title: Interactive MR imaging-guided biopsy and aspiration with a modified clinical C-arm system.
abstract: OBJECTIVE
  This investigation was performed to test the hypotheses that interactive guidance of MR image acquisition during needle-directed procedures using a clinical 0.2-T C-arm open MR imaging system integrated with a frameless optically linked stereotaxy system is feasible, and that procedure times can be sufficiently short to be well tolerated by the patient.
  
  
  METHODS
  One hundred six MR-guided procedures were performed in 86 patients (ranging in age from 5 months to 88 years) using a clinical C-arm imaging system supplemented with an in-room RF-shielded liquid crystal display monitor, a frameless stereotaxy system, rapid gradient-echo sequences for needle guidance, and MR-compatible monitoring and surgical lighting equipment. We performed 50 biopsies and aspirations of the head and neck in 37 patients, 23 biopsies of musculoskeletal lesions in 22 patients, 16 biopsies of abdominal sites in 10 patients, six biopsies of the thoracolumbar spine or sacrum in six patients, and 11 shoulder joint injections for MR arthrography in 11 patients, in addition to 38 MR arthrographic injections on the same imaging system described in a previous report. Tissue sampling included fine-needle aspiration (n = 90) and cutting needle core biopsy (n = 41). Thirty-five patients underwent both procedures. Procedures were evaluated for success of needle placement, procedure time, and complications.
  
  
  RESULTS
  Needle placement was successful in all cases, and no complications occurred. Tissue was sufficient for pathologic diagnosis for all but eight patients. Passes per patient averaged 2.1. For fine-needle aspiration, instrument time averaged 7 min 42 sec per pass, cutting needle core biopsy averaged 6 min 24 sec, and shoulder injection averaged 8 min.
  
  
  CONCLUSIONS
  MR imaging guidance for needle procedures on a clinical 0.2-T C-arm system with supplemental interventional accessories is feasible, with relatively rapid needle placement.
authors.affiliation: Department of Radiology, University Hospitals of Cleveland and Case Western Reserve University, OH 44106, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Lewin
authors.forename: C A
authors.initials: CA
authors.lastname: Petersilge
authors.forename: S F
authors.initials: SF
authors.lastname: Hatem
authors.forename: J L
authors.initials: JL
authors.lastname: Duerk
authors.forename: G
authors.initials: G
authors.lastname: Lenz
authors.forename: M E
authors.initials: ME
authors.lastname: Clampitt
authors.forename: M L
authors.initials: ML
authors.lastname: Williams
authors.forename: K R
authors.initials: KR
authors.lastname: Kaczynski
authors.forename: C F
authors.initials: CF
authors.lastname: Lanzieri
authors.forename: A L
authors.initials: AL
authors.lastname: Wise
authors.forename: J R
authors.initials: JR
authors.lastname: Haaga
mesh_terms: D000005:Abdomen; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D001707:Biopsy, Needle / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis; D013238:Stereotaxic Techniques