CT Fluoroscopic Guidance Research Articles

CT-Guided Percutaneous Drainage of a Duodenal Hematoma

CT-Guided Percutaneous Drainage of a Duodenal HematomaCarmelo Gullotto1 and Erik K. Paulson1Audio Available | Share

末梢肺結節に対するテレビ透視下およびreal-time CTガイド下気管支鏡の診断成績比較(第27回日本呼吸器内視鏡学会総会 : プレナリーセッション3)

末梢肺結節に対するテレビ透視下およびreal-time CTガイド下気管支鏡の診断成績比較(第27回日本呼吸器内視鏡学会総会 : プレナリーセッション3)

Shoulder MR arthrography guided by CT fluoroscopy

We describe a special shoulder MR arthrography technique, performed with an anterior approach under CT fluoroscopy guidance. CT guided anterior approach can easily and accurately detect anatomical location. Eighty-five MR arthrograms of the glenohumeral joint were obtained prospectively in 85 consecutive patients with shoulder pain in which rotator cuff and labral lesions were suspected. Total procedure time was less than 8 minutes and this was well tolerated by all patients. The mean level of pain reported by patients during the procedure was 2.1 on a scale of 0–10. This MR arthrography technique is useful particularly in patients with cuff and labral lesions. This technique of shoulder MR arthrography is accurate, rapid, easy to perform, and well tolerated by patients.

CT-fluoroscopy guided interstitial brachytherapy with image-based treatment planning for unresectable locally recurrent rectal carcinoma

Purpose The aim of the study is to develop high-dose-rate (HDR) conformal interstitial brachytherapy by means of combined CT-fluoroscopy guidance with CT-based treatment planning for locally recurrent rectal carcinoma. Methods and materials Brachytherapy needle insertion was guided with a helical CT scanner providing continuous fluoroscopy reconstruction. A video monitor placed adjacent to the CT gantry simultaneously allowed the operator to see the process of needle insertion. Final CT images were transferred by an online system to the treatment-planning computer, which reconstructed the implant needles and organ contours. The doses in planning target volume were normalized and geometrically optimized. The patients received a brachytherapy dose at 5 Gy twice daily with a hypofractionated accelerated schedule at a total dose of 30–50 Gy with or without external radiation therapy. Eighteen patients were treated with this procedure. Results Ten to thirty-six needles (average, 17.3) were successfully placed to the planning target volume in each patient. The average time for CT fluoroscopy was 357 seconds for each procedure. No accident was seen at needle insertion, but 2 patients developed incomplete peroneal nerve palsy after needle removal, but gradually recovered. CT-based treatment planning was faster and more accurate than projection reconstruction with conventional radiograms. Analysis of the dose volume histogram showed conformal dose distribution to the target, while avoiding normal structures. Conclusion CT fluoroscopy guidance ensures safety and increases the accuracy of needle placement in brachytherapy. Conformal high-dose-rate (HDR) interstitial brachytherapy with CT-based treatment planning is a method worth considering for locally recurrent rectal cancer.

Usefulness of New Automated Cutting Needle for Tissue-Core Biopsy of Lung Nodules Under CT Fluoroscopic Guidance

The goal of our study was to evaluate the efficacy and safety of a new type of automated cutting needle for tissue-core lung biopsy under real-time CT fluoroscopic guidance. Observational One hundred ten percutaneous needle tissue-core lung biopsies were performed with the Auto Surecut needle (Create Medic; Yokohama, Japan) under CT fluoroscopic guidance, and the specimens obtained underwent histopathologic evaluation. A final diagnosis was confirmed by independent surgical pathology. The rate of success for the diagnosis for specimens that were adequate for histopathologic analysis was 94.5% (104 of 110 specimens). The sensitivity, specificity, and accuracy in diagnosing malignancy were 95.1%, 100%, and 96.2%, respectively. A specific cell type could be characterized in 95.2% of those 104 lesions (99 lesions; malignant, 76 lesions; benign, 23 lesions). The specific cell type was precisely diagnosed, and was confirmed after surgery in 65 malignant lesions and 23 benign lesions. The biopsy-induced complications encountered were pneumothorax in 34.5% (38 of 110 patients) and hemoptysis in 6.4% (7 of 110 patients). No patient had a serious complication. CT fluoroscopy-guided lung biopsy using the Auto Surecut needle provides a high degree of diagnostic accuracy, allows for the specific characterization of lung nodules, and can be performed safely.

