CT监视下穿刺活检在脊柱病变鉴别诊断中的应用

目的：探讨CT监视下穿刺活检在脊柱病变鉴别诊断中的应用价值。方法：467例诊断不明确的脊柱病变患者中男281例，女186例；年龄2～82岁，平均43岁。在CT监视下行病变部位经皮穿刺活检。回顾分析穿刺活检的准确性、安全性。结果：467例患者共行476次穿刺，3例次取材不满意，取材满意率99．4％：4例次（8．4‰）发生轻微并发症，无严重并发症发生。407例416例次经手术或随访证实诊断准确．穿刺活检准确率87．9％；198例行手术治疗，穿刺病理与手术病理符合率为81．8％（162／198）。总的漏诊率、误诊率分别为12．6％和12．8％。结论：CT监视下穿刺脊柱病变活检是诊断准确率高、损伤小的微创检查．在脊柱病变的鉴别诊断中有重要作用。     

胸腰椎病变CT监视下穿刺活检路径分析

目的探讨胸腰椎病变CT监视下穿刺活检中穿刺路径的选择方法。方法141例胸腰椎病变临床诊断不清患者，其中胸椎70例，腰椎71例。根据病变位于脊椎的不同部位选择合适的穿刺路径，于CT监视下穿刺取材。穿刺路径：经椎旁路径63例，经椎弓根路径45例，经肋椎关节路径11例，其他路径22例。结果141例中共有128例诊断正确，穿刺结果诊断正确率为90．8％。无并发症发生。结论胸腰椎病变穿刺路径的选择要根据病变的位置不同具体分析。总的原则是安全、取材量多、对患者损伤小。     

CT介导同轴套管针脊柱病变经皮活检术

目的探讨CT介导同轴套管针经皮活检术在脊柱病变临床诊治中的价值。方法CT引导下同轴穿刺套管针经皮穿刺活检脊柱病变37例,其中胸椎9例,腰椎13例,骶椎8例,胸腰椎同时累及7例。根据病变的部位,采用经椎弓根或椎旁入路,进入病变部位后旋转套管切割病变组织,送组织学检查。结果所有37例患者均穿刺成功,每例患者获穿刺组织块1～4块,平均2.1块;34例获明确诊断,分别为转移性肿瘤15例,结核9例,脊索瘤5例,多发性骨髓瘤2例,骨巨细胞瘤2例,嗜酸性细胞肉芽肿1例,成功率91.9%;无一例严重并发症。结论CT介导同轴套管针脊柱病变经皮活检术诊断率高,并发症少,且微创、安全,价格低廉,值得在临床推广应用。     

高分辨率微细血流成像引导术前经皮穿刺活检

目的分析高分辨率微细血流成像(HDMFI)引导穿刺活检的临床价值。方法回顾性分析46例经手术切除病灶并明确病理诊断的单发占位病变患者,病灶位于浅表31例、腹腔8例、盆腔7例;术前接受超声引导下穿刺活检,最大径<1 cm者接受细针穿刺,≥1 cm者接受粗针活检,其中25例以常规CDFI(CDFI组)、21例以HDMFI靶向引导穿刺(HDMFI组);对比2组取材成功率、诊断符合率及穿刺并发症。结果对CDFI组共行细针活检16例、粗针活检9例,穿刺61次,其中52次取材成功,22例获得明确病理诊断;HDMFI组细针活检15例、粗针活检6例,穿刺48次,46次取材成功,20例获得明确病理诊断。CDFI组穿刺活检取材成功率、诊断符合率分别为85.25%(52/61)、88.00%(22/25),HDMFI组分别为95.83%(46/48)、95.24%(20/21),HDMFI组均高于CDFI组(P均<0.01)。术中及术后均未见穿刺并发症。结论 HDMFI可清晰显示病灶内部微细血流灌注,用于精准引导穿刺效果较CDFI更佳。     

Percutaneous computed-tomography-guided biopsy of the thoracic and lumbar spine

Axial computed tomographic scans were used to guide percutaneous needle biopsies in 76 patients with thoracic and lumbar spinal lesions. Prebiopsy evaluation included spine radiographs, radionuclide bone scans, computed tomographic scans, magnetic resonance imaging scans in some cases, and coagulation studies. Forty-five patients were diagnosed as having metastatic lesions, 11 infection, and 12 primary bone tumors. Of all patients, 34 had lytic vertebral lesions with significant collapse and questionable spinal stability. Six of those had a concomitant paravertebral mass. A clinical and pathologic correlation was completed for each of the cases studied. Histologic diagnosis confirming the clinical suspicion was obtained on the first biopsy attempt in 65 (86%) of the 76 cases.     

