Download PDF
CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2021; 05(03): 150-157
DOI: 10.1055/s-0041-1729778
Review Article

Percutaneous CT Guided Vertebral Biopsy: Anatomy and Technical Considerations

Kunal Bharat Gala
1   Division of Interventional Radiology, Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Nitin S. Shetty
1   Division of Interventional Radiology, Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Amit Kumar Janu
2   Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Neeraj Shetty
1   Division of Interventional Radiology, Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Suyash S. Kulkarni
1   Division of Interventional Radiology, Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

In this review article, the authors discuss the anatomy and technical aspects of CT-guided biopsy of vertebral lesions. CT guidance is highly useful for vertebral biopsies, as the anatomy of the spine is complex and varies widely across the levels. Prebiopsy imaging should be reviewed and later correlated with the final histopathological diagnosis. The majority of the spine biopsies are performed under local anesthesia, except those in critical locations and pediatric age groups. The biopsy sample is sent for histopathological analysis and/or microbiological analysis depending on the indications. It is preferable to use a coaxial system for biopsies, so multiple cores can be obtained with a single needle puncture, thus minimizing the negative yield and complications. Complications after image-guided percutaneous biopsy are rare and can be managed easily.

Keywords

spine biopsy - percutaneous biopsy - vertebral lesions


Publication History

Article published online:
20 September 2021

© 2021. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Desai SS. Early diagnosis of spinal tuberculosis by MRI. J Bone Joint Surg Br 1994; 76 (06) 863-869
    CrossrefPubMedGoogle Scholar
  • 2 Takenaka D, Ohno Y, Matsumoto K. et al Detection of bone metastases in non-small cell lung cancer patients: comparison of whole-body diffusion-weighted imaging (DWI), whole-body MR imaging without and with DWI, whole-body FDG-PET/CT, and bone scintigraphy. J Magn Reson Imaging 2009; 30 (02) 298-308
    CrossrefPubMedGoogle Scholar
  • 3 Bickels J, Jelinek JS, Shmookler BM, Neff RS, Malawer MM. Biopsy of musculoskeletal tumors. Current concepts. Clin Orthop Relat Res 1999; 368 (368) 212-219
    PubMedGoogle Scholar
  • 4 Tan SB, Kozak JAMM, Mawad ME. The limitations of magnetic resonance imaging in the diagnosis of pathologic vertebral fractures. Spine 1991; 16 (08) 919-923
    CrossrefPubMedGoogle Scholar
  • 5 Lis E, Bilsky MH, Pisinski L. et al Percutaneous CT-guided biopsy of osseous lesion of the spine in patients with known or suspected malignancy. AJNR Am J Neuroradiol 2004; 25 (09) 1583-1588
    PubMedGoogle Scholar
  • 6 Chang CY, Huang AJ, Bredella MA. et al Percutaneous CT-guided needle biopsies of musculoskeletal tumors: a 5-year analysis of non-diagnostic biopsies. Skeletal Radiol 2015; 44 (12) 1795-1803
    CrossrefPubMedGoogle Scholar
  • 7 Wu JS, Goldsmith JD, Horwich PJ, Shetty SK, Hochman MG. Bone and soft-tissue lesions: what factors affect diagnostic yield of image-guided core-needle biopsy?. Radiology 2008; 248 (03) 962-970
    CrossrefPubMedGoogle Scholar
  • 8 Heyer CM, Al-Hadari A, Mueller KM, Stachon A, Nicolas V. Effectiveness of CT-guided percutaneous biopsies of the spine: an analysis of 202 examinations. Acad Radiol 2008; 15 (07) 901-911
    CrossrefPubMedGoogle Scholar
