Basics of Computed Tomography

2016 ◽  
Author(s):  
Krikor Malajikian ◽  
Daniel Finelli
Keyword(s):  
Computed Tomography ◽  
Soft Tissues ◽  
Imaging Modality ◽  
Bone Biopsy ◽  
Bone Lesions ◽  
Disc Space ◽  
Ct Guided ◽  
Ct Arthrography ◽  
Facet Injections ◽  
Joint Injections

Computed tomography (CT)-guidance is typically used when precise needle placement is essential for a successful procedure. It uses ionizing radiation, which could pose risks to the patient and operating staff if proper technique is not used. The performing physician should adhere to all principles of minimizing radiation exposure to the patient and clinicians. Common CT-guided imaging procedures include facet injections, nerve root injections, sacroiliac joint injections, intradiscal procedures, vertebroplasty/sacroplasty, and image-guided ablation of painful bone lesions. Computed tomography is also the imaging modality of choice for aspiration of deep paraspinal soft tissues in addition to disc space or bone biopsy in acute discitis/osteomyelitis. In fluoroscopic-guided knee or shoulder joint injections, CT arthrography is a useful adjunct to better assess anatomy when MRI is contraindicated. When imaging the postoperative spine, CT myelography has some advantages over MRI, and CT is also superior to MRI in assessing par intra-articularis defects or spondylolysis.

scholarly journals Differences in Radiation Exposure of CT-Guided Percutaneous Manual and Powered Drill Bone Biopsy

2021 ◽  
Author(s):  
Sebastian Zensen ◽  
Sumitha Selvaretnam ◽  
Marcel Opitz ◽  
Denise Bos ◽  
Johannes Haubold ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Diagnostic Yield ◽  
Bone Biopsy ◽  
Lumbar Vertebrae ◽  
Bone Lesions ◽  
Anatomical Location ◽  
Thoracic Vertebrae ◽  
Level Of Evidence ◽  
Ct Guided ◽  
Bone Biopsies

Abstract Purpose Apart from the commonly applied manual needle biopsy, CT-guided percutaneous biopsies of bone lesions can be performed with battery-powered drill biopsy systems. Due to assumably different radiation doses and procedural durations, the aim of this study is to examine radiation exposure and establish local diagnostic reference levels (DRLs) of CT-guided bone biopsies of different anatomical regions. Methods In this retrospective study, dose data of 187 patients who underwent CT-guided bone biopsy with a manual or powered drill biopsy system performed at one of three different multi-slice CT were analyzed. Between January 2012 and November 2019, a total of 27 femur (A), 74 ilium (B), 27 sacrum (C), 28 thoracic vertebrae (D) and 31 lumbar vertebrae (E) biopsies were included. Radiation exposure was reported for volume-weighted CT dose index (CTDIvol) and dose–length product (DLP). Results CTDIvol and DLP of manual versus powered drill biopsy were (median, IQR): A: 56.9(41.4–128.5)/66.7(37.6–76.2)mGy, 410(203–683)/303(128–403)mGy·cm, B: 83.5(62.1–128.5)/59.4(46.2–79.8)mGy, 489(322–472)/400(329–695)mGy·cm, C: 97.5(71.6–149.2)/63.1(49.1–83.7)mGy, 627(496–740)/404(316–515)mGy·cm, D: 67.0(40.3–86.6)/39.7(29.9–89.0)mGy, 392(267–596)/207(166–402)mGy·cm and E: 100.1(66.5–162.6)/62.5(48.0–90.0)mGy, 521(385–619)/315(240–452)mGy·cm. Radiation exposure with powered drill was significantly lower for ilium and sacrum, while procedural duration was not increased for any anatomical location. Local DRLs could be depicted as follows (CTDIvol/DLP): A: 91 mGy/522 mGy·cm, B: 90 mGy/530 mGy·cm, C: 116 mGy/740 mGy·cm, D: 87 mGy/578 mGy·cm and E: 115 mGy/546 mGy·cm. The diagnostic yield was 82.4% for manual and 89.4% for powered drill biopsies. Conclusion Use of powered drill bone biopsy systems for CT-guided percutaneous bone biopsies can significantly reduce the radiation burden compared to manual biopsy for specific anatomical locations such as ilium and sacrum and does not increase radiation dose or procedural duration for any of the investigated locations. Level of Evidence Level 3.

