CT引导下经皮肺穿刺活检经验总结

目的：探讨CT导引下经皮肺穿刺活检的技术方法和影响诊断准确性的因素，防范并发症的心得。方法：回顾性分析36例肺内病变CT引导下经皮肺穿刺活检的技术方法，就如何提高穿刺准确性及影响诊断准确率的因素、防范并发症的心得进行讨论。结果：36例中，穿刺成功率100％，活检诊断准确率为30／36（83％）。3例发生轻度气胸。结论：CT引导下经皮肺穿刺活检术是安全的，可有效提高肺内病变的诊断准确性。但操作医生熟练的技术方法非常重要，并可以减少并发症的发生。     

CT引导下胸部穿刺活检的临床应用

CT引导下胸部穿刺活检已被临床广泛应用，既有创作小，操作简便，成功率高等优点，本文收集2003年-2005年46例经CT引导下胸部穿刺活检病例作回顾性分析，探讨CT引导胸部穿刺活检的临床应用的价值。     

CT导引下经皮细针穿刺活检

CT导引下经皮细针穿刺活检属于介入性放射学，经皮穿刺活检是有较长历史的一种诊断方法，早在1883年Leyden于肺炎病例作诊断性穿刺，开始为盲目性穿刺，并发症多，之后相继应用X线透视下活检，剖腹探查直视下细针穿刺 细胞学检查，选择性动脉造影导向下细针穿刺，超声导向下经皮活检和ERCP导向活检等。1976年Haage等首次报导CT导引下经皮穿刺活检，这比其它导向活检具有方便准确的优点，CT扫描精确的显示病变外形大小，密度和位置，以及与周围组织器官的空间关系，显示针尖在病变内的准确位置，安全可靠，成功率高，国内外正开展这一新技术于临床。     

CT引导下经皮椎体病变穿刺活检的临床研究

目的评价CT引导下经皮椎体病变穿刺活检的成功率、诊断正确性及临床应用价值。方法85例椎体病变患者经皮穿刺活检,病变位于颈椎3例,胸椎26例,腰椎37例和骶椎19例。影像学上表现57例为溶骨性病变,19例成骨性病变,9例溶骨性与成骨性病变共存。穿刺标本行细胞学及组织学检查。临床怀疑感染性病变时行细菌学检查。对穿刺标本进行诊断的正确性分析。结果CT证实85例穿刺活检针均位于病灶内,81例取得病变组织,活检成功率95%。活检标本包括29例骨组织标本,5例软组织标本,47例骨组织与软组织混合标本,4例未取得标本;病理结果包括44例转移瘤,17例原发性骨肿瘤,18例感染性病变,2例正常椎体组织。79例诊断正确,诊断正确性97.5%。结论CT引导下经皮椎体病变穿刺活检是对椎体病变作出正确诊断的重要手段,为临床提供了可靠的组织学依据,且穿刺部位正确、三维定向好、损伤小,可以作为诊断不明确的溶骨性及溶骨与成骨混合性椎体病变拟行椎体成形术术前常规。     

CT引导下经皮穿刺活检诊断颈部病变

目的 评价CT引导下的颈部病灶经皮穿刺活检的临床应用价值.方法 在CT引导下对15例颈部病灶经皮穿刺活检.结果 CT证实15例穿刺活检针均在病灶内,穿刺成功,全部取得病理结果,其中13例与临床诊断相一致.结论 CT引导下经皮穿刺活检颈部病变是安全、准确、微创的介入诊断技术.     

