C-Arm Cone-Beam CT Combined with a New Electromagnetic Navigation System for Guidance of Percutaneous Needle Biopsies: Initial Clinical Experience

 

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Abstract

Purpose: To evaluate the feasibility and efficacy of C-arm fluoroscopic cone-beam computed tomography (CACT) in combination with a new electromagnetic tracking (EMT) system for needle guidance during percutaneous biopsies.

Materials and Methods: 53 patients were referred for biopsy of thoracic (n = 19) and abdominal (n = 34) lesions. CT-like images of the anatomical region of interest (ROI) were generated using a flat panel-based angiographic system. These images were transmitted to an EMT system. A coaxial puncture needle with a sensor in its tip was connected with the navigation system and tracked into an electromagnetic field created via a field generator. Data generated within this field were merged with the CACT images. On a monitor both the anatomical ROI and needle tip position were displayed to enable precise needle insertion into the target. Through the coaxial needle, biopsy specimens for the histologic evaluation were extracted. Number of representative biopsy samples, number of core biopsies/patient, total procedure time, dose-area product, fluoroscopic time, and complications were recorded.

Results: 53 CACT/EMT-guided biopsy procedures were performed, 48 of which (91 %) yielded representative tissue samples. Four core biopsies were obtained from each patient. 40 (75 %) lesions were malignant and 13 (25 %) lesions were benign. The total procedure time was 9 ± 5 min (range, 3 – 23 min), fluoroscopic time was 0.8 ± 0.4 min (range, 0.4 – 2 min). The mean dose-area product (cGy cm²) was 7373 (range, 895 – 26 904). The rate of complications (1 pneumothorax, 2 hemoptyses) was 6 %.

Conclusion: CACT combined with EMT appears to be a feasible and effective technique for the guidance of percutaneous biopsies with a low rate of therapeutically relevant complications.

Key Points:

• Guidance of percutaneous biopsies with a combination of CACT and EMT is technically feasible.

• CACT/EMT-guided biopsies are associated with a good diagnostic yield.

• The rate of complications appears to be low for this guidance technique.

Citation Format:

• Kickuth R., Reichling C., Bley T. et al. C-Arm Cone-Beam CT Combined with a New Electromagnetic Navigation System for Guidance of Percutaneous Needle Biopsies: Initial Clinical Experience. Fortschr Röntgenstr 2015; 187: 569 – 576

Zusammenfassung

Ziel: Evaluation der Durchführbarkeit und Effizienz der Kombination aus C-Arm Flachdetektor-CT (FD-CT) und elektromagnetischer Navigation (EMN) bei der Steuerung perkutaner Nadelbiopsien.

Material und Methoden: Insgesamt wurden 53 Patienten wegen thorakaler (n = 19) und abdomineller (n = 34) Läsionen zugewiesen. Mithilfe einer mit FD-CT ausgerüsteten Angiografieanlage wurden dreidimensionale CT-artige Schnittbilder der anatomischen Region-of-Interest generiert. Diese Bilder wurden auf ein EMN-System transferiert. Eine koaxiale, mit einem Sensor versehene Punktionsnadel wurde mit dem EMN-System verbunden und in ein elektromagnetisches Wechselfeld, welches zuvor durch einen Feldgenerator erzeugt wurde, eingebracht. Die innerhalb dieses Feldes erzeugten Daten wurden mit den FD-CT-Bildern fusioniert. Auf einem Monitor wurden dann die anatomische Region-of-Interest und die Nadelposition angezeigt, sodass eine präzise Nadelinsertion in Richtung Zielläsion möglich war. Durch die Koaxialnadel wurden Zylinder für die histologische Untersuchung gewonnen. Erfasst wurden die Anzahl an repräsentativen Gewebeproben, die Anzahl an Stanzbiopsaten/Patient, die Gesamtprozedurzeit, das Dosisflächenprodukt, die Fluoroskopiezeit und die Komplikationen.

Ergebnisse: 53 FD-CT-/EMN-gesteuerte Biopsien wurden durchgeführt, von denen 48 (91 %) repräsentative Gewebeproben ergaben. Vier Stanzbiopsate wurden von jedem Patienten gewonnen. 40 (75 %) Läsionen waren maligne und 13 (25 %) Läsionen benigne. Die Gesamtprozedurzeit betrug 9 min ± 5 min (Spannweite, 3 – 23 min), die Gesamtfluoroskopiezeit lag bei 0,8 min ± 0,4 min (Spannweite, 0,4 – 2 min). Das Flächendosisprodukt (cGy cm²) betrug im Mittel 7373 (Spannweite, 895 – 26 904). Die Gesamtrate an Komplikationen (1 Pneumothorax, 2 Hämoptysen) lag bei 6 %.

Schlussfolgerung: Die Kombination aus FD-CT und EMN ist eine durchführbare und effektive Technik für die Steuerung perkutaner Biopsien mit einer niedrigen Rate an therapeutisch relevanten Komplikationen.

Kernaussagen:

• Die Steuerung perkutaner Biopsien mit einer Kombination aus FD-CT und EMN ist technisch durchführbar.

• FD-CT-/EMN-gesteuerte Biopsien sind mit einer guten diagnostischen Ausbeute verbunden.

• Die Rate an Komplikationen für diese Steuerungstechnik scheint niedrig zu sein.

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