Thoracic Nerve Root and Facet Injections: Computed Tomography

2016 ◽  
Author(s):  
Amaresh Vydyanathan ◽  
Allan L. Brook ◽  
Boleslav Kosharskyy ◽  
Samer N. Narouze
Keyword(s):  
Computed Tomography ◽  
Nerve Root ◽  
Soft Tissues ◽  
Spinal Nerve ◽  
Ct Fluoroscopy ◽  
Disc Disease ◽  
Direct Pressure ◽  
Facet Injections ◽  
Nerve Root Blocks ◽  
Pain Patients

Thoracic back pain patients present with associated radiculopathy, degenerative disc disease, spondylosis, stenosis, scoliosis, rib fractures, tumors, or after undergoing thoracic surgery. Thoracic transforaminal or selective nerve root blocks (SNRBs) may be both therapeutic and diagnostic. Therapeutic injections may include either local anesthetics for pain relief or corticosteroids for anti-inflammatory effects. The two types of pain amenable to therapeutic SNRBs include pain caused by irritation or direct pressure on a spinal nerve and pain originating from anatomic structures that are innervated by the sinuvertebral nerve. Although these blocks are traditionally performed under fluoroscopic guidance, computed tomography (CT) and CT fluoroscopy have been increasingly used to direct needle placement and have been advocated by experts due to superior visualization of the needle tip and the ability to clearly define spinal anatomy and adjacent soft-tissues.

CT and PET/CT-Guided Interventional Radiology Procedures

2011 ◽  
pp. 74-81
Author(s):  
Daniel A.T. Souza ◽  
Milana Flusberg ◽  
Paul B. Shyn ◽  
Servet Tatli ◽  
Stuart G. Silverman
Keyword(s):  
Computed Tomography ◽  
Interventional Radiology ◽  
Imaging Modality ◽  
Ct Guided ◽  
Percutaneous Interventions ◽  
Pet Ct ◽  
Wide Range ◽  
Interventional Radiology Procedures ◽  
Diagnostic Ct

Over the last several decades, computed tomography (CT) has become a critical imaging modality for the diagnosis of a wide range of diseases. CT has also become a valuable guidance modality for a large number of percutaneous interventions that are generally divided into diagnostic and therapeutic categories. This chapter discusses common diagnostic CT-guided interventions include biopsies, aspirations, and drainages, and other PET/CT-guided interventional radiology procedures.

scholarly journals Imaging in multiple myeloma: How? When?

Blood ◽  
2019 ◽  
Vol 133 (7) ◽  
pp. 644-651 ◽  
Author(s):  
Elena Zamagni ◽  
Paola Tacchetti ◽  
Michele Cavo
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Multiple Myeloma ◽  
Magnetic Resonance ◽  
Imaging Modality ◽  
Response To Therapy ◽  
Whole Body ◽  
Bone Lesions ◽  
Resonance Imaging ◽  
Pet Ct

Abstract Bone disease is the most frequent feature of multiple myeloma (MM) and represents a marker of end-organ damage; it is used to establish the diagnosis and to dictate the immediate need for therapy. For this reason, imaging plays a significant role in the management of MM patients. Although conventional radiography has traditionally been the standard imaging modality, its low sensitivity in detecting osteolytic lesions and inability to evaluate response to therapy has called for the use of more sophisticated techniques, such as whole-body low-dose computed tomography (WBLDCT), whole-body magnetic resonance imaging, and 18F-fluorodeoxyglucose–positron emission tomography/computed tomography (PET/CT). In this review, the advantages, indications of use, and applications of the 3 techniques in the management of patients with MM in different settings will be discussed. The European Myeloma Network and the European Society for Medical Oncology guidelines have recommended WBLDCT as the imaging modality of choice for the initial assessment of MM-related lytic bone lesions. Magnetic resonance imaging is the gold-standard imaging modality for detection of bone marrow involvement, whereas PET/CT provides valuable prognostic data and is the preferred technique for assessment of response to therapy. Standardization of most of the techniques is ongoing.

