CT-guided superior hypogastric plexus block

PURPOSE: This study reports our experience with CT-guided block in the superior hypogastric plexus, using a single needle and anterior approach, in patients with pelvic cancer. METHOD: Ten patients with pelvic malignancy underwent CT-guided hypogastric neurolytic block with alcohol via an anterior approach. A solution of 10, 15, or 20 ml of alcohol, 4 ml of bupivacaine HCl, and 2 ml of contrast medium was injected. The results were evaluated based on pain relief, using a four-grade analogue scale. RESULTS: CT images always showed spread of solution around the iliac vessels. Pain relief was complete in four cases, moderate in two, mild in three, and none in one. Best results were observed with the largest amounts of alcohol. CONCLUSION: CT-guided percutaneous superior hypogastric block is a safe, relatively easy, and effective procedure in patients with severe pain from pelvic malignancies.     

CT-guided suprasternal approach for mediastinal biopsy.

A case involving the use of the suprasternal approach for CT-guided biopsy of small retrosternal lesions is discussed, with the mention of some technical details.     

CT-guided transthoracic needle biopsy

CT-guided biopsy of pulmonary and mediastinal lesions is safe and effective. It is most valuable in those cases in which fluoroscopic guidance is not possible due to resolution or anatomic consideration. CT guidance permits puncture of lesions as small as 0.5 cm, typically not seen fluoroscopically. Sensitivity of biopsy in malignant lung lesions in our series of 83 cases was 92%. Pneumothorax is the most frequent complication (10–60%) and requires chest tube insertion in 5–15% of patients.     

CT导引下的纵隔病变穿刺活检

目的探讨CT导引纵隔病变穿刺活检技术及其临床意义。方法35例纵隔病变在CT导引下行穿刺活检。结果35例纵隔病变穿刺活检病灶成功率100%。诊断准确率94.2%(33/35),其中恶性病变诊断准确率100%(21/21),良性病变为85.7%(11/14)。并发气胸3例(8.6%),纵隔出血1例(2.9%)。结论CT导引下穿刺活检术对于纵隔病变诊断的正确率高,对纵隔病变的诊治具有很大的帮助。     

Triaditis: nondiagnosis at CT-guided liver biopsy.

Percutaneous biopsy plays an important role in the workup of patients with focal hepatic lesions and, with constant advancements in technique, has achieved a high degree of accuracy. However, recently we performed percutaneous liver biopsies on three patients that have resulted in the pathological diagnosis of only portal triaditis. In all three cases, further investigation revealed the existence of focal malignancies. A thorough review of the has failed to reveal other reports of portal triaditis coexisting with focal malignancies or presenting as a focal lesion on radiological imaging studies. We present the three case histories with a discussion of portal triaditis and the possible significance of that diagnosis to physicians pursuing the diagnosis of focal hepatic malignancies.     

CT-guided biopsy. Comments on the puncture technique

Computed tomography is an universally applied method of controlling diagnostic puncture of unrecognized processes in practically any region of the human body. The conditions required, the puncture technique, the various pathways and the types of needles used are discussed.     

CT-guided fine-needle aspiration biopsy of spinal lesions.

PURPOSE: A retrospective study of CT-guided fine-needle aspiration biopsies (FNABs) of spinal lesions performed over a period of 6 years was carried out with the aim of assessing the safety and efficacy of the procedure and to analyse the various approaches used. MATERIAL AND METHODS: Ninety-three FNABs were performed in 87 patients, 4-70 years of age, under CT guidance. Lytic or mixed vertebral lesions with or without a paraspinal soft tissue component were included in the study. The approach depended on the anatomic region and part of the vertebra involved. RESULTS: A definite cytological diagnosis was obtained in 77 patients (88.5%); of these, 47 patients had benign lesions and 30 patients had neoplasms. The most common pathologies encountered were tuberculosis (n=33) and metastases (n=17). There were 10 inconclusive FNABs; these showed blood only, necrotic material or scanty material insufficient for diagnosis. There were no procedure-related complications. CONCLUSION: CT-guided FNAB is a safe and effective technique for the evaluation of spinal lesions and is helpful in planning therapy. Choosing the appropriate approach results in a low complication rate.     

