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CT-Guided Biopsy of Bone: A Radiologist's Perspective

¹ Department of Radiology, University of Michigan Hospitals, 1500 E Medical Center Dr., Ann Arbor, MI 48109.
² Division of Radiologic Sciences, Wake Forest University, Winston-Salem, NC.
³ Department of Radiology, University of Toledo Medical Center, Toledo, OH.
⁴ Department of Orthopedic Surgery, University of Michigan Hospitals, Ann Arbor, MI.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Photograph shows three needle types for biopsy of bone lesions. First type is Bonopty coaxial system (C. R. Bard, Inc.) (A). Introducer (1) with trocar (below) traverses soft tissue. Trocar is removed to allow drill bit (2) to replace it and traverse bone. Note cutting portion of drill bit (straight arrow). Once in position, bit is removed to allow bone biopsy needle (3) with trocar (below) to be positioned. Once positioned, biopsy needle trocar is removed and biopsy sample is obtained. Second type is Quick-Core biopsy "gun" (B) (Cook) for soft-tissue cores only. Note illustrated needle is 9 cm long; a longer needle is required to fit through Bonopty coaxial system. Third type of needle is 11-gauge InterV Traplok system (C) (Medical Device Technologies, Inc.). Note detail of trap device (curved arrow) to help retain biopsy tissue core within needle.

View larger version (54K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Shoulder illustrations. Axial (A) and coronal (B) shoulder illustrations show zones permissible for biopsy (green) including anterior deltoid (Y). Areas outlined in blue should be avoided, such as posterior deltoid (N). Note deltopectoral groove (straight arrows), neurovascular structures (curved arrow, A), and cephalic vein (blue, B).

View larger version (73K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Shoulder illustrations. Axial (A) and coronal (B) shoulder illustrations show zones permissible for biopsy (green) including anterior deltoid (Y). Areas outlined in blue should be avoided, such as posterior deltoid (N). Note deltopectoral groove (straight arrows), neurovascular structures (curved arrow, A), and cephalic vein (blue, B).

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —63-year-old man with grade I chondroblastoma. Axial CT section of left shoulder shows 11-gauge biopsy needle (arrows) with tip within sclerotic lesion in humeral head (H). Anterior approach through anterior portion of deltoid muscle (D) was used.

View larger version (59K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —Illustration of forearm in axial plane. Interosseous membrane (arrows) separates extensor (E) and flexor (F) compartments. Special care should be taken not to violate interosseous membrane, thus avoiding contamination of multiple compartments. R = radius, U = ulna.

View larger version (75K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —20-year-old woman with enchondroma of radius. Axial CT image through forearm shows 11-gauge needle (arrow) with tip in radius (asterisk). Care is taken not to traverse interosseous membrane.

View larger version (59K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —Illustrations of pelvis at level of iliac bone (right) and inferior pubic ramus (left). Gluteus muscle group (G) and rectus femoris muscle (arrowhead) must be avoided. Ideal approach is directly into iliac bone (arrows), either anterior or posterior.

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7 —74-year-old man with osteoblastic osteosarcoma. Axial CT image of pelvis with patient prone shows 14-gauge needle (black arrow) with tip within lesion (white arrow). Posterior approach through iliac bone, thus avoiding gluteal muscles (G), was used.

View larger version (89K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8 —70-year-old man with metastatic lung cancer. Axial CT scan through pelvis shows lytic metastasis in left anterior iliac bone (asterisk); 18-gauge needle (arrow) (Quick-Core, Cook) is seen traversing lytic lesion.

View larger version (49K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9 —Illustration of axial thigh. Rectus femoris muscle (RF) and hamstrings (HAM) are to be avoided. Medial or lateral approach through vastus medius (VM) and vastus lateralis (VL) is preferred. F = femur.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10A —58-year-old man with metastatic adenocarcinoma. Coronal T2-weighted MR image shows marrow replacement in distal femur (F), soft-tissue signal abnormality (arrows) surrounding medial distal femur, and adjacent intramedullary low signal (arrowheads).

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10B —58-year-old man with metastatic adenocarcinoma. Axial CT image of distal femur shows 11-gauge needle (arrow) used to obtain core biopsy of femoral lesion (F).

View larger version (49K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11 —Illustration of lower leg. Axial image shows optimal entry site for tibial biopsy (green and arrows) that avoids muscle compartments. T = tibia, F = fibula.

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12 —52-year-old woman with enchondroma. Axial CT scan of left leg shows 14-gauge core biopsy needle (arrows) traversing tibia (T) through anteromedial approach. Note marrow replacement of tibia.

View larger version (92K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13 —34-year-old woman with right first metatarsal osteoma. Axial CT scan of right foot shows 11-gauge biopsy needle (arrow) sampling osteoma (asterisk) in medial aspect of first metatarsal (T).

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14 —20-year-old woman with enchondroma of radius. Axial CT scan of right forearm shows biopsy needle (arrows). Because of little surrounding tissue in distal extremity to stabilize needle during imaging-guided placement, sterile towel (T) was rolled and used to support needle.

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 15 —35-year-old woman with metastatic renal cell cancer. Axial CT scan of chest shows 18-gauge soft-tissue biopsy needle (arrow) sampling chest wall mass (arrowhead).

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 16 —55-year-old woman with metastatic breast cancer. Axial image of spine shows core biopsy needle (arrow) through vertebral lytic lesion (arrowhead) using transpedicular approach.

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 17 —61-year-old woman with nodular sclerosing Hodgkin's disease treated with radiation. Axial image of spine shows 16-gauge core biopsy needle (arrow) through lytic vertebral lesion (arrowhead) using costovertebral approach.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 18A —56-year-old woman with metastatic lung cancer. Axial image of spine shows 22-gauge spinal needle (arrow) in posterior paraspinal soft tissues (arrowhead), through which saline was injected to displace lung away from biopsy needle path.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 18B —56-year-old woman with metastatic lung cancer. Axial image shows coaxial needle and introducer (arrow) with tip within vertebral lytic lesion. Note adjacent spinal canal (asterisk).

View larger version (65K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 19 —45-year-old man with parosteal osteosarcoma. Axial image of left arm shows 11-gauge biopsy needle (arrow) sampling periosteal bone apposition (arrowhead) adjacent to humerus (H) via preferred anterior transdeltoid approach.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 20A —52-year-old man with grade II chondrosarcoma. Oblique radiograph of pelvis shows expansile, radiolucent lesion (arrowheads) of right acetabulum extending into proximal ischium.

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 20B —52-year-old man with grade II chondrosarcoma. Sequential axial CT section through pelvis with gantry angled shows needle (arrow) entering anteriorly at iliac bone (I), path oblique to CT scan plane.

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 20C —52-year-old man with grade II chondrosarcoma. Sequential axial CT section through pelvis with gantry angled shows needle (arrow) oblique to CT scan plane with distal tip at tumor (arrowhead).

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 20D —52-year-old man with grade II chondrosarcoma. Sequential axial CT section through pelvis with gantry angled shows needle (arrow) oblique to CT scan plane with distal tip having traversed tumor (arrowhead).

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