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目的确定在三维锥形线束CT引导下肾脏占位活检是否安全、准确,特别是在难以到达的解剖部位。材料与方法采用三维锥形线束CT用来引导进行41例病变的立体定向活检,这些病灶是超声或CT引导无法显示的部位。在三维锥形线束CT引导时,通过绕病人旋转C臂上的平板探测器血管造影系统,获取三维容量数据。在此数据中确定针道的穿刺轨迹,配准后从透视获得融合图像以及从数据获得一个层面,从而对穿刺进行实时定位。结果在这41例病变中,22例为恶性,17例为良性,2例不能确诊。这2例不能确诊的病变证明是肾细胞癌。良性病变在影像学随访过程中(平均29个月)没有进展。此操作的敏感度、特异度、阳性预测值、阴性预测值和准确度分别为91.7%、100%、100%、89.5%和95.1%。平均辐射剂量与面积的乘积为44.0Gy.cm2(16.5～126.5)。其并发症仅为1例出现轻微的出血。结论在三维锥形线束CT引导下对肾脏小占位进行安全、准确的活检是可行的,特别对于肾脏中难以到达的解剖位置。
Objective To determine if a kidney-space biopsy is safe and accurate under the guidance of a three-dimensional cone-beam CT, especially in difficult-to-reach anatomical sites. Materials and Methods Stereotactic biopsies of 41 lesions were guided using a three-dimensional cone-beam computed tomography (CT). These lesions were not displayed by ultrasound or CT guidance. Three-dimensional volumetric data was acquired by rotating a flat-panel detector angiography system on the C-arm about the patient while the three-dimensional cone beam CT was being guided. The puncture trajectory of the needle track is determined in this data, the fused image is obtained from the perspective after registration, and a level is obtained from the data to locate puncture in real time. Results Of the 41 lesions, 22 were malignant, 17 were benign and 2 were not diagnosed. These two cases of undiagnosed lesions proved to be renal cell carcinoma. There was no improvement in benign lesions during imaging follow-up (mean, 29 months). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of this procedure were 91.7%, 100%, 100%, 89.5% and 95.1%, respectively. The product of the average radiation dose and area is 44.0 Gy.cm2 (16.5 to 126.5). The complication was only mild bleeding in 1 case. Conclusions A safe and accurate biopsy of small renal masses under the guidance of a three-dimensional cone beam CT is feasible, especially for intractable anatomic locations in the kidney.