Adult traumatic brachial plexus injury

Injury to the brachial plexus in the adult is usually a closed injury and the result of considerable traction to the shoulder. Brachial plexus injury in the adult is an increasingly common clinical problem. Recent advances in neurosurgical techniques have improved the outlook for patients with brachial plexus injuries. The choice of surgical procedure depends on the level of the injury and the radiologist has an important role in guiding the surgeon to the site of injury. This article will describe the anatomy and pathophysiology of traction brachial plexus injury in the adult. The neurosurgical options available will be described with emphasis on the information that the surgeon wants from imaging studies of the brachial plexus. The relative merits of MRI and CT myelography are discussed.     

MRI of the brachial plexus

Magnetic resonance imaging is the imaging method of first choice for evaluating the anatomy and pathology of the brachial plexus. This review discusses the used imaging techniques, the normal anatomy, and a variety of pathologies that can involve the brachial plexus. The pathology includes primary and secondary tumors (the most frequent secondary tumors being superior sulcus tumor and metastatic breast carcinoma), radiation plexopathy, trauma, thoracic outlet syndrome, neuralgic amyotrophy, chronic inflammatory demyelinating polyneuropathy (CIDP), and multifocal motor neuropathy (MMN). Received: 26 June 2000/Accepted: 19 July 2000     

Magnetic resonance imaging of the brachial plexus. Anatomy

The brachial plexus is a difficult region to evaluate with radiological techniques. MR imaging has great potentials for the depiction of the various anatomical structures of the brachial plexus--i.e., spinal ganglion, ventral nerve rami root exit of the neural foramina, trunks and cords. Moreover, MR imaging, thanks to its direct multiplanarity, to its excellent soft-tissue contrast, and to its lack of motion artifacts, allows good evaluation of pathologic conditions in the brachial plexus, especially traumas and cancers. On the contrary CT, in spite of its high spatial resolution and good contrast, cannot demonstrate the anatomical structures of the brachial plexus. US detects superficial structures, and conventional radiographs depict only indirect changes in the adjacent lung apex and skeletal structures. From November 1989 to May 1990, 20 normal volunteers (15 males and 5 females; average age: 35 years) were studied with MR imaging. Multisection technique was employed with a dedicated coil and a primary coil. The anatomical structures of the brachial plexus were clearly demonstrated by T1-weighted sequences on the sagittal and the axial planes. T2-weighted pulse sequences on the coronal plane were useful for the anatomical definition of the brachial plexus and for eventual tissue characterization. The correct representation of the anatomical structures of the brachial plexus allowed by MR imaging with our standard technique makes MR imaging the most appropriate exam for the diagnosis of pathologic conditions in the brachial plexus, although its use must be suggested by specific clinical questions.     

CT-guided biopsy of pelvic masses

CT-guided fine-needle puncture (FNP) was carried out in 74 patients with pelvic masses and resulted in a correct diagnosis in 36/45 patients (80%) with malignant disease. FNP was true-positive in 66.7% and false-negative in 20%. In benign and inflammatory pelvic space-occupying lesions, FNP confirmed the suspected CT diagnosis in all cases by cytology and bacteriology. CT-guided puncture should always be used complementary to CT when a mass of unclear etiology is present.     

Pancreatic transplants: CT-guided biopsy

With use of computed tomographic (CT) guidance, 10 biopsies of pancreatic allografts were performed in four patients to determine the cause of pancreatic dysfunction. All biopsies were performed with an 18-gauge biopsy needle and with use of a biopsy gun. On four occasions, simultaneous biopsies of the pancreatic head and tail were performed. In nine of the 10 biopsies, specimens obtained were adequate for diagnosis. In two of the four simultaneous procedures, important histologic differences were noted between specimens from the head and those from the tail of the allograft. No complications occurred. These findings demonstrate the ease, accuracy, and safety of CT-guided biopsies of pancreatic transplants with a biopsy gun. Simultaneous sampling of the pancreatic head and tail may provide important clinical information that may not be available when the usual cystoscopically guided biopsy of the pancreatic head is used.     