肺部肿块CT引导下穿刺活检的体会

CT引导下肺部肿块穿刺活检为胸部介入放射学的重要内容之一，自Haage等开展肺穿刺活检以来，各国学者相继开展了这项工作，已广泛应用于临床，成为获取病理诊断资料的重要手段，适用于周围型肺部病灶、胸膜、胸壁病变，被公认为胸部疾病诊断和鉴别诊断的重要方法之一，为临床治疗提供确切的治疗依据，我科自2003年11月至今，在螺旋CT引导下，共进行肺部肿块穿刺30例，现总结如下：     

CT引导下肺实性结节切割活检术后出血与气胸的多因素分析

目的 探讨CT引导下经皮穿刺肺实性结节切割活检术后并发出血、气胸的危险因素.方法 回顾性分析肺实性结节(≤3 cm)320例经16 G半自动切割活检的临床及影像学资料,行单因素和多因素Logistic回归分析.结果 活检术后针道出血发生率33.1％,气胸发生率18.1％,良恶性诊断准确率约99.6％.针道长度是出血的独立危险因素,针道每增加3 cm,风险增加3.881倍,且风险也随穿刺时间(P=0.061)和穿胸膜次数(P=0.062)呈正相关.年龄、位置和针-胸膜夹角是气胸独立风险因素,年龄每增加10岁,风险增加2.102倍;上肺叶病灶显著低于下肺叶;针-胸膜夹角每增加20°,风险增加2.413倍,肺气肿以微弱差距(P=0.086)被排除方程之外.以出血、气胸概率值绘制ROC曲线,AUC值分别为0.753和0.725.结论 CT引导下肺实性结节切割活检术后出血、气胸的发生受多种因素影响,术前仔细评估,术中操作熟练度可以有效预判和降低出血、气胸的发生.     

超声与CT经皮穿刺在超声可视性胸部病变定性诊断中的对比研究

目的 比较彩色超声(彩超)与CT经皮穿刺在超声可视性胸部病变定性诊断中的病灶刺中率、病理诊断阳性率以及并发症发生率.方法 回顾2015年1月至2016年6月影像学资料提示超声可视性胸部病变患者112例,病变与皮肤之间无骨骼及肺气遮挡,其中经超声引导下穿刺52例(超声组),经CT引导下穿刺60例(CT组),比较两组的病灶刺中率、病理诊断阳性率及并发症发生率.结果 超声组刺中率100％ (52/52),高于CT组91.7％ (55/60),超声组病理诊断阳性率为96.2％ (50/52),高于CT组80.0％ (48/60),超声组并发症发生率3.8％(2/52),低于CT组18.3％(11/60).结论 对于超声可视性胸部病变,超声引导下的穿刺活检较CT更加可靠.     

CT引导下肺活检和并发症的预防

CT引导肺活检作为一种安全有效的活检技术已广泛应用于临床,在肺部疾病的诊断和治疗中的地位日益突出.本文对该技术的适应证、禁忌证、术前准备、介入技术和常见的并发症及其预防进行总结,供大家参考和借鉴.     

IG4电磁导航系统辅助CT引导下肺结节穿刺活检术的临床应用

目的 评价IG4电磁导航系统在CT引导下经皮穿刺肺活检术中的应用价值.方法 选择40例患者20例行IG4电磁导航系统辅助CT引导下肺穿刺活检,20例行常规CT引导下肺穿刺活检,记录2组定位时间、调针次数、扫描次数、辐射剂量、瞄准精度以及并发症情况.结果 IG4电磁导航系统辅助组中20例患者在穿刺过程中成功应用该系统,其肺活检平均定位时间为(10.05±1.75) min(7.5～14.0 min);穿刺针平均调整次数(1.10±0.31)次(1～5次);平均扫描次数为(3.30±0.73)次(3～6次);剂量长度乘积(DLP)均值为(724.25±186.23) mGy·cm (415.50～1 080.50 mGy·cm);20次穿刺定位中,15次瞄准精度＜5 mm,4次为5～ 10 mm,1次为13 mm,穿刺针瞄准精度均值为(4.72±3.33) mm(1～13 mm).常规穿刺组肺活检平均定位时间(15.10±2.40) min(11～19 min);穿刺针平均调整次数(4.05±1.32)次(3～7次);平均扫描次数为(6.05±1.32)次(5～9次),剂量长度乘积(DLP)均值为(1419.10±387.59) mGy·cm (900.50～1 958.90 mGy·cm).40例患者均无严重并发症发生.两组患者平均定位时间、平均穿刺针调整次数、平均扫描次数、剂量长度乘积均值对比差异均有统计学意义.结论 电磁导航系统辅助下CT引导肺穿刺活检术可缩短定位时间,减少调针次数、扫描次数,同时可减少患者接受的辐射剂量,是一种值得推广的影像引导新方法.     

