title: MR cone-beam CT fusion image overlay for fluoroscopically guided percutaneous biopsies in pediatric patients.
abstract: Lesions only visible on magnetic resonance (MR) imaging cannot easily be targeted for image-guided biopsy using ultrasound or X-rays but instead require MR guidance with MR-compatible needles and long procedure times (acquisition of multiple MR sequences). We developed an alternative method for performing these difficult biopsies in a standard interventional suite, by fusing MR with cone-beam CT images. The MR cone-beam CT fusion image is then used as an overlay to guide a biopsy needle to the target area under live fluoroscopic guidance. Advantages of this technique include (i) the ability for it to be performed in a conventional interventional suite, (ii) three-dimensional planning of the needle trajectory using cross-sectional imaging, (iii) real-time fluoroscopic guidance for needle trajectory correction and (iv) targeting within heterogeneous lesions based on MR signal characteristics to maximize the potential biopsy yield.
authors.affiliation: Image Guided Therapy, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. asthakor@stanford.edu.|Division of Interventional Radiology, Department of Radiology, Lucile Packard Children's Hospital, Stanford University, 725 Welch Road, Palo Alto, CA, 94304, USA. asthakor@stanford.edu.
authors.forename: Avnesh S
authors.initials: AS
authors.lastname: Thakor
authors.affiliation: Image Guided Therapy, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: Premal A
authors.initials: PA
authors.lastname: Patel
authors.affiliation: Image Guided Therapy, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Gu
authors.affiliation: Image Guided Therapy, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Rea
authors.affiliation: Image Guided Therapy, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: Joao
authors.initials: J
authors.lastname: Amaral
authors.affiliation: Image Guided Therapy, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: Bairbre L
authors.initials: BL
authors.lastname: Connolly
mesh_terms: D000293:Adolescent; D002648:Child; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008954:Models, Biological; D015233:Models, Statistical; D064847:Multimodal Imaging / Q000379:methods; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique
keywords: Biopsy; Bone; Children; Cone-beam computed tomography; Image fusion; Magnetic resonance imaging; Soft tissue