激光导引装置在胸部病变CT导引穿刺活检中的应用

目的　评价激光导引装置在胸部病变CT导引穿刺活检中的作用。资料与方法　有手术病理或临床随访的胸部病变CT穿刺活检 335例 ,其中 1 39例应用激光导引装置 (激光组 ) ,其余 1 96例无激光导引装置 (非激光组 )。依据手术病理、临床随访结果对活检病变作出最后诊断。比较激光组与非激光组在诊断正确率、并发症发生率方面有无差别。P <0 .0 5定义为有显著性差异。结果　激光组诊断正确率为 90 .6 % (1 2 6/ 1 39) ,明显高于非激光组 82 .7% (1 62 / 1 96)的诊断正确率 (χ2 =4.31 ,P =0 .0 379)。对于直径 >3cm的病灶 ,激光组和非激光组诊断正确率相近 (分别为 93 .3 %和 89.7% ,χ2 =0 .60 ,P =0 .44) ,但对≤ 3cm的病灶 ,激光组诊断正确率明显高于非激光组 (分别为 88.6 %和 77.1 % ,χ2 =4.1 2 ,P =0 .0 4 2 3) ;对于紧贴胸膜病灶 ,激光组诊断正确率 (94.6 % )略高于非激光组(91 .5 % ) ,两者之间无统计学差异 (χ2 =0 .30 ,P =0 .5833) ,对于非紧贴胸膜病灶 ,激光组诊断正确率 (89.2 % )明显高于非激光组 (79.9% ) (χ2 =3 .87,P =0 .0 4 90 )。激光组和非激光组气胸发生率分别为 1 2 .2 % (1 7/ 1 39)和 1 2 .8%(2 5/ 1 96) (χ2 =0 .0 1 ,P =0 .92 73)。结论　激光导引装置在经皮胸部CT导引穿刺活检     

CT导引穿刺活检对脊柱病变的诊断价值

目的：评估 CT 导引经皮穿刺活检对脊柱病变的诊断价值。方法：回顾性分析行 CT 导引经皮穿刺并经手术病理证实的103例脊柱病变患者的病例资料。103例中良性病变60例,恶性病变43例。活检部位包括颈椎7例、胸椎34例、腰椎52例和骶椎10例。穿刺活检要点为选择最佳层面和穿刺点以及多点穿刺。患者的体位（仰卧位或俯卧位）和活检路径取决于病灶部位。穿刺针为 Ackermann 针,有17例辅助使用抽吸针。活检标本送病理科进行细胞病理学检查。结果：103例活检术中穿刺针均安全地穿刺入病变内,活检成功率为100％。穿刺活检正确诊断89例,假阴性11例,假阳性3例,总的诊断符合率为86．4％,恶性和良性病变分别为90．69％和83．33％,差异无统计学意义（χ2＝1．157,P ＞0．05）;对颈椎、胸椎、腰椎和骶椎病变的诊断符合率分别为85．71％,79．41％,90．38％和90．00％。所有患者未发生严重并发症。结论：CT 导引经皮穿刺活检是诊断脊柱病变的安全有效的方法。     

CT介入放射学的近况与展望

ＣＴ介入放射学的近况与展望卢延张雪哲ＣＴ介入放射学包括活检和介入性治疗，已广泛应用于日常临床工作中，为了较全面地了解ＣＴ介入放射学近年来的概况，兹将最近有关这方面的报告加以综述（以１９９６年北美放射学会议资料为主），希望ＣＴ介入放射学在我国进一步向广...     

CT导引下胰腺细针穿刺活检

目的：评价ＣＴ导引下胰腺穿刺抽吸活检的临床应用。材料与方法：活检部位包括胰头部３０例，胰体１１例，胰尾９例，共５０例。全部采用２２Ｇ抽吸针。活检的要点包括选择最佳层面和进针点，作多点扇状快速穿刺抽吸。结果：胰腺穿刺活检的阳性率９７．９％。未发现并发症。结论：ＣＴ导引下胰腺细针穿刺活检正确率高，并发症少，是胰腺疾病有价值的术前诊断方法。     

