Performance of Computed Tomography-Guided Spine Biopsy for the Diagnosis of Malignancy and Infection

2021 ◽  
Author(s):  
Lauren Harris ◽  
Devika Rajashekar ◽  
Puneet Sharma ◽  
Karoly M David
Keyword(s):  
Computed Tomography ◽  
Vertebral Osteomyelitis ◽  
Ct Guided ◽  
Exact Test ◽  
Suspected Infection ◽  
Included Patient ◽  
Chi Squared ◽  
Ct Guided Biopsy ◽  
Spinal Biopsy

Abstract BACKGROUND Computed tomography (CT)-guided percutaneous biopsies are used to guide treatment in vertebral osteomyelitis and spinal malignancy, but the efficacy of this study remains unclear. OBJECTIVE To investigate the performance of CT-guided spinal biopsy, and factors that may influence its success. METHODS Retrospective study of all consecutive patients who underwent a CT-guided spine biopsy at a UK teaching hospital between April 2012 and February 2019. Biopsies were performed by 3 consultant neuroradiologists for a lesion suggestive of either malignancy or infection. Data collection included patient factors, biopsy factors, further investigations required, and diagnosis. Data were analyzed using contingency tables, analysis of variance, unpaired t-test, chi-squared test, and Fisher's exact test. RESULTS A total of 124 percutaneous biopsies were performed on 109 patients with a mean follow-up of 34.5 mo (range 4-86 mo) and a mean age of 66 yr (range 27-93). Approximately 32.3% (n = 40) of the biopsies investigated possible infection, and 67.7% investigated malignancy. The sensitivity for infected cases was 37.0%, and for malignancy 72.7%. The diagnostic accuracy was 57.5% and 78.6%, respectively. Complication rate was 1.6%. In our study, neither needle gauge, anatomic level of the biopsy, or bone quality significantly affected the rate of positive biopsy. CONCLUSION Both in our study and in the wider literature, CT-guided biopsy has a vastly superior sensitivity for malignancy compared with suspected infection. These procedures may be painful, poorly tolerated, and are not entirely risk free. As such we advocate judicious use of this modality particularly in cases of suspected infection.

scholarly journals The Efficacy of Computed Tomography-Guided Percutaneous Spine Biopsies in Determining a Causative Organism in Cases of Suspected Infection: A Systematic Review

2019 ◽  
Vol 70 (1) ◽  
pp. 96-103 ◽  
Author(s):  
Madeleine Sertic ◽  
Leighanne Parkes ◽  
Sabrina Mattiassi ◽  
Kenneth Pritzker ◽  
Michael Gardam ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Vertebral Osteomyelitis ◽  
Causative Organism ◽  
Inclusion Criteria ◽  
Clinical Value ◽  
Ct Guided ◽  
Suspected Infection ◽  
Study Selection ◽  
Vertebral Biopsy ◽  
Culture Yield

Purpose In suspected spondylodiscitis and vertebral osteomyelitis, computed tomography (CT)-guided biopsies are often performed to determine a causative organism and guide antimicrobial therapy. The aim of this study is to determine the diagnostic culture yield of CT-guided biopsies performed in cases of suspected spinal infections. Methods A literature search of PubMed and MEDLINE up to April 2017 was performed for keywords “CT guided vertebral biopsy infection,” “CT-guided spine biopsy infection,” “CT guided spine biopsy yield,” and “CT guided vertebral biopsy yield.” Inclusion criteria primarily consisted of studies exclusively using CT-guided biopsies in cases of suspected infectious lesions only. After study selection, published articles were analysed to determine diagnostic culture yield. Descriptive statistics were applied. Results 220 search results were screened; 11 met our inclusion criteria and were reviewed. In total, 647 biopsies of suspected infectious spinal lesions were performed. Positive cultures were obtained in 241 cases. Upon excluding one paper's skewed results, the net pooled results culture yield was 33%. Several cultures grew multiple organisms, leading to a total of 244 species identified. Most common isolated organisms include S taphylococcus aureus (n = 83), coagulase-negative S taphylococcus (n = 45), and Mycobacteria (n = 38). Conclusions The diagnostic culture yield of CT-guided biopsies in cases of suspected spinal infection is 33%. In the majority of cases, a causative organism is not identified. This suggests that improvements can be made in biopsy technique and specimen transfer to optimize culture yield and increase the clinical value of the procedure.

scholarly journals A retrospective analysis of computed tomography guided biopsy in the diagnosis of primary bone tumors