scholarly journals Psoas hematoma due to segmental vessel injury leads to paresis following CT-guided biopsy of lumbar vertebrae: A case report

2020 ◽  
Vol 11 ◽  
pp. 457
Author(s):  
Pratik Patel ◽  
Dhanish Mehendiratta ◽  
Vivek Bhambhu ◽  
Samir Dalvie ◽  
Aniruddha Kulkarni ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Needle Biopsy ◽  
Bone Biopsy ◽  
Lumbar Vertebrae ◽  
Metastatic Breast ◽  
Hemorrhagic Complication ◽  
Ct Guided ◽  
Segmental Artery ◽  
Adjacent Structures ◽  
Left Posterior

Background: Percutaneous bone biopsy is the first-line procedure for obtaining a tissue diagnosis to confirm focal, diffuse vertebral, and/or paravertebral metastatic lesions. Percutaneous bone biopsy to evaluate metastatic disease can be performed under fluoroscopy, ultrasonography, magnetic resonance (MR) imaging, and computed tomography (CT). Notably, CT-scans best direct and demonstrate the needle position for these procedures, decreasing the risk of injury to critical adjacent structures (e.g. major vessels, nerve roots). Hemorrhagic complication to lumbar segmental arteries following needle biopsy are uncommon; only a few cases have been reported. Although percutaneous bone biopsy is typically safe when performed utilizing computed tomography (CT) guidance, here we encountered a 60-year-old-female who developed a L4 lumbar segmental artery psoas hematoma following this procedure requiring emergent embolization. Case Description: A 60-year-old female, with a history of breast cancer, underwent a CT-guided core needle biopsy of an L4 lytic lesion (e.g., likely a metastasis). This acutely resulted in the onset of radicular leg pain and weakness. When the postprocedural CT scan demonstrated a large psoas hematoma attributed to laceration of the left posterior L4 segmental artery, the patient required emergent embolization. Following this procedure, she exhibited a fully neurological recovery. Conclusion: Following a CT-guided L4 vertebral biopsy to document metastatic breast carcinoma, a 60-year-old patient developed an immediate postprocedure CT-documented psoas hematoma due to laceration of the left posterior L4 segmental artery. Following emergent embolization, the patient recovered full neurological function.

scholarly journals Role of robotic arm assistance in computed tomography guided bone biopsy

2019 ◽  
Vol 7 (6) ◽  
pp. 2127
Author(s):  
Natasha N. Mehta ◽  
Nikit Mehta ◽  
Nitin Gorde
Keyword(s):  
Image Guidance ◽  
Bone Biopsy ◽  
Robotic Arm ◽  
Bone Lesions ◽  
Practical Skills ◽  
Ct Guided ◽  
Nerve Structure ◽  
Metastatic Lesions ◽  
Technological Developments

Background: Use of robotic assistance technique has significant benefits over conventional techniques. The present study looks at the recent technological developments in image guidance for bone biopsy procedures.Methods: Patients who were referred to the department of radiodiagnosis, Bharti Hospital and Dot3d scanning center, Sangli, Maharashtra, India from July 2017 till December 2018 with suspected bone lesions were included in the study. These patients underwent robotic arm CT guided bone biopsy of their lesions.Results: In the present study, 47 patients were included. Authors observed that 93.6% had a positive diagnosis based on CT guided bone biopsy. Metastatic lesions were diagnosed in 8 cases. Inflammatory lesions and tuberculosis were other commonly observed diagnosis.Conclusions: Further growth and development of medical imaging devices have allowed more interventional procedures to be performed and more patients to benefit from them. Radiologists needs to develop a thorough understanding of the anatomical structure involved and need to acquire both solid grounding in technology and the practical skills to visualize a nerve structure.

scholarly journals PET/CT-guided versus CT-guided percutaneous core biopsies in the diagnosis of bone tumors and tumor-like lesions: which is the better choice?