CT引导淋巴瘤穿刺活检的临床应用

目的探讨CT引导下穿刺活检深部病灶确诊淋巴瘤的临床应用价值。方法58例患者在CT引导下用16~20G活检枪穿刺取材,穿刺部位包括纵隔、肺部、后腹膜、胃肠道、脾、肾、肾上腺及骨骼肌肉深部肿块。病理行常规HE染色及免疫组化染色检查。结果CT引导下穿刺活检确诊恶性淋巴瘤47例,诊断阳性率81%,假阴性11例;其中4例重复穿刺活检明确诊断。穿刺确诊病例中,89.4%(42/47)获得淋巴瘤的组织学分型,另5例因组织少,仅诊断为恶性淋巴瘤,未做出具体分型。本组病例无一例发生严重并发症。结论CT引导深部病灶穿刺活检术对淋巴瘤诊断有确诊率高,并发症少,快速、安全的优点;对恶性淋巴瘤的确诊及组织学分型有重要的作用。     

CT 引导下腰椎病变穿刺活检

探讨ＣＴ引导下腰椎及椎间盘突变穿刺活检的价值和方法。方法在ＣＴ引导下用Ａｃｋｅｒｍａｎｎ氏对３２例腰椎及腰椎间盘病变进行了穿刺活检。结果：３２例均经追踪或／和手术证实,穿刺准确率为９０．６％。无１例引起严重并并发症及后遗症。结论ＣＴ引导下行腰椎活检是一种安全可靠的方法。．     

Imaging tumours of the brachial plexus

Tumours of the brachial plexus are rare lesions and may be classified as benign or malignant. Within each of these groups, they are further subdivided into those that are neurogenic in origin (schwannoma, neurofibroma and malignant peripheral nerve sheath tumour) and those that are non-neurogenic. Careful pre-operative diagnosis and staging is essential to the successful management of these lesions. Benign neurogenic tumours are well characterized with pre-operative MRI, appearing as well-defined, oval soft-tissue masses, which are typically isointense on T1-weighted images and show the "target sign" on T2-weighted images. Differentiation between schwannoma and neurofibroma can often be made by assessing the relationship of the lesion to the nerve of origin. Many benign non-neurogenic tumours, such as lipoma and fibromatosis, are also well characterized by MRI. This article reviews the imaging features of brachial plexus tumours, with particular emphasis on the value of MRI in differential diagnosis.     

Sonography of brachial plexus traction injuries

OBJECTIVE: Our purpose was to evaluate the feasibility of sonography in identifying nerve abnormalities in patients with traction injury of the brachial plexus. CONCLUSION: Sonography of the brachial plexus was technically feasible, although the entire brachial plexus could not be evaluated. Sonography appears to be a useful bedside imaging technique for assessing brachial plexus injury. The potential of sonography as a complementary diagnostic tool in the evaluation of these patients warrants further investigation.     

臂丛神经MRI正常表现

目的：分析臂丛神经在MRI不同成像序列中的正常表现。方法：20名正常志愿者行常规及MR新技术检查。观察各序列中臂丛神经的表现。结果：常规T1WI、T2WI臂丛神经呈等信号,STIR上呈高信号。横断面上,显示神经根自椎间孔处穿出,行于斜角肌间隙,后与锁骨下动脉及腋动脉伴行;冠状面上,显示为由C5～T1神经孔旁起始的条索状结构;矢状面上表现为结节状结构,行于斜角肌间隙,围绕锁骨下动脉。3D-FIESTA-c序列显示椎管内神经前后根为脑脊液高信号环绕下的等信号丝状结构。薄层无间隔STIR图像上背景组织信号抑制,椎管外臂丛神经显示为条状高信号结构,3D—FSPGR图像显示神经为条状等信号,同时反应其与邻近组织结构的关系。结论：联合常规及MRI新技术,可全面、清晰地显示臂丛神经。