CT引导下经皮穿刺活检在脊柱占位性病变诊断中的应用

目的探讨CT引导下经皮穿刺活检对脊柱占位性病变的诊断价值。方法 2008年5月～2010年8月对临床不能明确诊断的30例脊柱占位性病变行CT引导下椎体穿刺活检术,在CT扫描监控下,使用骨穿刺活检针,局麻下经椎弓根或椎弓根旁途径取脊柱占位性病变骨质适量,通过变换工作通道方向或用不同直径的骨活检针进行多向多点取材,将钻取标本立即置于10%福尔马林中保存,标本送病理检查及相应的病理细胞学检查。结果 30例均成功穿刺取材,其中28例获得明确诊断:原发恶性肿瘤7例,脊柱转移性肿瘤13例,化脓性脊柱炎2例,脊柱结核2例,嗜酸性肉芽肿1例,神经纤维瘤1例,椎体血管瘤1例,修复性肉芽肿1例;2例未能明确诊断,采取切除活检,术后病理检查结果为嗜酸性肉芽肿1例,转移性腺癌(肺源性)1例。穿刺活检总的诊断准确率93.3%(28/30)。结论 CT引导下穿刺活检术对于脊柱占位性病变诊断具有安全、活检阳性率高特点,是诊断脊柱占位性病变的理想方法,对指导治疗具有重要意义。

CT-guided Percutaneous Biopsy for Diagnosing Spinal Space-occupying Lesion

Objective To investigate the value of CT-guided percutaneous biopsy in the diagnose of spinal space-occupying lesions. Methods Between May 2008 and August 2010,30 patients with uncertain lesions in the spine received CT-guided percutaneous biopsy in our hospital.Under the guidance with CT,and local anesthesia,we performed percutaneous spinal biopsy through the pedicle of vertebral arch or para-pedicle-of-vertebral-arch approach.Through different channels or with biopsy needles in various diameters,we collected multi-site samples,which were then preserved in 10% Formalin for pathological examination.Results The biopsy was successfully completely in all the 30 cases,of which certain diagnosis was made in 28,including 7 cases of primary malignant tumor,13 cases of spinal metastatic carcinoma,2 cases of pyogenic spondylitis,2 cases of spinal TB,1 case of eosinophilic granuloma,1 case of neurofibroma,1 case of vertebral hemangioma,and 1 case of reparative granuloma.The other two patients,who didn’t get certain diagnosis,underwent surgical biopsy,which showed eosinophilic granuloma in one and metastatic adenocarcinoma in the other.The overall accuracy rate of the percutaneous biopsy was 93.3%(28/30). Conclusions CT-guided percutaneous biopsy is safe for diagnosing spinal space-occupying lesions with safety and a high positive rate.It is an ideal diagnostic approach,which can play an instructive role in the treatment of the patients.