2017 ◽  
Vol 3 (3) ◽  
pp. 569
Author(s):  
Kuriakku Puthur Dominic ◽  
Davis Dijoe ◽  
Jacob Toms
Keyword(s):  
Computed Tomography ◽  
Bone Tumors ◽  
Diagnostic Efficiency ◽  
Ct Guided ◽  
Primary Bone Tumor ◽  
Primary Bone Tumors ◽  
Guided Biopsy ◽  
Ct Guided Biopsy ◽  
Significant Step ◽  
Primary Bone

<p><strong>Background:</strong> Primary bone tumors account for a small yet significant number in the total incidence of tumors. Computed tomography (CT) guided percutaneous core biopsy is a novel yet significant step in the approach towards the diagnosis of bone tumors and is increasingly performed by orthopaedic oncologists around the world. This study is aimed to evaluate the diagnostic accuracy of CT guided biopsy in the diagnosis of primary bone tumors. <strong></strong></p><p><strong>Methods:</strong> Patients who underwent CT guided biopsy and subsequent excision for primary bone tumors from January 2008 to July 2015 were analysed. CT guided biopsy results were compared with post-operative histopathological reports to evaluate its sensitivity and specificity.</p><p><strong>Results:</strong> A total of 161 patients were included in the retrospective study. Among them, 147 were true positives, 7 were false negatives, 6 were true negatives and one was false positive. The sensitivity of CT guided biopsy in the diagnosis of primary bone tumor was 95.4 % with specificity of 85.7% with a diagnostic efficiency of 90.5%. The complication rate was 4.3%.</p><p><strong>Conclusions:</strong> CT guided biopsy is a safe, simple and effective procedure to rule out and rule in the diagnosis of primary bone tumors.</p>

Abstract TP308: Transitional Care in Stroke Certified and Non-certified Hospitals: The Comprehensive Post-Acute Stroke Services (COMPASS) Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Janet Prvu Bettger ◽  
Sara Jones ◽  
Anna Kucharska-Newton ◽  
Janet Freburger ◽  
Walter Ambrosius ◽  
...  
Keyword(s):  
Transitional Care ◽  
Discharge Planning ◽  
Care Transitions ◽  
Cluster Randomized Trial ◽  
Stroke Patients ◽  
Care Needs ◽  
Post Discharge ◽  
Exact Test ◽  
Chi Squared

Background: Greater than 50% of stroke patients are discharged home from the hospital, most with continuing care needs. In the absence of evidence-based transitional care interventions for stroke patients, procedures likely vary by hospital even among stroke-certified hospitals with requirements for transitional care protocols. We examined the standard of transitional care among NC hospitals enrolled in the COMPASS study comparing stroke-certified and non-certified hospitals. Methods: Hospitals completed an online, self-administered, web-based questionnaire to assess usual care related to hospitals’ transitional care strategy, stroke program structural components, discharge planning processes, and post-discharge patient management and follow-up. Response frequencies were compared between stroke certified versus non-certified hospitals using chi-squared statistics and Fisher’s exact test. Results: As of July 2016, the first 27 hospitals enrolled (of 40 expected) completed the survey (67% certified as a primary or comprehensive stroke center). On average, 54% of stroke patients were discharged home. Processes supporting hospital-to-home care transitions, such as timely follow-up calls and follow-up with neurology, were infrequent and overall less common for non-certified hospitals (Table). Assessment of post-discharge outcomes was particularly infrequent among non-certified sites (11%) compared with certified sites (56%). Uptake of transitional care management billing codes and quality metrics was low for both certified and non-certified hospitals. Conclusion: Significant variation exists in the infrastructure and processes supporting care transitions for stroke patients among COMPASS hospitals in NC. COMPASS as a pragmatic cluster-randomized trial will compare outcomes among hospitals that implement a CMS-directed model of transitional care with those hospitals that provide highly variable transitional care services.

scholarly journals Computed tomography-guided percutaneous trephine removal of the nidus in osteoid osteoma patients: experience of a single center in Brazil

2015 ◽  
Vol 48 (4) ◽  
pp. 211-215 ◽  
Author(s):  
Marcelo Petrilli ◽  
Andreza Almeida Senerchia ◽  
Antonio Sergio Petrilli ◽  
Henrique Manoel Lederman ◽  
Reynaldo Jesus Garcia Filho
Keyword(s):  
Computed Tomography ◽  
Osteoid Osteoma ◽  
Medical Records ◽  
Demographic Data ◽  
Procedural Pain ◽  
Lesion Site ◽  
Single Center ◽  
Ct Guided ◽  
Patients Experience

