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MR Imaging–Guided Adrenal Biopsy Using an Open Low-Field-Strength Scanner and MR Fluoroscopy

Claudius W. König1, Philippe L. Pereira, Jochen Trübenbach, Jan Fritz, Stephan H. Duda, Fritz Schick and Claus D. Claussen

1 All authors: Department of Diagnostic Radiology, Eberhard-Karls-University of Tuebingen, Hoppe-Seyler-Str.3, D-72076 Tuebingen, Germany.



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Fig. 1A. 74-year-old man with symptomatic adrenal metastasis from small cell lung cancer. Transverse T2-weighted fast spin-echo MR image (TR/TE, 5447/134) for biopsy planning shows acute hemorrhage (arrow).

 


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Fig. 1B. 74-year-old man with symptomatic adrenal metastasis from small cell lung cancer. Sagittal fluoroscopic fast imaging with steady-state free precession image shows needle guidance towards lesion (arrow).

 


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Fig. 1C. 74-year-old man with symptomatic adrenal metastasis from small cell lung cancer. Sagittal (C) and Paraaxial (D) breath-hold T2-weighted fast spin-echo MR images (1856/105, 5 slices in 14 sec) before biopsy show sampling from nonhemorrhagic parts of lesion (arrow, D).

 


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Fig. 1D. 74-year-old man with symptomatic adrenal metastasis from small cell lung cancer. Sagittal (C) and Paraaxial (D) breath-hold T2-weighted fast spin-echo MR images (1856/105, 5 slices in 14 sec) before biopsy show sampling from nonhemorrhagic parts of lesion (arrow, D).

 


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Fig. 2. 53-year-old woman with pheochromocytoma with needle placement before biopsy. Transverse unenhanced T1-weighted three-section breath-hold fast low-angle shot MR image (TR/TE, 54/7.4; flip angle, 70°; scanning time, 7 sec) shows stylet partially withdrawn in 16-gauge cannula for detailed depiction of its tip.

 


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Fig. 3A. 47-year-old man with large adrenal metastasis from adenocarcinoma of lung. Sagittal MR fluoroscopic fast imaging with steady-state free precession image (TR/TE, 17.8/8.1; flip angle, 90°) shows angulated approach with 13-gauge cannula.

 


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Fig. 3B. 47-year-old man with large adrenal metastasis from adenocarcinoma of lung. MR fluoroscopic image shows needle tip (arrow) close to upper pole of kidney during expiration.

 


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Fig. 3C. 47-year-old man with large adrenal metastasis from adenocarcinoma of lung. Continued MR fluoroscopic image shows target lowering with inspiration.

 


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Fig. 3D. 47-year-old man with large adrenal metastasis from adenocarcinoma of lung. MR fluoroscopic image shows needle advancement into lesion with easy avoidance of pleura and kidney (asterisk). Only two fluoroscopic series (each with 23-sec scanning time for 20 images) were needed. Note that needle conspicuity and anatomic survey were not compromised by low spatial resolution (48 x 128 pixels) of MR fluoroscopic sequence.

 

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