CT导引穿刺活检对纵隔病变的诊断价值

目的 评估CT导引经皮细针穿刺活检对纵隔病变的诊断价值.方法 回顾性研究CT导引经皮穿刺纵隔病变104例.活检部位包括前纵隔73例、中纵隔29例和后纵隔2例.病灶大小2.31 cm×1.11 cm～14.5 cm×10.3 cm,病灶直径＜3.0 cm 16例,3.1～5.0 cm 39例,＞5 cm 49例,使用18～20 G穿刺针作穿刺抽吸活检.结果 穿刺活检成功率100%,穿刺活检诊断为恶性病变67例、良性27例、假阴性8例,假阳性2例.穿刺活检正确率、灵敏度和特异度分别为90%、92%和100%.病变大小和病变良恶性对活检正确率差异无统计学意义(P＞0.05).并发症为轻度气胸(6例)、咯血(2例)和纵隔气肿(1例).结论 CT导引经皮细针穿刺活检纵隔病变是安全可行的诊断方法.     

CT导引下纵隔穿刺活检

ＣＴ导引下纵隔穿刺活检张雪哲苑丽萍蒲群ＣＴ导引下纵隔穿刺活检术是纵隔病变鉴别诊断的手段之一。我院自１９８５年８月至１９９６年５月做胸部活检３１９例，其中４１例为ＣＴ导引下纵隔肿块穿刺活检。笔者重点讨论纵隔穿刺活检技术和临床应用价值。材料与方法４１例中...     

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。     

18G套管血管穿刺针导引20G活检枪经皮穿刺活检的临床应用(附45例报告)

目的 :评价 18G套管血管穿刺针引导 2 0G活检枪经皮穿刺活检的临床应用效果。方法 :45例患者均为占位性病变 ,其中肺 18例、肝 16例、甲状腺 2例、纵隔 3例、颈深部软组织 2例、胸膜 3例、腹腔 1例 ,均在CT导向下以 18G套管血管穿刺针先行穿刺病灶 ,后以 2 0G弹射式活检枪取活检和 (或 )涂片。结果 :共行活检手术 47次 ,穿刺成功率 10 0 % ;取材成功率 93 .3 % ( 4 2 / 45 ) ,活检诊断率 95 .2 % ( 4 0 / 42 ) ;肝组取材率、成功率、诊断正确率 10 0 % ;肺组取材率、成功率 88.9%( 16/ 18) ,诊断符合率 87.5 % ( 14 / 16)。并发症 :气胸 3例 ,咯血 1例 ,总发生率 8.9% ( 4 / 45 )。结论 :18G套管血管穿刺针引导 2 0G活检枪经皮穿刺活检能够提高共轴法穿刺取材成功率 ,降低并发症 ,缩短手术时间 ,是一种安全、高效、简便的共轴穿刺方法。     

胸部病变CT导向活检的临床应用

目的 分析ＣＴ导引下胸部病变穿刺活检的临床应用。材料与方法对４０例胸部病变包括肺内３２例,肺门１例,纵隔２例,胸膜５例患者行ＣＴ定位穿刺活检,采用０－２１Ｇ抽吸针或９号腰穿针,选最佳层面和进针点,作多点提插旋转穿抽吸,结果 胸部病变穿刺活检总阳性率;细胞学８４％,组织学１００％,其中２例出现无症状的少量气胸,未发现严重并发症。结论 ＣＴ导引入胸中穿刺活正确率高,并发症少,有地疾病早期确诊治疗,免除     

CT导向活检方法的研究及其临床应用

作者就６５例胸腹部病灶在ＣＴ导向下穿刺活检，对体表标记定位及十字定位作比较，提出了改良体表定位法，对较小病灶的穿刺可减少穿刺方向调整次数，提高一次穿刺成功率。穿刺部位胸部４０例，腹部２５例。恶性病变３５例，良性病变３０例。穿刺诊断总准确率９０．８％，恶性病变准确率８８．６％，没有假阳性。除１例胸部穿刺发生张力性气胸外，余１３例轻微并发症不需特殊处理。     

CT引导经皮肺穿刺切割活检对肺内疑难病变诊断的研究

目的:探讨CT导引下经皮肺穿刺切割活检技术及临床应用价值。方法:在CT定位导引下使用槽式切割活检针进行病理组织学检查。结果:110例病变中,12例肺内弥漫性病变,98例肺内局灶性病变。在局灶性病变中,邻近胸膜的病灶36例,邻近肺门的病灶6例,距穿刺点胸膜最远8. 5cm。病灶靶区刺中率98. 18% (10. 8/110 ) ,切割取材成功率92 . 72 % (10 2 /110 ) ,病理确诊率96 . 36 % (10. 6 /110 ) ,并发症19.0 9(2 1/110 )。结论:①让患者保持相对固定的呼吸屏气相位,精确控制进针深度、角度及穿刺路径是刺中病灶靶区、减少并发症的关键;②CT导引下经皮肺穿刺切割活检技术是肺内疑难病变定性诊断的理想方法,具有重要的临床意义     

