Helical CT versus intermittent CT fluoroscopic guidance for musculoskeletal needle biopsies: impact on radiation exposure, procedure time, diagnostic yield, and adverse events

A M Cahalane; S Habibollahi; S J Staffa; K Yang; F J Fintelmann; C Y Chang

doi:10.1007/s00256-022-04226-y

Helical CT versus intermittent CT fluoroscopic guidance for musculoskeletal needle biopsies: impact on radiation exposure, procedure time, diagnostic yield, and adverse events

Skeletal Radiol. 2023 Jun;52(6):1119-1126. doi: 10.1007/s00256-022-04226-y. Epub 2022 Nov 10.

Authors

A M Cahalane^{1

2}, S Habibollahi³, S J Staffa^{4

5}, K Yang⁶, F J Fintelmann^{4

7}, C Y Chang^{3

4}

Affiliations

¹ Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. acahalane@mgh.harvard.edu.
² Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. acahalane@mgh.harvard.edu.
³ Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
⁴ Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
⁵ Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
⁶ Division of Diagnostic Imaging Physics, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
⁷ Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.

PMID: 36355218
DOI: 10.1007/s00256-022-04226-y

Abstract

Objective: Image-guided percutaneous needle biopsies are essential in the workup of musculoskeletal (MSK) lesions. While helical CT (HCT) is well established, intermittent CT fluoroscopy (iCTF) is an increasingly used alternative. The purpose of this study is to establish whether differences in subject radiation exposure, procedure time, yield, or adverse events exist between HCT and iCTF guidance.

Materials and methods: This retrospective cohort study included consecutive MSK needle biopsies performed on a single-CT scanner over a 12-month period at a tertiary academic center. Subject demographics, radiation dose, and outcomes were abstracted from the medical record. Comparisons between the two cohorts were performed using Student's t-test for continuous data and using Fisher's exact test for categorical data and a two-tailed p value less than 0.05 was considered significant.

Results: Two hundred sixteen adults (115 (53.2%) females) with a mean age of 58.8 ± 18.4 years, underwent 216 biopsies (109 (50.5%) HCT guided, 107 (49.5%) iCTF guided) between June 2017 and June 2018. Dose-length product (DLP) and volume CT dose index (CTDIvol) were significantly higher for the HCT cohort (HCT 698.9 ± 400.8 mGycm vs iCTF 312.8 ± 170.8 mGycm; p < 0.005 and HCT 19.1 mGy ± 8.8 vs iCTF 6.9 mGy ± 1.5, p < 0.001). No significant difference in diagnostic yield, procedure time, or adverse event rate was identified.

Conclusion: For CT-guided MSK needle biopsies, iCTF decreases subject radiation dose compared to HCT without negatively affecting outcomes. iCTF should be strongly considered by radiologists performing MSK biopsies given the reduced patient radiation exposure.

Keywords: Biopsy; CT fluoroscopy; Helical CT; Musculoskeletal; Radiation dose.

MeSH terms

Adult
Aged
Biopsy, Needle
Female
Fluoroscopy / methods
Humans
Image-Guided Biopsy* / adverse effects
Image-Guided Biopsy* / methods
Male
Middle Aged
Radiation Dosage
Radiation Exposure*
Retrospective Studies
Tomography, Spiral Computed
Tomography, X-Ray Computed / methods