| ObjectiveThe objective of this study was to evaluate the diagnostic performance and safety of magnetic resonance (MR) imaging-guided percutaneous head and neck and mediastinal biopsy procedures using a0.23-T open MR system with optical tracking navigation.MethodsA retrospective analysts of77patients (51male,26female; mean age,43years; range,11-88years) who underwent MRI-guided percutaneous biopsy of a head and neck lesion was performed. Mean lesion diameter was3cm (range,1-7.8cm). Rapid gradient echo sequences were used for image guidance.23/77lesions were biopsied after intravenous gadolinium. Tissue sampling techniques included needle aspiration (n(?)=(?)19) and core needle biopsy (n(?)=(?)58). Outcome variables included technical success, diagnostic accuracy, procedure time and complications. A retrospective analysis of59participants (38males and21females; mean age,45years; range,16-73years) who underwent MR imaging-guided percutaneous mediastinal biopsy procedures was performed. Average lesion diameter was3.7cm (range,1.0-11.5cm). Masses great or equal to3.5cm (29/59,49%) and masses between1.5and3.4cm not located adjacent to large vessels or trachea (8/59,14%) were sampled with core-needle biopsy technique only. Masses smaller or equal to1.4cm (8/59,13%) and masses between1.5and3.4cm diameter located adjacent to large vessels or trachea (14/59,24%) were sampled using fine needle aspiration technique only. Three different types of access routes were used. An extrapleural paravertebral approach was used for biopsy of posterior (20/59,34%) and middle mediastinal lesion (1/59,2%). An extrapleural parastemal approach was used for biopsy of anterior mediastinal lesions (19/59,32%). A transpulmonary approach was used in lesion not accessible through a parastemal or paravertebral approach (6/59,10%anterior,7/59,12%middle and6/59,10%posterior mediastinal lesions, total19/59,32%). Histopathological analysis of surgical specimen and clinical and imaging follow-ups were used as the reference standard. The procedures were evaluated for technical success rate, number of biopsy passes, diagnostic performance, procedure time, and complications.ResultsIn the77head and neck patients, a sufficient amount of tissue for pathological analysis was obtained. Pathological analysis diagnosed41malignant lesions and36benign lesions. In42cases, surgical correlation was available. In35cases, the final diagnosis was confirmed by imaging and clinical follow-up. MR-guided biopsy had a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of93.2%,100%,100%,91.7%, and96%, respectively. Procedure time was29min (range,15-47min). No major complications occurred. Technical success was achieved in57of the59procedures (96.6%) of mediastinal biopsy. For the fine-needle aspiration, a mean of3passes (range,2-4passes) was performed. For the core-needle biopsy, a mean of4passes (range,3-6passes) was performed. Pathological and cytological analysis of biopsy specimens showed41of57malignant lesions (71.9%) and16of57benign lesions (28.1%), with a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of93.2%(41of44),100%(13of13),100%(41of41),81.2%(13of16), and94.7%(54of57), respectively. Procedure time was30minutes (range,20-50minutes). Mild hemoptysis occurred in3cases, and in2cases, a small pneumothorax occurred. ConclusionsMagnetic resonance imaging-guided biopsy of head and neck lesions and mediastinal masses has high diagnostic performance in clinical practice. Interactive, navigated MRI guidance for core-needle biopsy and FNA of head and neck or mediastinal lesions is effective and safe, and may be especially useful for deep situated masses with close proximity to vessels, nerves, and osseous structures. As a supplement to US or CT-guided biopsies, it is worth further clinical promotion and application. |
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