CT导引四肢骨活检的价值(附50例报告)

目的　报告应用CT导引活检在四肢骨病变诊断中的方法和作用。方法　对 5 0例四肢骨病变行CT导引下活检。每例常规取样 2～ 3次。对 13例灶区或灶周硬化明显者应用了Ackmann骨钻针 ,对 42例应用了Temno核心切割针 ,12例囊性或有明显液化区的病灶则加用了细抽吸针。结果　活检的诊断准确率 88%( 4 4/5 0 )。 6例假阴性者的病灶特征包括 3例增生硬化性病灶 ,2例液化性及 1例混合性病灶。 5 0例可以分为原发恶性骨肿瘤 (n =2 3) ,原发良性骨肿瘤及肿瘤样病变 (n =12 ) ,骨转移 (n =8)及骨感染 (n =7)四类 ,其活检准确率分别为 91%、83%、10 0 %和 71%。Ackmann骨钻针、Temno核心切割针及细抽吸针的活检准确率分别为6 2 %、83%和 5 8%。未发生严重并发症。结论　CT导引下四肢骨活检是一种安全、准确而有效的方法。根据病变类型选用骨钻针、核心切割针或细抽吸针 ,并注意避开坏死区及多靶点取样 ,三种活检针的取样结果有互补性 ,合理联合使用可以提高诊断准确率。

Assessment of CT-Guided Bone Biopsy in Extremities(A Report of 50 Cases)

Objective In this article we report our methods and effects of CT-guided bone biopsy in extremities.Methods 50 patients with extremital bone lesion were candidates for CT-guided biopsy.Two or more procedures were routinely performed in each case.Ackmann drill was used for 13 patients with sclerotic lesions.Temno core needle was used for 42 cases.Fine needle aspiration was combined for 12 patients with cystic or obviously liquefied lesions.Results In the 50 cases,a diagnosis was possible in 88%(44/50).The six unsatisfactory results were from sclerotic lesions(n=3),liquefied lesions(n=2) and mixed lesion(n=1).50cases were divided into primary malignant tumors(n=23),primary benign tumors and tumor-like lesions(n=12),metastatic tumors(n=8),and bone inflammations (n=7).Their diagnostic accuracies of CT-guided biopsy were 91%,83%,100% and 71% separately.No severe complications were observed in our series.Conclusion CT-guided extremital bone biopsy is a safe,accurate and effective method.Bone drill,needle core and fine needle aspiration should be slected according to the type of bone lesions.In order to increasing its accuracy,the operator should avoid necrotic areas and select more then one point to get samples.One modality can be performed concomitantly with other one in the evaluation of bone lesions,since the three modalities are complementary.