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Min-hao Wu ◽  
Ling-fei Xiao ◽  
Huo-wen Liu ◽  
Zhi-qiang Yang ◽  
Xiao-xiao Liang ◽  
...  
Keyword(s):  
Bone Tumors ◽  
Diagnostic Performance ◽  
Bone Biopsy ◽  
Chinese Patients ◽  
Bone Lesions ◽  
Ct Guided ◽  
Tumor Dissemination ◽  
Pet Ct ◽  
Significant Difference ◽  
Tumor Like Lesions

Abstract Objective The present study aimed to evaluate the diagnostic performance and safety of PET/CT-guided percutaneous core bone biopsy and to compare the PET/CT-guided method to conventional CT-guided percutaneous core biopsies to diagnose Chinese patients with bone tumors and tumor-like lesions. Methods Data for 97 patients with bone tumors and tumor-like lesions diagnosed by percutaneous core bone biopsy from February 2013 to November 2018 were retrospectively analyzed. The study included 42 cases in the PET/CT group and 55 cases in the CT alone group. The diagnostic performance, cost and complications associated with the intervention were compared between the two groups. All patients were eventually confirmed to have bone tumors and tumor-like lesions according to surgical pathology findings. Results There were no significant differences in patient characteristics (P > 0.05). For the patients in the PET/CT group, the overall diagnostic yield of the initial biopsies and the diagnostic accuracy derived from the surgically proven cases were both 97.62%, which was significantly higher than the values in the CT group during the same period (P < 0.05). No major biopsy-related complications (e.g., serious bleeding or tumor dissemination) occurred before, during, or after the intervention. Therefore, no significant difference was observed between the two groups with regard to the complication rate (P > 0.05). Conclusion Compared with CT-guided percutaneous bone biopsy, PET/CT-guided percutaneous bone biopsy is an effective and safe alternative with high diagnostic performance in the evaluation of hypermetabolic bone lesions to diagnose bone tumors and tumor-like lesions.

Technical Feasibility of Electromagnetic US/CT Fusion Imaging and Virtual Navigation in the Guidance of Spine Biopsies

2020 ◽  
Author(s):  
Giovanni Mauri ◽  
Salvatore Gitto ◽  
Lorenzo Carlo Pescatori ◽  
Domenico Albano ◽  
Carmelo Messina ◽  
...  
Keyword(s):  
Intervertebral Disc ◽  
Bone Biopsy ◽  
Fusion Imaging ◽  
Bone Lesions ◽  
Technical Feasibility ◽  
Ct Guided ◽  
Spinal Lesions ◽  
Procedure Duration ◽  
Group 2 ◽  
Group 1

Abstract Purpose To test the technical feasibility of electromagnetic computed tomography (CT) + ultrasound fusion (US)-guided bone biopsy of spinal lesions. Materials and Methods This retrospective study included 14 patients referred for biopsy of spinal bone lesions without cortical disruption or intervertebral disc infection. Lesions were located in the sacrum (n = 4), lumbar vertebral body (n = 7) or intervertebral disc (n = 3). Fusion technology matched a pre-procedure CT scan with real-time ultrasound. The first six procedures were performed under both standard CT and CT + US fusion guidance (group 1). In the last eight procedures, the needle was positioned under fusion imaging guidance alone, and CT was only used at the end of needle placement to confirm correct positioning (group 2). Additionally, we retrieved 8 patients (controls) with location-matched lesions as group 2, which were biopsied in the past with the standard CT-guided technique. The procedure duration and number of CT passes were recorded. Results Mean procedure duration and median CT pass number were significantly higher in group 1 vs. group 2 (45 ± 5 vs. 26 ± 3 minutes, p = 0.002 and 7; 5.25–8.75 vs. 3; 3–3.25, p = 0.001). In controls, the mean procedure duration was 47 ± 4 minutes (p = 0.001 vs. group 2; p = 0.696 vs. group 1) and the number of CT passes was 6.5 (5–8) (p = 0.001 vs. group 2; p = 0.427 vs. group 1). No complications occurred and all specimens were adequate overall. In one case in group 2, the needle position was modified according to CT assessment before specimen withdrawal. Conclusion Electromagnetic CT+US fusion-guided bone biopsy of spinal lesions is feasible and safe. Compared to conventional CT guidance, it may reduce procedural time and the number of CT passes.