  • 9 Dupuy DE, Rosenberg AE, Punyaratabandhu T, Tan MHH, Mankin HJ. Accuracy of CT-guided needle biopsy of musculoskeletal neoplasms. AJR Am J Roentgenol 1998; 171 (03) 759-762
    CrossrefPubMedGoogle Scholar
  • 10 Ebraheim NA, Rollins JRJ Jr, Xu R, Yeasting RA. Projection of the lumbar pedicle and its morphometric analysis. Spine 1996; 21 (11) 1296-1300
    CrossrefPubMedGoogle Scholar
  • 11 Ebraheim NA, Xu R, Ahmad M, Yeasting RA. Projection of the thoracic pedicle and its morphometric analysis. Spine 1997; 22 (03) 233-238
    CrossrefPubMedGoogle Scholar
  • 12 Mills MK, Shah LM. Imaging of the perivertebral space. Radiol Clin North Am 2015; 53 (01) 163-180
    CrossrefPubMedGoogle Scholar
  • 13 Patel IJ, Davidson JC, Nikolic B. et al Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol 2012; 23 (06) 727-736
    CrossrefPubMedGoogle Scholar
  • 14 Veltri A, Bargellini I, Giorgi L, Alexandre P, Silva M, Okan A. CIRSE Guidelines on Percutaneous Needle Biopsy (PNB). Cardiovasc Intervent Radiol 2017; 40 (10) 1501-1513
    CrossrefPubMedGoogle Scholar
  • 15 Gupta S, Wallace MJ, Cardella JF, Kundu S, Miller DL, Rose SC. Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for percutaneous needle biopsy. J Vasc Interv Radiol 2010; 21 (07) 969-975
    CrossrefPubMedGoogle Scholar
  • 16 Lee MJ, Fanelli F, Haage P. Hausegger K, Van Lienden KP. Patient safety in interventional radiology: a CIRSE IR checklist. Cardiovasc Intervent Radiol 2012; 35 (02) 244-246
    CrossrefPubMedGoogle Scholar
  • 17 Ghelman B. Biopsies of the musculoskeletal system. Radiol Clin North Am 1998; 36 (03) 567-580
    CrossrefPubMedGoogle Scholar
  • 18 Hadjipavlou AG, Kontakis GM, Gaitanis JN, Katonis PG, Lander P, Crow WN. Effectiveness and pitfalls of percutaneous transpedicle biopsy of the spine. Clin Orthop Relat Res 2003; ( (411) 54-60
    CrossrefPubMedGoogle Scholar
  • 19 Davis TM. Spinal biopsy techniques. In: McGraw JK, ed. Interventional Radiology of the Spine. Totowa, NJ: Humana Press Inc 2004: 181-96
  • 20 Haaga JR, LiPuma JP, Bryan PJ, Balsara VJ, Cohen AM. Clinical comparison of small-and large-caliber cutting needles for biopsy. Radiology 1983; 146 (03) 665-667
    CrossrefPubMedGoogle Scholar
  • 21 Domanski HA, Akerman M, Carlén B. et al Core-needle biopsy performed by the cytopathologist: a technique to complement fine-needle aspiration of soft tissue and bone lesions. Cancer 2005; 105 (04) 229-239
    CrossrefPubMedGoogle Scholar
  • 22 Yaffe D, Greenberg G, Leitner J, Gipstein R, Shapiro M, Bachar GN. CT-guided percutaneous biopsy of thoracic and lumbar spine: A new coaxial technique. AJNR Am J Neuroradiol 2003; 24 (10) 2111-2113
    PubMedGoogle Scholar
  • 23 Joshi A, Magar SR, Chand P. Panth R, Khatri Chhetri BR. Tru-cut biopsy as the initial method of tissue diagnosis in bone tumors with soft tissue extension. Indian J Orthop 2013; 47 (02) 195-199
    CrossrefPubMedGoogle Scholar
  • 24 Rimondi E, Staals EL, Errani C. et al Percutaneous CT-guided biopsy of the spine: results of 430 biopsies. Eur Spine J 2008; 17 (07) 975-981
    CrossrefPubMedGoogle Scholar
  • 25 Olscamp A, Rollins J, Tao SS, Ebraheim NA. Complications of CT-guided biopsy of the spine and sacrum. Orthopedics 1997; 20 (12) 1149-1152
    CrossrefPubMedGoogle Scholar
  • 26 Kattapuram V, Rosenthal I. Review article percutaneous biopsy of skeletal lesions. AJR 1991; 157: 934-942
    CrossrefPubMedGoogle Scholar
  • 27 Freiberger H. Closed biopsy: skeletal review needle. AJR Am J Roentgenol 1983; 140 (01) 113-115