Combining fine-needle aspiration and core biopsy under CT fluoroscopy guidance: a better way to treat patients with lung nodules?

The goal of our study was to evaluate the efficacy of the combined use of fine-needle aspiration and tissue core biopsy under real-time CT fluoroscopy guidance. One hundred thirty-eight percutaneous needle lung biopsy samples were obtained by two methods. The samples obtained by tissue fine-needle aspiration underwent cytologic evaluation, and those obtained by core biopsy using an automated cutting needle underwent histologic evaluation. The final diagnosis was confirmed by independent surgical pathologic findings, independent culture results, or clinical follow-up. Rates of adequate specimens obtained and of precise diagnosis by combined use of fine-needle aspiration and core biopsy were 97.1% (134/138) and 94.2% (130/138) evaluated lung lesions, respectively, whereas those rates were 84.8% (117/138) and 79.7% (110/138) by fine-needle aspiration alone and 91.3% (126/138) and 89.1% (123/138) by core biopsy alone, respectively. Precise diagnosis was achieved by the combined use of the techniques in 30 (93.8%) of 32 lesions ranging from 3 to 10 mm in diameter, 42 (93.3%) of 45 lesions ranging from 11 to 20 mm, 43 (93.5%) of 46 lesions ranging from 21 to 30 mm, and 100% of 15 lesions ranging from 31 to 100 mm. In 89 of 90 lesions shown to be malignant by CT-guided lung biopsy and 30 of 44 shown to be benign, specific cell types could be proven from specimens obtained by the combined use of the two different types of needle biopsy. The combined use of fine-needle aspiration and core biopsy improves the diagnostic ability of CT fluoroscopy-guided lung biopsy, even in small lesions.

Using a Dedicated Lung-Marker System for Localization of Pulmonary Nodules Before Thoracoscopic Surgery

Our aim was to evaluate the effectiveness of a commercially available dedicated lung-marker system for localization of pulmonary nodules before video-assisted thoracoscopic surgery. Guidewires were positioned under CT fluoroscopy guidance in 16 patients (11 men, five women; age range, 39-79 years; mean age, 60.4 years). We measured the size of the targeted nodule, its distance to the closest pleural surface, the angle between the introducer needle and the chest wall, and the time for performance of the procedure in each patient. Note was made of any complications after guidewire placement. In the 16 patients, the average nodule size was 6.7 mm (range, 3-12 mm), the average distance to the pleural surface was 10.6 mm (range, 3-22 mm), and the average pleural puncture angle was 59 degrees (range, 25-78 degrees). The marking procedure was completed within an average of 9.5 min (range, 7-15 min). Small pneumothoraces occurred in five (31.3%) of 16 patients. In 15 (93.8%) of 16 patients, thoracoscopic resection of the targeted nodule was successful; in one patient with dyspnea (6.3%), inaccurate localization resulting in an open thoracotomy occurred because an intervening fissure was not visualized. Dislodgement of the guidewire into the pleural space occurred in one patient (6.3%). The dedicated lung-marker system is a fast and effective method for localization of pulmonary nodules before thoracoscopic resection.

Large core biopsy of the pancreas under CT fluoroscopy control: results and complications.

The objective of this study was to evaluate the accuracy and complication rate of CT fluoroscopy-guided percutaneous core biopsies of the pancreas in patients with a suspected pancreatic neoplasm. Sixty-three CT-guided biopsies were performed in 57 consecutive patients over a period of 20 months. Forty-nine of the 57 patients had a malignant lesion (85.9%). All procedures were done under CT fluoroscopic guidance. A high-speed biopsy gun with 14, 16, or 18 gauge cutting-type needles was used. Based on final pathologic diagnosis as the standard of reference, the diagnostic efficacy was determined. Complications during and afterward up to the patient's discharge from hospital (mean, 8.1 days; range, 1-48 days) were noted. Core biopsy of the pancreas resulted in a correct diagnosis in 51 of 63 biopsies, yielding a sensitivity for malignancy of 78.1%, a specificity of 100%, a positive predictive value of 100%, and an overall accuracy of 81.0%. One patient of 57 developed an acute pancreatitis related to the biopsy (1.6%). CT fluoroscopic-guided core biopsy is a safe and reliable tool for the pretherapeutic evaluation of pancreatic lesions.