Radiography and computed tomography imaging of osteoarthritis

2016 ◽  
Author(s):  
Daichi Hayashi ◽  
Ali Guermazi ◽  
Frank W. Roemer
Keyword(s):  
Computed Tomography ◽  
Imaging Modality ◽  
Joint Damage ◽  
Conventional Radiography ◽  
Longitudinal Change ◽  
Cartilage Defects ◽  
Imaging Data ◽  
Ongoing Research ◽  
Ct Arthrography ◽  
Additional Tool

Osteoarthritis (OA) is the most prevalent joint disorder in the elderly worldwide and there is still no effective treatment, other than joint arthroplasty for end-stage OA, despite ongoing research efforts. Imaging is essential for assessing structural joint damage and disease progression. Radiography is the most widely used first-line imaging modality for structural OA evaluation. Its inherent limitations should be noted including lack of ability to directly visualize most OA-related pathological features in and around the joint, lack of sensitivity to longitudinal change and missing specificity of joint space narrowing, and technical difficulties regarding reproducibility of positioning of the joints in longitudinal studies. Magnetic resonance imaging (MRI) is widely applied in epidemiological studies and clinical trials. Computed tomography (CT) is an important additional tool that offers insight into high-resolution bony anatomical details and allows three-dimensional post-processing of imaging data, which is of particular importance for orthopaedic surgery planning. However, its major disadvantage is limitations in the assessment of soft tissue structures compared to MRI. CT arthrography can be useful in evaluation of focal cartilage defects or meniscal tears; however, its applicability may be limited due to its invasive nature. This chapter describes the roles and limitations of both conventional radiography and CT, including CT arthrography, in clinical practice and OA research. The emphasis is on OA of the knee, but other joints are also mentioned where appropriate.

scholarly journals Computed tomography-guided bone lesion biopsy, our experience in 2018 and 2019

2020 ◽  
Vol 48 (2-3) ◽  
pp. 73-76
Author(s):  
Elvira Krešić ◽  
◽  
Ana-Marija Alduk ◽  
Maja Prutki ◽  
Ivan Karlak ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Histological Analysis ◽  
Bone Lesion ◽  
Bone Lesions ◽  
Histopathological Analysis ◽  
Ct Guided ◽  
Metastatic Lesions ◽  
Ct Guided Biopsy ◽  
Procedural Complications ◽  
Histopathological Results

To present our results from 2018 and 2019 and to present the clinical data of the accuracy and clinical usefulness of computed tomography (CT)-guided biopsy for diagnosing suspicious bone lesion. The retrospective study included 98 consecutive patients who underwent CT-guided bone lesion biopsy from January 2018 to December 2019. The localization of the bone lesions, the adequacy of the sample for histopathological analysis, histopathological results, and the procedure’s complications were analyzed. The specimens collected from 76 patients/lesions (77.6%) were considered appropriate for diagnosis. Histological analysis of bone samples showed 52 (68.4%) metastatic lesions. The most common primary tumor origins were breast carcinoma 28 (53.8%) and lung carcinoma six (11.5%). In three patients (4%), the infection was confirmed. No tumor cells were found in 17 (22.4%) patients. There were no post-procedural complications. CT-guided bone lesion biopsy is a safe and effective method for diagnosing suspicious bone lesions that has a great effect in clinical practice without any significant complications.

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