    CrossrefPubMedGoogle Scholar
  • 28 Garg V, Kosmas C, Josan ES. et al Computed tomography-guided percutaneous biopsy for vertebral neoplasms: a department’s experience and hybrid biopsy technique to improve yield. Neurosurg Focus 2016; 41 (02) E17
    CrossrefPubMedGoogle Scholar
  • 29 Gul SB, Polat AV, Bekci T, Selcuk MB. Accuracy of percutaneous CT-guided spine biopsy and determinants of biopsy success. J Belg Soc Radiol 2016; 100 (01) 62
    CrossrefPubMedGoogle Scholar
  • 30 Ottolenghi CE, Schajowicz F, Deschant FA. Aspiration biopsy of the cervical spine. Technique and results in thiry-four cases. J Bone Joint Surg Am 1964; 46: 715-733
    CrossrefPubMedGoogle Scholar
  • 31 Geremia G, Joglekar S. Percutaneous needle biopsy of the spine. Neuroimaging Clin N Am 2000; 10 (03) 503-533
    PubMedGoogle Scholar
  • 32 Stringham DR, Hadjipavlou A, Dzioba RBLP, Lander P. Percutaneous transpedicular biopsy of the spine. Spine 1994; 19 (17) 1985-1991
    CrossrefPubMedGoogle Scholar
  • 33 McGraw JK. Spinal Biopsy Techniques. Totowa, NJ: Humana Press Inc 2004: 181-196
  • 34 Pierot L, Boulin A. Percutaneous biopsy of the thoracic and lumbar spine: transpedicular approach under fluoroscopic guidance. AJNR Am J Neuroradiol 1999; 20 (01) 23-25
    PubMedGoogle Scholar
  • 35 Renfrew DL, Whitten CG, Wiese JA, el-Khoury GY, Harris KG. CT-guided percutaneous transpedicular biopsy of the spine. Radiology 1991; 180 (02) 574-576
    CrossrefPubMedGoogle Scholar
  • 36 Ward JC, Jeanneret B, Oehlschlegel C, Magerl F. The value of percutaneous transpedicular vertebral bone biopsies for histologic examination. Results of an experimental histopathologic study comparing two biopsy needles. Spine 1996; 21 (21) 2484-2490
    CrossrefPubMedGoogle Scholar
  • 37 Aribas BK, Dingil G, Dogan K, Sahin G, Pak I, Ardic F. Factors in sample volume and quality of CT-guided vertebral biopsy: location and needle trajectory. Turk Neurosurg 2010; 20 (01) 21-26
    PubMedGoogle Scholar
  • 38 Garcés J, Hidalgo G. Lateral access for CT-guided percutaneous biopsy of the lumbar spine. AJR Am J Roentgenol 2000; 174 (02) 425-426
    CrossrefPubMedGoogle Scholar
  • 39 Patel IJ, Rahim S, Davidson JC. et al Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions-Part II: Recommendations: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2019; 30 (08) 1168-1184.e1
    CrossrefPubMedGoogle Scholar
  • 40 Hau A, Kim I, Kattapuram S. et al Accuracy of CT-guided biopsies in 359 patients with musculoskeletal lesions. Skeletal Radiol 2002; 31 (06) 349-353
    CrossrefPubMedGoogle Scholar
  • 41 Yang YJDT, Damron TA. Comparison of needle core biopsy and fine-needle aspiration for diagnostic accuracy in musculoskeletal lesions. Arch Pathol Lab Med 2004; 128 (07) 759-764
    CrossrefPubMedGoogle Scholar
  • 42 Puri A, Shingade VU, Agarwal MG. et al CT-guided percutaneous core needle biopsy in deep seated musculoskeletal lesions: a prospective study of 128 cases. Skeletal Radiol 2006; 35 (03) 138-143
    CrossrefPubMedGoogle Scholar
  • 43 Yang SY, Oh E, Kwon JW, Kim HS. Percutaneous image-guided spinal lesion biopsies: Factors affecting higher diagnostic yield. AJR Am J Roentgenol 2018; 211 (05) 1068-1074
    CrossrefPubMedGoogle Scholar
  • 44 Nourbakhsh A, Grady JJ, Garges KJ. Percutaneous spine biopsy: a meta-analysis. J Bone Joint Surg Am 2008; 90 (08) 1722-1725
    CrossrefPubMedGoogle Scholar
  • 45 Czervionke LFFD. Percutaneous spine biopsy. Image Guided Spine Interv 2003; xx: 141-187
    PubMedGoogle Scholar