Abstract Objective: To report the results of computed tomography (CT)-guided percutaneous resection of the nidus in 18 cases of osteoid osteoma. Materials and Methods: The medical records of 18 cases of osteoid osteoma in children, adolescents and young adults, who underwent CT-guided removal of the nidus between November, 2004 and March, 2009 were reviewed retrospectively for demographic data, lesion site, clinical outcome and complications after procedure. Results: Clinical follow-up was available for all cases at a median of 29 months (range 6–60 months). No persistence of pre-procedural pain was noted on 17 patients. Only one patient experienced recurrence of symptoms 12 months after percutaneous resection, and was successfully retreated by the same technique, resulting in a secondary success rate of 18/18 (100%). Conclusion: CT-guided removal or destruction of the nidus is a safe and effective alternative to surgical resection of the osteoid osteoma nidus.

scholarly journals A Case of Radiation Fibrosis Appearing as Mass-Like Consolidation after SBRT with Elevation of Serum CEA

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Kotaro Terashima ◽  
Yoshiyuki Shioyama ◽  
Satoshi Nomoto ◽  
Saiji Ohga ◽  
Takeshi Nonoshita ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Short Interval ◽  
Primary Lung Cancer ◽  
Dorsal Side ◽  
Ct Guided ◽  
Radiation Fibrosis ◽  
Ct Guided Biopsy ◽  
Serum Cea ◽  
The Right

We report a case of radiation fibrosis appearing as mass-like consolidation, which was difficult to distinguish from local recurrence. A 72-year-old woman was diagnosed as having primary lung cancer (cT1N0M0 stage IA) in the right upper lobe and was treated with SBRT of 48 Gy in 4 fractions. After 12 months, mass-like consolidation appeared around the irradiated area, and after 13 months, it had increased in size. FDG-PET revealed high uptake (SUVmax=5.61) for the consolidation. CT-guided biopsy was performed, but we could not confirm the diagnosis. Considering her poor respiratory function and her age, short-interval follow-up was performed. After 15 months, the consolidation enlarged at the dorsal side, and carcinoembryonic antigen (CEA) became elevated (14.6 ng/mL). Serum KL-6 (436 U/mL) and SP-D (204 ng/mL) were also elevated. However, after 16 months, serum CEA slightly decreased. The consolidation gradually retracted on follow-up CT images. CEA, KL-6, and SP-D were also decreased by degrees. After 40 months, there is no evidence of local recurrence.

scholarly journals En-block resection of a giant retroperitoneal lipoma presented as huge abdominal swelling: a case report

2021 ◽  
Vol 8 (8) ◽  
pp. 2484
Author(s):  
Rajendra Bagree ◽  
Rishab Agrawal ◽  
Sweta Gupta ◽  
Pradeep Panwar ◽  
Veena Shukla ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Mass Effect ◽  
Early Recurrence ◽  
Rare Entity ◽  
Retroperitoneal Mass ◽  
Ct Guided ◽  
Abdominal Symptoms ◽  
Important Differential Diagnosis ◽  
Well Differentiated

Retroperitoneal lipomas are an extremely rare entity with only less than 20 cases described in the literature so far. They can attain immoderate size due to space provided in the retroperitoneum and cause abdominal symptoms like abdominal pain, swelling and obstipation due to mass effect. Case presented here as of 53 years old male with complaint of abdominal swelling that had been progressive for the last 1 year. On computed tomography (CT) it revealed giant retroperitoneal mass? liposarcoma? occupying the space immensely. Intraoperatively, two giant retroperitoneal tumours were found which did not show any features of infiltration to nearby structures, therefore the sole tumour annihilation was achieved, which was diagnosed as benign lipoma on histopathology report later. The most important differential diagnosis is the well differentiated liposarcoma, which could only be confirmed after resection and histopathological assessment. Retroperitoneal lipomas are clearly not distinguishable from well differentiated liposarcomas on CT guided and USG guided biopsy and thus it could be misleading. Hence surgical resection with negative margins along with histopathological confirmation is treatment of choice with regular follow up to diagnose early recurrence if any.