Management of Pneumothorax After Percutaneous CT-Guided Lung Biopsy

To evaluate the efficacy of simple aspiration of air from the pleural space to prevent increased pneumothorax and to avoid chest tube placement in cases of pneumothorax following CT-guided lung biopsy. Observational. One hundred thirty-four consecutive percutaneous needle lung biopsies using real-time CT fluoroscopy guidance formed the basis of our study. All patients that demonstrated moderate or severe pneumothorax on postbiopsy chest CT images underwent percutaneous manual aspiration regardless of symptoms while on the CT scanner table. Correlation between the incidence of pneumothorax after biopsy and many factors (i.e., gender, age, number of pleural passes, presence of emphysema, lesion size, and lesion depth) were determined, and management of each case of biopsy-induced pneumothorax was reviewed. Postbiopsy pneumothorax occurred in 46 of 134 procedures (34.3%). Twenty of the 46 patients were treated by manual aspiration, while 26 patients were simply observed. In 43 of the 46 pneumothoraces (93.5%), the pneumothorax resolved completely on follow-up chest radiographs without requiring tube placement. Only three patients (2.2% of the entire series; 6.5% of those who had pneumothorax develop) required chest tube placement. The risk of pneumothorax significantly increased with lesion size and depth. Results of our nonprospective, nonrandomized study suggest that percutaneous manual aspiration of biopsy-induced pneumothorax performed immediately after biopsy may prevent progressive pneumothorax and subsequent chest tube placement.

CT Fluoroscopy Guidance for Transbronchial Needle Aspiration: An Experience in 35 Patients

To demonstrate the usefulness of real-time guidance with CT fluoroscopy to improve the yield of transbronchial needle aspiration (TBNA). Prospective, observational. A tertiary-care, university-affiliated medical center. From December 1998 to April 2000, 35 patients underwent CT fluoroscopy-guided TBNA. Patients with subcarinal and precarinal lymph nodes were only included if a previous attempt was nondiagnostic, as the initial yield in this setting with conventional TBNA is high. TBNA was performed using standard technique in a CT-scan suite. Needle location was confirmed with fluoroscopy without IV contrast being used. Specimens were evaluated on-site for adequacy. The procedure had to be aborted in three patients before TBNA could be performed. Samples were obtained in 32 patients. Samples were nondiagnostic in four patients. Adequate tissue was obtained in 28 of 32 patients (87.5%). Twenty-two patients had a specific benign or malignant diagnosis made, and 6 patients had lymphocytes only on the specimen. In follow-up, only one of these six patients proved to have a malignancy. All procedures were performed within a regular interventional CT time slot of 1 h. No TBNA side effects were noted. TBNA under CT fluoroscopic guidance is easy to perform. The yield in all accessible lymph node stations is high.

CT fluoroscopy-assisted needle puncture and ethanol injection for hepatocellular carcinoma: a preliminary study.

We assessed the usefulness of real-time CT fluoroscopy for needle guidance and evaluated the clinical usefulness of a unified CT fluoroscopy and angiography system in the treatment of hepatocellular carcinoma. A single-session percutaneous ethanol injection was performed with CT fluoroscopy guidance and monitoring for 15 hepatocellular carcinomas with an average size of 2.5 cm (range, 0.7-4.7 cm) in 10 consecutive patients. Of these, seven lesions were not seen on sonography. To mark the lesion for puncture, we performed CT arteriography or arterial injection of iodized oil. A puncture guide was applied to 12 lesions. The average depth from the skin's surface to the lesion was 9.3 cm (range, 4.5-11.5 cm), and the puncture route was transthoracic in five lesions and transabdominal in 13. The overall success rate in puncturing the lesions was 94.4% (17/18 sessions). The average number of punctures was 3.3, and it significantly decreased after introduction of a puncture guide compared with freehand puncture (p < .01). The average amount of injected ethanol was 12.7 ml (range, 4-27 ml). The ratio of injected ethanol dose to calculated ethanol dose was 0.6. Local recurrence occurred in four (26.7%) of 15 lesions after an average of 5 months. Using CT fluoroscopy for guidance of the needle and for monitoring ethanol infusion in the target lesion, we have found single-session percutaneous ethanol injection to be possible for hepatocellular carcinomas smaller than 5 cm or not revealed by sonography. The puncture guidance equipment was helpful for accurate insertion of the needle into the lesion, allowing a minimum number of punctures and minimal radiation exposure.

Percutaneous abdominal and pelvic interventional procedures using CT fluoroscopy guidance.

