The Diagnostic Value Of 1.0-T Multiparameter Magnetic Resonance Imaging-guided Precision Biopsy In Central Pulmonary Lesions

[Research Background]With the development of precision medicine,histopathological diagnosis and tumor molecular biological detection have become the basis of lung cancer treatment,and accurate and adequate tissue sampling is the prerequisite for obtaining pathologic diagnosis.For patients with central pulmonary lesions,bronchoscopy is the main method to obtain pathological diagnosis,but for some cases of negative or not tolerate bronchoscopy,image-guided percutaneous puncture biopsy is a good alternative.Computed tomography(computed tomography,CT)is the most commonly used method of puncture biopsy of thoracic lesions and is widely used to guide biopsy of lung peripheral lesions.However,CT-guided percutaneous biopsy of central pulmonary lesions has two defects,causes its application to be limited:1.the central pulmonary lesions often accompanies the lung atelectasis and the obstructive pneumonia,the CT sometimes is difficult to be clear to puncture target area;2.the central pulmonary lesions changes adjacent to the pulmonary arteriovenous and so on important blood vessels,the CT scanning cannot clearly display the pathological change and the pulmonary blood vessel's.At present,the IMRI technique has been widely used in craniocerebral,head and neck,mammary gland and skeletal muscle with various rapid imaging sequences adapted to MRI intervention(interventional magnetic resonance Imaging,IMRI)and clinical application of MRI compatible interventional devices,liver,prostate and many other parts of minimally invasive diagnosis and treatment.Magnetic resonance imaging(magnetic resonance Imaging,MRI)is characterized by high contrast of soft tissue,arbitrary planar imaging,functional imaging,vascular emptying effect,and no ionizing radiation damage,which differentiate between the central pulmonary lesions and atelectasis,Obstructive pneumonia and the relationship between the lesions and pulmonary portal vessels showed significant advantages.[Objective]This study was designed to explore the feasibility,accuracy and safety of 1.0-T Multiparameter Magnetic Resonance Imaging-Guided Percutaneous Precision Biopsy in Central Pulmonary Lesions.[Material and Method]During January 2015-December 2016,104 patients were treated by MRI in Shandong Province Medical Imaging Research Institute guided by the percutaneous biopsy in central pulmonary lesions.As a forward-looking single center single arm study,it has been identified and approved by the Institutional Ethics Review Committee,the registration form.The group Standard is:(1)Pulmonary central type lesions from the three bronchial;(2)clinical suspicion is a malignant lesion,before treatment need to clear pathological diagnosis;(3)The clinical consideration is benign pathological change,but the curative effect is not good,need to clear pathological diagnosis;(4)Not suitable for open chest or patients refused surgical surgery of the central pulmonary lesions,The histological pathologic type should be prescribed to guide the treatment plan.The exclusion criteria are:(1)Severe emphysema,puncture into the road cannot avoid the lung bubble,(2)Serious coagulation dysfunction(international standardized ratio is greater than 1.5 or activation part of the clotting activity time,the normal upper limit of twice times);(3)Severe platelet abnormalities(<50×109/L)(4)Installing a cardiac pacemaker and other MRI contraindication,(5)The patient can not cooperate,or the patient's family refused to sign the needle biopsy agreement.According to whether the lung is divided into two groups,including 32 cases with atelectasis,not accompanied by atelectasis in 72 cases.1.0T Open Magnetic resonance guided percutaneous puncture biopsy of 104 cases of central pulmonary lesions,and histopathological examination after operation.the results of postoperative pathology or clinical,imaging follow-up 6 months or more of the diagnosis as the final clinical diagnosis results.The diagnostic accuracy,sensitivity,specificity,positive predictive value and negative predictive value of MRI guided percutaneous puncture biopsy of the central pulmonary lesions were calculated by comparing the pathologic results with the final diagnosis results.To calculate the incidence of complications such as pneumothorax and hemoptysis,and to compare the diagnostic accuracy,sensitivity and specificity of the nodules with atelectasis with the accurate test of Fisher's,the difference was significant between P<0.05.There was a significant difference.[Result]104 cases of pulmonary central pulmonary lesions were successfully performed by MRI-guided percutaneous puncture biopsy to obtain pathological tissue,The average puncture time is 27 ? 5 minutes(range 21-47 minutes).In this study,the MRI T2WI-TSE rapid scanning sequence,in 32 cases of pulmonary central pulmonary lesions accompanied by atelectasis,can be clearly differentiated 30 cases,the accuracy of 93.8%.When the magnetic resonance T2WI-TSE sequence transverse scan distinguishes between tumor and atelectasis,sagittal scan can clearly show the relationship between the lesions and atelectasis.MRI E-T1WI-TSE and DWI scan sequences were used as supplemental scan sequences when the MRI T2WI-TSE Rapid scans sequence to differentiate lung atelectasis.104 cases of pulmonary central pulmonary lesions were successfully performed by MRI-guided percutaneous puncture biopsy to obtain pathological tissue,90 cases of malignant lesion of central pulmonary lesions were diagnosed by puncture pathology,14 cases of benign lesion,pathology(21 cases)after surgical resection,and clinical and imaging follow-up for 6 months(83 cases),The final diagnosis result was malignant 93 cases,benign 11 cases.The accuracy of MRI-guided percutaneous puncture biopsy in the diagnosis of central pulmonary lesions was 97.1%,sensitivity 96.8%,specificity 100%,positive predictive value 100%,negative predictive value 78.6%.The accuracy of the Atelectasis group was 93.8%,sensitivity 93.3%,specificity 100%,the accuracy rate of atelectasis was 98.6%,sensitivity 98.4%,specificity 100%.There was no statistically significant difference between the two groups(P<0.05).Puncture biopsy-related complications:The incidence of pneumothorax is 6.7%(7/104),no closed thoracic drainage,the incidence of self-limiting hemoptysis is 1.9%(2/104),no other serious complications occur.[Conclusion]1.Magnetic resonance T2WI-TSE sequence,E-tlwi-tse sequence and DWI sequence can clearly analyze atelectasis and necrosis,which is helpful for the determination of puncture target to improve the accuracy of percutaneous biopsy of pulmonary central type lesions.2.The vascular flow effect of magnetic resonance can clearly distinguish the blood vessels around or inside the tumor,avoid the injury of blood vessels,clear the relationship between the lesions and the peripheral arteries,and improve the safety of the biopsy of hilar lesions.3.The feasibility,accuracy and safety of percutaneous puncture biopsy under 1.0-T Multiparameter Magnetic Resonance Imaging is a technique worthy of clinical popularization.