肺炎型肺泡癌增强 CT 扫描及CT 导引下活检的临床应用

目的：探讨肺炎型肺泡癌(BAC)的 CT 表现特点及 CT 导引穿刺活检的应用价值。方法回顾分析病理证实的14例肺炎型 BAC 的影像学特征。结果14例肺炎型 BAC 中,实变肺组织内支气管充气征10例(71.4%),实变肺组织内蜂房状气腔或空洞征5例(35.7%),实变区周围呈现磨玻璃密度影及多发结节影5例(35.7%)；增强 CT 扫描实变区可见混杂的低密度区内血管造影征11例(78.6%),平均达峰时间为90 s,时间-密度曲线呈速升缓降型9例(64.2%)。结论CT 平扫表现肺段、叶性实变区内蜂窝状气腔及空洞、血管造影征、枯树枝征及周围多发腺泡结节及磨玻璃密度区、增强扫描实变区可见血管造影征,时间-密度曲线呈速升缓降型是肺炎型 BAC 的主要特点；CT 引导肺穿刺活检是较理想的确诊手段,二者结合可以大大提高早期诊断率。     

骨肿瘤及肿瘤样病变CT引导下穿刺活检与手术病理对照研究

目的CT引导下经皮穿刺活检骨肿瘤及肿瘤样病变与手术病理对照研究,评价CT引导下穿刺活检术的诊断价值。方法CT引导下经皮穿刺活检骨骼病变,选择其中经手术病理诊断为骨肿瘤或肿瘤样病变的病例362例,将2种方法进行对照。结果362例穿刺针均在位,穿刺均获成功,并获得穿刺病理诊断及手术病理诊断,其中285例穿刺结果与手术病理相符,77例不相符,其组织学定性的准确率为78.7%（285/362）。结论CT引导下经皮穿刺活检对于骨肿瘤及肿瘤样病变的诊断具有重要临床应用价值,是安全有效的检查方法。但是实际工作中应该采取临床、影像和病理相结合的科学分析。     

CT引导下弯针穿刺乙醇消融术治疗肝动脉化疗栓塞后残存肝癌

原发性肝癌起病隐匿,临床发现时多已为中晚期,失去了手术切除的机会,非手术治疗肝癌成为研究热点。肝动脉化疗栓塞（transarterial chemoembolization,TACE）和无水乙醇瘤内注射（percutaneous ethanol injection,PEI）是目前临床最为广泛应用的非手术疗法,疗效明显。然而,实践表明单独应用均有一定的局限性,联合应用可提高疗效,因而肝癌综合治疗成为趋势。我们针对TACE治疗后残存活性肝癌病灶,采用CT引导下弯针穿刺无水乙醇消融治疗,取得了满意疗效,现将结果报道如下。     

CT-guided lung biopsy: incidence of pneumothorax after instillation of NaCl into the biopsy track

This study was conducted to evaluate whether instillation of NaCl 0.9% solution into the biopsy track reduces the incidence of pneumothoraces after CT-guided lung biopsy. A total of 140 consecutive patients with pulmonary lesions were included in this prospective study. All patients were alternatingly assigned to one of two groups: group A in whom the puncture access was sealed by instillation of NaCl 0.9% solution during extraction of the guide needle (n = 70) or group B for whom no sealing was performed (n = 70). CT-guided biopsy was performed with a 18-G coaxial system. Localization of lesion (pleural, peripheral, central), lesion size, needle-pleural angle, rate of pneumothorax and alveolar hemorrhage were evaluated. In group A, the incidence of pneumothorax was lower compared to group B (8%, 6/70 patients vs. 34%, 24/70 patients; P < 0.001). All pneumothoraces occurred directly post punctionem after extraction of the guide needle. One patient in group A and eight patients in group B developed large pneumothoraces requiring chest tube placement (P = 0.01). The frequency of pneumothorax was independent of other variables. After CT-guided biopsy, instillation of NaCl 0.9% solution into the puncture access during extraction of the needle significantly reduces the incidence of pneumothorax.     

