Advantages of multidetector-row CT with multiplanar reformation in guiding percutaneous lung biopsies.
OBJECTIVE
This study aimed to assess the usefulness of multiplanar reformations (MPR) during multidetector-row computed tomography (MDCT)-guided percutaneous needle biopsy of lung lesions difficult to access with the guidance of the native axial images alone owing to overlying bony structures, large vessels or pleural fissures.


METHODS
MDCT-guided transthoracic needle biopsy (TNB) was performed on 84 patients (55 men and 29 women; mean age 65 years) with suspected lung neoplasm by using a spiral MDCT scanner with the simultaneous acquisition of six slices per rotation. We determined the site of entry of the 22-gauge Chiba needle on native axial images and coronal or sagittal MPR images. We took care to ensure the shortest needle path without overlying large vessels, main bronchi, pleural fissures or bony structures; access to the lung parenchyma as perpendicular as possible to the pleural plane; and sampling of highly attenuating areas of noncalcified tissue within the lesion.


RESULTS
Diagnostic samples were obtained in 96% of cases. In 73 patients, lesions appeared as a solid noncalcified nodule <2 cm; 11 lesions were mass-like. In 22, the biopsy required MPR guidance owing to overlying ribs (18), fissures (2) or hilar-mediastinal location (2).


CONCLUSIONS
MDCT MPR images allowed sampling of pulmonary lesions until now considered unreachable with axial MDCT guidance because of overlying bony structures (ribs, sternum and scapulae) or critical location (hilar-mediastinal, proximity to the heart or large vessels). Compared with the conventional procedure, the use of MPR images does not increase the rate of pneumothorax or the procedure time.
De Filippo
M
M
Dipartimento di Scienze Cliniche, Sezione di Scienze Radiologiche, Università degli Studi di Parma, Parma, Italy. massimo.defilippo@unipr.it
Onniboni
M
M
Rusca
M
M
Carbognani
P
P
Ferrari
L
L
Guazzi
A
A
Casalini
A
A
Verardo
E
E
Cataldi
V
V
Tiseo
M
M
Sverzellati
N
N
Chiari
G
G
Rabaiotti
E
E
Corsi
A
A
Cacciani
G
G
Sommario
M
M
Ardizzoni
A
A
Zompatori
M
M
D000230:Adenocarcinoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D002276:Carcinoid Tumor / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D018288:Carcinoma, Small Cell / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008168:Lung / Q000473:pathology*; D008175:Lung Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000556:secondary; D008223:Lymphoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D008230:Lymphomatoid Granulomatosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D009339:Needles; D036542:Tomography, Spiral Computed / Q000379:methods*