The purpose of our study was to assess the use of low-milliamperage CT fluoroscopy guidance for percutaneous abdominopelvic biopsy and therapeutic procedures. We reviewed the clinical records and relevant imaging studies of 97 patients who underwent 119 percutaneous CT fluoroscopy-guided abdominal or pelvic procedures: fluid collection aspiration or drainage catheter insertion (n = 59), biopsy (n = 49), hepatocellular carcinoma ethanol ablation (n = 6), chemoneurolysis (n = 4), and brachytherapy catheter insertion (n = 1). These procedures were guided using a helical CT scanner providing real-time fluoroscopy reconstruction at six frames per second. A control panel and video monitor beside the gantry allowed direct operator control during all interventional procedures. One hundred twelve (94.1%) procedures were successfully performed using either a stand-off needle holder and continuous real-time CT fluoroscopy guidance or incremental manual insertion and intermittent CT fluoroscopy to confirm position. Image quality using low milliamperage was adequate for needle or drainage tube placement in all but two low-contrast liver lesions. Two hematomas were accessed but yielded no fluid on aspiration; one drainage procedure was abandoned after the patient developed endotoxic shock. Imaging of ethanol distribution during injection facilitated tumor ablation and neurolytic procedures. CT fluoroscopy allowed rapid assessment of needle, guidewire, dilator, and catheter placement, especially in nonaxial planes. Average CT fluoroscopy time for biopsy and therapeutic procedures was 133 sec (range, 35-336 sec) and 186 sec (range, 20-660 sec), respectively. CT fluoroscopy is a practical clinical tool that facilitates effective performance of percutaneous abdominal and pelvic interventional procedures.

Computed tomography-fluoroscopy guided injection of cyanoacrylate to mark a pulmonary nodule for thoracoscopic resection

There have been several reports regarding aids to localize small and/or deeply situated peripheral pulmonary lesions thoracoscopically. However, we have found that they were not always reliable and have attempted to use a cyanoacrylate adhesive as an alternative. We injected 0.1-0.2 ml of Histoacryl (n-butyl-2-cyanoacrylate) blue through a 22 gauge long needle to the lung parenchyma immediately beneath the pleural surface that was nearest to the target nodule. Following local anesthesia of the thoracic wall, we inserted the needle tip to the desired position under CT-fluoroscopic guidance. After retracting the syringe piston to confirm that no blood was aspirated, we injected the adhesive and immediately removed the needle. The adhesive polymerized immediately after its injection into the lung parenchyma to form a hard nodule. There was no complication except mild pneumothorax and slight pain at the puncture site. The adhesive nodule measured 1.0-1.5 cm in diameter and was hard enough to be easily located thoracoscopically in all the 8 patients/9 nodules studied. The nodule was also recognizable by its blue color visible under the pleura. CT-fluoroscopy guided injection of Histoacryl blue provided a reliable marker for the localization of pulmonary nodules, especially in those patients with severe anthracosis in the pulmonary parenchyma.

CT Fluoroscopy-Guided Interventions in Intracranial Disease

Real-time CT fluoroscopy (CTF), which permits real-time monitoring of CT images at a rate of 8 images per second with a 0.5 s delay time, has recently entered clinical use. The purpose of this paper is to evaluate the usefulness of CTF as a tool for guiding intracranial interventions. Twenty-six interventional procedures were undertaken in 16 patients under CTF guidance. These included puncture of intracranial hematoma (n=8), hematoma drainage (n=9), cerebrospinal fluid (CSF) drainage (n=3), biopsy of intracranial tumors (n=4), and marking of intracerebral tumors (n?2). Needle puncture and placement were clearly monitored by CTF in all the cases. Hematoma puncture and drainage, CSF drainage, and tumor marking were performed successfully under CTF guidance. Biopsy failed in one patient with suspected brain tumor. Intra- and extra-tumor bleeding was observed in two patients who underwent tumor biopsy and was detected by CTF immediately after the occurrence. Our preliminary study indicates that real-time CTF is a potentially valuable tool for guiding neurosurgical interventions.

Evaluation of biopsy needles and prototypic needle guide devices for percutaneous biopsy with CT fluoroscopic guidance in simulated organ tissue.

The authors evaluated accuracy and success rates for placement of fine-aspiration, core, and coaxial biopsy needles in pork meat with three needle guide devices and computed tomographic fluoroscopic guidance. Accuracy and reliability with a metallic sponge-forceps needle holder was equal to or greater than those with other devices, and it was preferred by operators due to its lighter weight and single-handed manipulation. All needle holders functioned poorly with thin-walled needles.