The usefulness of percutaneous fine-needle aspiration biopsy in infants and children

During the past 2 years percutaneous fine-needle aspiration biopsy has been employed to help establish or confirm diagnosis in 32 infants and children. A 22-gauge needle is used to aspirate the site of suspected disease. For lesions inside the chest or abdomen, the needle is guided with the help of fluoroscopy, ultrasound, or computed tomography (CT) scan. Nineteen of the 32 patients had malignant disease, including lymphoma, neuroblastoma, rhabdomyosarcoma, Ewing's sarcoma, osteosarcoma, and leukemia. In all patients with solid tumors, tissue obtained at operation confirmed the accuracy of the diagnosis. In seven children with suspiciously enlarged lymph nodes, an open biopsy was avoided when the needle aspirate was clearly benign. In four children, the early appearance of metastatic or recurrent malignancy was confirmed without the need for open biopsy. In this small series, there were no false-negative or false-positive needle aspirates, and no complications directly related to the procedure. The skill and experience of the cytopathologist is essential to the success of this technique. Percutaneous fine-needle aspiration biopsy is a safe and reliable alternative method of establishing a diagnosis in infants and children with suspected malignant disease.     

Experience in 300 cases of CT-directed stereotactic surgery for lesion biopsy and aspiration of haematoma

Despite advances in imaging of the brain, an accurate diagnosis of brain lesions requires tissue sampling and histological verification. A series of CT-directed procedures has been performed in 300 patients with deep sited, multiple, diffuse, extensive, small or inflammatory lesions, brain stem haematomas and tumours presenting with epilepsy. A positive diagnosis was obtained in 271 cases (92.8%), no diagnosis in 21 cases (7.2%). Therapeutic results were also obtained in eight cases (2.7%) of brain stem haematoma aspiration. Complications occurred in 14 cases (4.7%) including one death (0.3%). Because of the importance of an accurate diagnosis in order to avoid inappropriate therapy, together with the relative safety of the technique, CT-directed stereotactic biopsy should be considered in all patients harbouring deep seated, multiple, diffuse, small or inflammatory brain lesions.     

胸腰椎经皮椎弓根螺钉置钉的准确性分析

目的:分析胸腰椎经皮椎弓根螺钉固定术的置钉准确性.方法:回顾分析2010年7月～2012年12月我院53例胸腰椎经皮椎弓根螺钉固定术患者,男31例,女22例;年龄18～73岁,平均51.2岁.腰椎退变性疾病24例,胸腰椎骨折29例.置钉节段为T8～S1.根据术后CT轴位扫描图像以及患者是否出现椎弓根螺钉相关并发症,将椎弓根螺钉位置分级:0级,螺钉位于椎弓根皮质内;1级,螺钉突破椎弓根骨壁但≤2mm;2级,螺钉突破椎弓根骨壁＞2mm,但无神经受压等症状;3级,出现螺钉相关并发症.结果:共置入椎弓根螺钉212枚,平均4.0枚/例.212枚螺钉中,0级175枚(82.5％);1级32枚(15.1％);2级4枚(1.9％);3级1枚(0.5％),患者出现神经受压症状,行翻修术.37枚位置不佳的螺钉中,24枚向内侧切出椎弓根,13枚向外侧切出.结论:胸腰椎经皮椎弓根螺钉固定技术虽置钉位置欠佳率较高,但很少发生2级以上置钉位置不佳者.     