scholarly journals Aggressive Vertebral Hemangiomas Causing Compression Fracture with Neurological Deficits: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Hongming Rao ◽  
Guishuang Li ◽  
Limin Liu ◽  
Yuming Huang ◽  
Zhengquan Xu ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Body Height ◽  
Compression Fracture ◽  
Neurological Deficits ◽  
Ct Guided ◽  
Guided Biopsy ◽  
Estimated Blood Loss ◽  
Ct Guided Biopsy ◽  
Vertebral Hemangiomas

Abstract Background:In rare instances, aggressive vertebral hemangiomas (VHs) can cause compression fracture, resulting in severe pain and neurological deficits. But the diagnosis and treatment of these aggressive lesions are challenging because of these lesions are rare and atypical. This study aimed to evaluate the safety and efficacy of surgical management for aggressive VHs with vertebral compression fracture by a modified multimodality surgery.Methods:We retrospectively reviewed 6 cases suffering from aggressive VHs with compression fracture and neurological deficits in our department from July 2011 to April 2016. These patients were treated by the multimodality surgery, includingpreoperative embolization, intraoperative injection of gelfoam mixed with cement, and laminectomy decompression.The follow-up period was at least 3 years. Perioperative parameters, clinical outcomes, and radiographical data were collected and analyzed.Results: The 6 patients involved 1 male and 5 females (mean age, 52.3 years).The levels involved were: in thoracic spine (5 cases) and lumbar spine (1 case).Preoperative CT-guided biopsy was conducted in all patients, with 5 patients had definitive pathologic diagnosis. All patients were treated successfully with the multimodal surgery, with no cement leakage and other severe complications. The mean operation time was 182.2 minutes, and the estimated blood loss was 908.3 ml.At an average follow-up of 49.8 months, clinical outcomes assessed by the visual analogue scale and Frankel grade were significantly improved. The vertebral body height and kyphosis angle of the fractured vertebra were also corrected postoperatively. No affected vertebra re-fracture and adjacent vertebral fracture were developed, and none of the patients experienced recurrence of tumor at final follow-up.Conclusions:In cases of aggressive VHs causing compression fracture with neurological deficits, CT-guided biopsy is indicated for the diagnosis. The multimodality surgery (preoperative embolization, intraoperative injection of gelfoam mixed with bone cement combined laminectomy decompression) is effective and safe, and can be considered as an acceptable surgical choice.

scholarly journals Benign Notochordal Cell Tumor of the Sacrum with Atypical Imaging Features: The Value of CT Guided Biopsy for Diagnosis

2013 ◽  
Vol 7 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Dario Pasalic ◽  
Patrick H. Luetmer ◽  
Christopher H. Hunt ◽  
Peter S. Rose ◽  
Felix E. Diehn ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Definitive Diagnosis ◽  
Cell Tumor ◽  
Invasive Technique ◽  
Imaging Features ◽  
Ct Guided ◽  
Notochordal Cell ◽  
Orthopedic Surgeons ◽  
Guided Biopsy ◽  
Ct Guided Biopsy

We report a case of a benign notochordal cell tumor (BNCT) of the sacrum with atypical imaging features, which was incidentally discovered in a 74-year-old man undergoing evaluation for progressively worsening hip and back pain. It is important for radiologists, pathologists and orthopedic surgeons to be aware of the diagnosis of BNCT and be familiar with its radiographic features to avoid unnecessary treatment. This case illustrates the advantage of percutaneous computed tomography (CT)-guided biopsy as a minimally invasive technique for definitive diagnosis of a BNCT with atypical imaging features.

Creation of a Steerable Coaxial Needle System for Indirect Line-of-Site Computed Tomography-Guided Procedures

2018 ◽  
Author(s):  
S. Lowell Kahn
Keyword(s):  
Computed Tomography ◽  
Target Lesion ◽  
Drainage Procedure ◽  
Ct Guided ◽  
Simple Modification ◽  
Intended Target ◽  
Coaxial Needle ◽  
Ct Guided Biopsy ◽  
Vascular Structures ◽  
Safe Performance

A standard computed tomography (CT)-guided biopsy, aspiration, injection, or drainage procedure typically requires a direct line of access from the skin to the target lesion or collection. Safe performance of these procedures is ideally done without violation of vascular structures or solid or hollow viscous. When a direct pathway to the target is absent, patients are commonly denied the procedure and instead referred to surgery. This chapter describes a solution for CT-guided procedures when a direct line of access to the intended target is unavailable. The technique involves a coaxial needle system with simple modification (curving) of the inner needle.

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