CT引导甲状腺穿刺活检术的应用

目的 探讨CT导向甲状腺穿刺活检在介入治疗甲状腺功能亢进(甲亢)基础研究中的应用.方法 对15例甲状腺动脉行PVA(直径150 μm)微粒及平阳霉素栓塞治疗的Graves病(GD)患者于术前、术后共行52次甲状腺穿刺活检,穿刺术前按甲状腺肿大程度进行分组:(1)甲状腺Ⅱ°以上肿大患者19例次,行触摸法穿刺活检术.(2)甲状腺不肿大或Ⅱ°以下肿大患者33例次,按时间先后依次进行触摸下和CT引导下穿刺活检,触摸下穿刺取材9例次后,因触摸穿刺成功率较低而改行CT引导下穿刺取材.结果 ①甲状腺Ⅱ°以上肿大患者19例次行触摸法穿刺活检术17例次成功,成功率89.5%.②甲状腺不肿大或Ⅱ°以下肿大组中触摸法穿刺活检术成功5/9例次,CT引导穿刺活检术成功22/24例次(91.7%)两者比较,差异有统计学意义(P＜0.05).③全部病例未出现穿刺并发症.结论 CT导引甲状腺穿刺活检术,是介入治疗GD术后为基础研究提供标本的一种准确、安全、成功率高的穿刺方法.     

CT-Guided Biopsy of Small Liver Lesions: Visibility,Artifacts, and Corresponding Diagnostic Accuracy

Purpose Our study aimed to determine the visibility of small liver lesions during CT-guided biopsy and to assess the influence of lesion visibility on biopsy results. Material and Methods Fifty patients underwent CT-guided core biopsy of small focal liver lesions (maximum diameter, 3 cm); 38 biopsies were performed using noncontrast CT, and the remaining 12 were contrast-enhanced. Visibility of all lesions was graded on a 4-point-scale (0 = not visible, 1 = poorly visible, 2 = sufficiently visible, 3 = excellently visible) before and during biopsy (with the needle placed adjacent to and within the target lesion). Results Forty-three biopsies (86%) yielded diagnostic results, and seven biopsies were false-negative. In noncontrast biopsies, the rate of insufficiently visualized lesions (grades 0–1) increased significantly during the procedure, from 10.5% to 44.7%, due to needle artifacts. This resulted in more (17.6%) false-negative biopsy results compared to lesions with good visualization (4.8%), although this difference lacks statistical significance. Visualization impairment appeared more often with an intercostal or subcostal vs. an epigastric access and with a subcapsular vs. a central lesion location, respectively. With contrast-enhanced biopsy the visibility of hepatic lesions was only temporarily improved, with a risk of complete obscuration in the late phase. Conclusion In conclusion, visibility of small liver lesions diminished significantly during CT-guided biopsy due to needle artifacts, with a fourfold increased rate of insufficiently visualized lesions and of false-negative histological results. Contrast enhancement did not reveal better results.     

比较CT引导穿刺活检对肺内大小结节的诊断价值

目的 比较研究ＣＴ引导刺活检对肺内不同大小结节诊断应用价值。方法 对９６例患者的肺人结节，依大小将大于３ｃｍ的列为大结节，小于３ｃｍ的列为小结节。确诊率通过组织病理学结果评价。并记录肺出智力气胸的发生率。结果 肺内大结节ＣＴ引导穿刺确诊率为９１％，气胸发生率８％；肺内小结节ＣＴ引导穿刺确诊率为９０％，气胸发生率１０％。结论 ＣＴ引导穿刺活检肺内大结节，小结节确诊率是机上的，两者的并发症同样低。     

MRI-guided biopsy and fine needle aspiration biopsy (FNAB) in the diagnosis of musculoskeletal lesions

Objectives

The purpose of this study was to evaluate the diagnostic performance of magnetic resonance imaging (MRI) guided musculoskeletal biopsy and the value of fine needle aspiration biopsy (FNAB) when combined with histologic biopsy.