Breath-hold after forced expiration before removal of the biopsy needle decreased the rate of pneumothorax in CT-guided transthoracic lung biopsy

Purpose

To assess the effect of a breath-hold after forced expiration on the rate of pneumothorax after computed tomography (CT)-guided transthoracic needle biopsy of pulmonary lesions.

Materials and methods

Between January 2008 and December 2011, percutaneous CT-guided lung biopsy was performed in 440 patients. Two hundred and twenty-one biopsies were performed without (control group) and two hundred and nineteen biopsies were performed with (study group) the study maneuver – a breath-hold after forced expiratory approach. Multivariate analysis was performed between groups for risk factors for pneumothorax, including patient demographics, lesion characteristics, and biopsy technique.

Results

A reduced number of pneumothoraces (18 [8.2%] vs 35 [15.8%]; P = 0.014) but no significant difference in rate of drainage catheter insertions (2 [0.9%] vs (4 [1.8%]; P = 0.418) were noted in the study group as compared with the control group. By logistic regression analysis, three factors significantly and independently affected the risk for pneumothorax including lesion size (transverse and longitudinal diameter), distance from pleura and utilizing or avoiding the breath-hold after deep expiration maneuver.

Conclusion

Breath-holding after forced expiration before removal of the biopsy needle during the percutaneous CT-guided transthoracic lung biopsy almost halved the rate of overall pneumothorax. Small lesion size (longitudinal diameter) and the distance from pleura were also predictors of pneumothorax in our study.     

Risk factors for pneumothorax and bleeding after CT-guided percutaneous coaxial cutting needle biopsy of lung lesions.

PURPOSE: To evaluate risk factors for pneumothorax and bleeding after computed tomography (CT)-guided percutaneous coaxial cutting needle biopsy of lung lesions. MATERIALS AND METHODS: This study involved 117 consecutive patients with 117 intrapulmonary lesions. Statistical analysis of factors related to patient characteristics, lung lesions, and biopsy technique was performed to determine possible contribution to the occurrence of pneumothorax and bleeding. Interactions between related factors were considered to prevent colinearity. RESULTS: Pneumothorax occurred in 12% (14 of 117) of patients. Needle aspiration of two moderate asymptomatic pneumothoraces were performed; there was no chest tube insertion. Lesion depth (P =.0097), measured from the pleural puncture site to the edge of the intrapulmonary lesion along the needle path, was the single significant predictor of pneumothorax. The highest risk of pneumothorax occurred in subpleural lesions 2 cm or shorter in depth (this represented 33% of lung lesions but caused 71% of all pneumothoraces; OR = 7.1; 95% CI, 1.3-50.8). Bleeding presented as lung parenchyma hemorrhage and hemoptysis in 30 patients (26%). Hemoptysis occurred in four patients (3%). Univariate analysis identified lesion depth (P <.0001), lesion size (P <.015), and pathology type (P =.007) as risk factors for bleeding. Multivariate logistic regression analysis identified lesion depth as the most important risk factor, with the highest bleeding risk for lesions more than 2 cm deep (14% of lesions caused 46% of all bleeding; OR = 17.3; 95% CI, 3.3-121.4). CONCLUSIONS: In CT-guided coaxial cutting needle biopsy, lesion depth is the single predictor for risk of pneumothorax, which occurs at the highest rate in subpleural lesions. Increased risk of bleeding occurs in lesions deeper than 2 cm.