Percutaneous transpedicular biopsy of thoracic and lumbar vertebrae--method and diagnostic validity

BACKGROUND: Percutaneous transpedicular needle biopsy was performed on thoracic and lumbar vertebral bodies with a thin trocar (2.0 mm outer diameter) under observation with a conventional X-ray image intensifier in order to establish a correct histopathological diagnosis. We also evaluated the clinical validity of this less invasive diagnostic method in terms of the accuracy of the pathological diagnosis. METHODS: Twenty-eight thoracic or lumbar vertebrae of 26 patients with abnormalities observed on routine X-ray, CT, or MRI images underwent percutaneous transpedicular needle biopsy under local anesthesia. A threaded trocar with an outer diameter of 2.0 mm was screwed into the intra-vertebral lesion through the pedicle from the posterior side under control of X-P imaging, and a small amount of tissue or fluid was collected. RESULTS: For all patients but two, where inadequate specimens were obtained, correct diagnoses were made, which were confirmed by pathological diagnoses of massive tissue obtained during subsequent reconstructive surgery. CONCLUSIONS: The accuracy rate of diagnosis with this biopsy method was 92% without significant intra- or postoperative complications. Therefore, it can be concluded that this less invasive biopsy method used in conjunction with conventional X-ray apparatus has good potential to result in correct preoperative diagnosis of thoracic and lumbar lesions so that more effective treatment can be determined.     

Role of percutaneous fine-needle aspiration biopsy in suspected intrathoracic malignancy.

Percutaneous fine-needle aspiration (PFNA) biopsy is an accepted technique for the diagnosis of suspected intrathoracic malignancy, but the appropriate indications for its use have not been clearly defined. To help establish guidelines, we performed a retrospective analysis of 188 patients who underwent PFNA biopsy for suspected intrathoracic malignancy. Biopsy led to a diagnosis in 72% (135/188) of the patients, but in 27% (50/188) samples were inadequate for cytological diagnosis, and in 2% (3/188) samples were adequate but failed to yield a diagnosis. Fifty-three patients underwent surgical intervention, thus allowing histological confirmation of the cytological diagnosis. In patients with a diagnosis from PFNA biopsy, operation confirmed malignancy in 97% (37/38) and a specific cell type in 79% (30/38). In patients without a diagnosis after biopsy, a malignancy was found in 73% (11/15) at the time of operation. This suggests a high rate of accuracy when PFNA biopsy provides a diagnosis. However, it also illustrates that a substantial percentage of PFNA biopsy attempts fail to yield a diagnosis in patients ultimately found to have malignancies. This implies that PFNA biopsy might best be reserved for patients who are not surgical candidates.     

经皮椎体后凸成形术对胸腰椎溶骨性肿瘤的疗效观察

目的：观察经皮椎体球囊后凸成形术（PKP）治疗胸腰椎溶骨性肿瘤的疗效及安全性。方法：回顾性分析2009年1月至2010年10月经皮椎体成形术（PVP）治疗胸腰椎溶骨性肿瘤35例,其中脊柱转移瘤23例,血管瘤9例,多发性骨髓瘤3例。术前均有顽固性背痛,无神经症状,CT及MRI提示椎体溶骨性病变。在C型臂透视下行椎弓根穿刺球囊扩张椎体后注射骨水泥,采用VAS评分、WHO疼痛缓解标准及Owestry功能障碍指数（ODD来评估疼痛缓解,日常功能恢复情况,并对病椎的高度变化进行分析,记录骨水泥外漏情况。随访时间为术后1天、1月、6月,采用t检验进行统计学分析。结果：35例患者手术顺利,术后24h内疼痛缓解,无脊髓或神经根损伤及压迫症状,复查X片见椎体内骨水泥填充良好。手术前后VAS评分、活动能力（ODD和病椎高度对应比较,差别均有统计学意义（P〈0．05）,术后随访6月疼痛缓解、日常活动功能改善趋于稳定。结论：PKP能迅速缓解胸腰椎溶骨性肿瘤引起的疼痛,有效恢复病椎高度,并发症相对较少,提高患者生存质量,具有简单、安全、有效等优点。