRUS biopsy in the mid gland (0.75 vs 0.68) and base (0.81 vs 0.61) but not in the apex (0.67 vs 0.70). On mixed model analysis erMRI significantly increased the accuracy of prostate cancer localization by DRE or TRUS biopsy (each p <0.0001). CONCLUSIONS: For prostate cancer localization erMRI contributes significant incremental value to DRE or TRUS biopsy findings (each p <0.0001).     

靶向穿刺与靶向联合系统穿刺对前列腺PI-RADS评分4~5分患者的诊断效能比较

目的比较靶向穿刺与靶向联合系统穿刺对多参数磁共振(mpMRI)前列腺影像报告与数据系统(PI-RADS)评分4~5分患者的诊断效能。方法回顾性分析2018年1月至2020年2月南京大学医学院附属鼓楼医院378例前列腺PI-RADS评分为4~5分且接受前列腺靶向穿刺联合系统穿刺患者的临床资料。中位年龄69(64,75)岁,中位前列腺特异性抗原9.5(6.7,16.3)ng/ml,中位前列腺体积34.1(23.5,48.4)ml。PI-RADS评分4分240例,5分138例。所有患者均行经会阴前列腺穿刺,在mpMRI/经直肠超声融合图像引导下,先行2针靶向穿刺,再行12针系统穿刺。评估穿刺病理及穿刺阳性的Gleason评分,通过χ²检验或Fisher精确检验比较不同穿刺方式前列腺癌和有临床意义前列腺癌(CsPCa)的检出情况。结果378例中290例阳性,88例阴性。靶向穿刺平均2.4针/例,系统穿刺平均12.0针/例,靶向穿刺与系统穿刺对前列腺癌的检出率差异无统计学意义[73.3%(277/378)与68.3%(258/378),P=0.129],对CsPCa的检出率差异无统计学意义[55.8%(211/378)与49.7%(188/378),P=0.094],准确率差异无统计学意义[79.1%(299/378)与77.8%(294/378),P=0.658],穿刺针数阳性率差异有统计学意义[64.2%(580/904)与23.1%(1049/4536),P<0.001]。靶向穿刺与靶向穿刺联合系统穿刺的病理符合率为92.3%(349/378),对前列腺癌的检出率差异无统计学意义[73.3%(277/378)与76.7%(290/378),P=0.275],对CsPCa的检出率差异无统计学意义[55.8%(211/378)与62.2%(235/378),P=0.076]。靶向穿刺对前列腺癌的漏诊率为4.5%(13/290),对CsPCa的漏诊率为10.2%(24/235)。在PI-RADS评分4分的患者中,靶向穿刺与靶向穿刺联合系统穿刺对前列腺癌的检出率差异无统计学意义[65.4%(157/240)与69.2%(166/240),P=0.381],对CsPCa的检出率差异无统计学意义[46.7%(112/240)与52.9%(127/240),P=0.171];靶向穿刺的准确率为82.1%(197/240),对前列腺癌的漏诊率为5.4%(9/166),对CsPCa的漏诊率为11.8%(15/127)。在PI-RADS评分5分的患者中,靶向穿刺与靶向穿刺联合系统穿刺对前列腺癌的检出率差异无统计学意义[87.0%(120/138)与89.9%(124/138),P=0.452],对CsPCa的检出率差异无统计学意义[71.7%(99/138)与78.3%(108/138),P=0.211];靶向穿刺的准确率为73.9%(102/138),对前列腺癌的漏诊率为3.2%(4/124),对CsPCa的漏诊率为8.3%(9/108)。结论对于PI-RADS评分为4~5分的高危前列腺癌患者,靶向穿刺以更少的穿刺针数可获得与靶向穿刺联合系统穿刺相近的检出效果,但仍存在诊断不准确及漏诊的可能。     

Awake stereotactic biopsy of brain stem lesions: technique and results

Summary Background. Brain stem lesions are a heterogenous pathological group. In adults, pre-operative radiological diagnoses prove to be wrong in 10 to 20% of cases. It is therefore imperative to have a tissue diagnosis for appropriate therapeutic measures. Unless these lesions have a sizeable exophytic component, open biopsy and/or resection is marred by low diagnostic yield and prohibitive mortality/morbidity rates.Methods. We describe our experience with awake stereotactic biopsy of brain stem lesions. Keeping the patient awake and monitoring clinically during the procedure allows us to make necessary changes in the trajectory of the biopsy probe to minimize the morbidity. A series of 13 brain stem lesions were stereotactically biopsied using CT guidance. Seven had midbrain lesions; four had pontine and two had Ponto-medullary lesions. A frontal, pre-coronal, transcortical trajectory was used in all patients.Findings. Histological diagnosis was established in all but one patient. There was no procedural mortality, and morbidity was minimal and temporary, occurring in three patients.Conclusion. Awake stereotactic biopsy is a safe technique when combined with clinical monitoring.