Materials and methods

A total of 172 biopsies were performed under MRI guidance, 170 were histologic biopsies. In 112 cases, a fine needle aspiration biopsy was also performed. In two cases, a stand-alone FNAB was performed. The diagnostic performance was evaluated retrospectively by comparing the histopathologic and cytologic diagnosis with the current or final diagnosis after at least one year of clinical and imaging follow-up. A 0.23 T open MRI scanner with an interventional stereotactic guidance system was used.

Results

The overall diagnostic accuracy of MRI guided biopsy was 0.95, sensitivity 0.91, specificity 0.98, positive predictive value (ppv) 0.97 and negative predictive value (npv) 0.93. The diagnostic accuracy of trephine biopsy alone was 0.93, sensitivity 0.89, specificity 0.98, ppv 0.97 and npv 0.91 and accuracy for FNAB alone was 0.85, sensitivity 0.80, specificity 0.90, ppv 0.89 and npv 0.82.

Conclusions

MRI guidance is a feasible and accurate tool in percutaneous musculoskeletal biopsies. Fine needle biopsy is a useful low-cost supplement to histologic biopsy.     

弹簧芯状活检针在CT引导经皮肺穿刺活检中的应用

目的：探讨CT引导下使用弹簧芯状活检针行比皮肺穿刺活检的诊断准确性和并发症发生率。方法：38例使用弹簧芯状活检针的经皮肺穿刺活检。CT扫描确定并引导穿刺途径,达预定位置取材。结果：35例有明显的病理诊断,诊断准确性92％,恶性肿瘤和良性病变的诊断准确性分别为97％和100％。活后并发气胸4例,咯血1例,结论：CT引导下使用弹簧芯状活检针行经皮肺穿刺活检的气胸发生率与细针抽吸相近,使弹簧芯状活检针行CT引导下肺穿刺活检可以提高诊断的准确性。     

Transjugular liver biopsy in liver transplant patients using an 18-gauge automated core biopsy needle

Aim of this retrospective study is to evaluate accuracy and safety of transjugular liver biopsy using an 18-gauge automated core biopsy needle, in patients underwent liver transplantation. 183 consecutively transjugular liver biopsy were performed in 115 liver transplant patients. An 18-gauge automated core needle biopsy was used in all patients. Technical success was achieved in 182 procedures (99.5%). In one patient we were not able to obtain a liver sample. The mean number of passages was 1.43 (range 1–5). Mean number of fragments was 2 (range 1–12). Mean total length of the specimens was 1.7 cm (range 0.5–3.4 cm). The specimen was adequate for diagnosis in 172 (94.5%) cases and suboptimal or inadequate in 10 (4.5%). Suboptimal or inadequate samples were associated with higher number of passages (2.0 vs. 1.4, p < 0.012), higher number of fragments (4.3 vs. 1.9, p < 0.0001) and decreased total length of the specimens (0.99 vs. 1.73, p < 0.03). As only complication one patient (0.5%) had a large perihepatic hematoma requiring blood transfusion. In conclusion using an 18-gauge automated core needle biopsy, in most liver transplant recipients, an accurate diagnosis can be obtained with one or two passages. This is associated with a low risk of complications.     

低剂量技术降低CT引导下经皮肺切割活检吸收剂量的临床研究

目的 探讨临床应用低剂量技术降低CT引导下经皮肺穿刺自动切割活检(ACNB)辐射剂量的可行性。方法 412例ACNB中146例(A组)采用传统方法引导,266例(B组)采用低剂量技术引导,按图像颗粒均匀性、解剖结构细节、界面清晰度和有无伪影等评定图像质量,比较2组穿刺活检准确率、操作时间及辐射剂量,并探讨CT引导中降低辐射剂量的方法。结果 B组图像解剖结构细节分辨率降低,但不影响穿刺成功率。A、B组穿刺准确率分别为95.9%、95.1%,操作时间为(16±2.2)、(15.9±2.0)min,组间差异均无统计学意义。A、B组有效剂量为(1.74±0.7)及(0.59±0.14)mSv,B组有效剂量降低66%,差异有统计学意义(t=19.3415,P(0.05)。结论 CT引导下经皮肺穿刺活检是诊断和鉴别肺部病变的重要方法,低剂量扫描、缩小扫描范围及减少扫描次数能显著降低受检者X线辐射剂量,但不影响诊断效果。