The Application Value Of Open MR-guided Percutaneous Transpedicular Bone Drill Biopsy Of Thoracolumbar Lesions

ObjectiveTo evaluate the feasibility,safety and accuracy of open0.23T MR-guided percutaneous transpedicular biopsy of thoracolumbar vertebral body lesions.Material and Methods35men and18women were included in our study.A total of53procedures of vertebral body lesions were underwent percutaneous transpedicular biopsy applying12G MR-compatible bone drill(Neuerburg Bone Biopsy Set, COOK) under the guidance of0.23T open-configuration MR scanner(Marconi,Philips) mounted with optical tracking system(iPath200,Philips Medical System).Among them,17cases were located in thoracic spine,and the other cases in lumbar spine.The biopsy specimens were evaluated with histopathology,supplemented with immunohistochemical method necessarily.The final diagnosis was confirmed by histologic samples from surgery or by clinical follow-up minimum of6months.Comparing histopathologic diagnosis with the final diagnosis,we calculate the sensitivity, specificity,positive predictive value,negative predictive value and accuracy of the biopsy of thoracic and lumbar vertebral body lesions respectively,and analyze the accuracies to confirm the statistical differences applying Fish’s exact test. We recorded the time of procedures,and the complication occurred intraoperatively or postoperatively.Results 53cases were successfully punctured and obtained adequate tissues. Among them,50cases obtained histopathological classification,including metastatic tumor(17cases),myeloma(6cases),lymphoma(5cases),chronic inflammation(9cases), tuberculosis(7cases),eosinophilic granuloma(3cases),osteoporotic fracture(3cases), and myelofibrosis(1case).According the histopathologic results,the thoracolumbar spine lesions were malignant in28cases and benign in25cases,included9cases malignant and8cases benign located in thoracic vertebra, and19cases malignant and17cases benign in lumbar vertebra. The final diagnoses from surgery or clinical follow-up minimum of6months were31malignant lesions and22benign lesions.The sensitivity, specificity,positive predictive value,negative predictive value and accuracy of open MRI guided percutaneous transpedicular biopsy of thoracic vertebral body lesions were90.3%(28/31),100%(22/22),100%(28/28),888%(22/25),94.3%(50/53), respectively.The sensitivity, specificity,positive predictive value,negative predictive value and accuracy of open MRI guided percutaneous transpedicular biopsy of thoracic vertebral body lesions were90%(9/10),100%(7/7),100%(9/9),87.5%(7/8),94.1%(16/17),respectively.The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of open MRI guided percutaneous transpedicular biopsy of lumbar vertebral body lesions were90.5%(19/21),100%(15/15),100%(19/19),88.2%(15/17),94.4%(34/36),respectively. There was no significant difference for accuracy,sensitivity and specificity between thoracic spine biopsy and lumbar spine biopsy (all p>0.05,Fisher’s exact test).The time of procedures in our group ranged from25min to57min (average37±5).No serious complication occurred intraoperatively or postoperatively in the group,except that local pain occurred in3cases and disappeared after bed rest for1-2days.Conclusion1.0.23T open MRI can meet the image requirement of percutaneous biopsy with its capacity for clearly displaying thoracolumbar body lesions and surrounding tissue structure.2.Open MRI-guided percutaneous transpedicular biopsy of thoracolumbar body lesions is an accuracy,safety and feasible diagnostic technique with high diagnosis accuracy and low complication.3.Open MRI will be an alternative choice for guiding minimally invasive treatment of thoracolumbar body lesions.