Extended stereotactic brain biopsy in suspected primary central nervous system angiitis: good diagnostic accuracy and high safety

Abstract

Objective To evaluate the diagnostic accuracy and safety of extended stereotactic brain biopsy (ESBB) in a single center cohort with suspected primary angiitis of the central nervous system (PACNS). Methods A standardized stereotactic biopsy targeting MRI-positive lesions and collecting samples from the meninges and the cortex as well as from the white matter was performed in 23 patients with clinically suspected PACNS between 2010 and 2017. The relationship between biopsy yield and clinical characteristics, cerebrospinal fluid parameters, MR-imaging, time point of biopsy and exact localization of biopsy as well as number of tissue samples were examined. Results PACNS was confirmed in 7 of 23 patients (30.4%). Alternative diagnoses were identified in 7 patients (30%). A shorter time period between the onset or worsening of symptoms ( p = 0.018) and ESBB significantly increased the diagnostic yield. We observed only minor and transient postoperative complications in 3 patients (13.0%). ESBB led to a direct change of the therapeutic regime in 13 of 23 patients (56.5%). Careful neuropathological analysis furthermore revealed that cortical samples were crucial in obtaining a diagnosis. Conclusion ESBB is a safe approach with good feasibility, even in critically ill patients, and high diagnostic accuracy in patients with suspected PACNS changing future therapies in 13 of 23 patients (56.5%). Early biopsy after symptom onset/worsening is crucial and (sub)acute MRI-lesions should be targeted with a particular need for biopsy samples from the cortical layer.

Novel method using DW-MRI and ADC images to guide stereotactic biopsy for the diagnosis small primary angiitis of the central nervous system: A case report

“…In one study, the classic angiographic features of angiitis were associated with biopsy or postmortem con rmation in only 4.6% of patients 28 (32/701), and positive angiography was not correlated with positive biopsy results in a study of 34 PACNS patients 29 . The diagnosis rate of PACNS achieved with surgical biopsy ranged from 36-83% in previous studies 13,15 .…”

“…The diagnosis of PACNS is challenging, and a de nite diagnosis can only be made using biopsy ndings after brain surgery [7][8][9][10][11][12][13][14] or stereotactic biopsy 15 . However, there are no reports of specialized methods based on radiological features to guide stereotactic biopsy for the diagnosis of PACNS.…”

Novel method using DW-MRI and ADC images to guide stereotactic biopsy for the diagnosis small primary angiitis of the central nervous system: A case report

“…Pathology plays a vital role in the diagnosis of PACNS, whereas imaging plays an auxiliary role to the pathological examination. If no pathological examination is made, PACNS can only be an exclusionary diagnosis 1,6,15 .…”

“…Areas of CT or MR enhancement, or areas of abnormal MRS are often been used to guide stereoscopic biopsy and localize intracranial lesions. A framed stereotactic device biopsy, positioning by CT-enhanced, MR-enhanced T1, T2-weighted imaging and MRA-enhanced imaging, was used to diagnose a case of PACNS 15 . The diagnosis rate can reach 80% when imaging is used to assist pathological biopsy 6, 22 .…”

“…The diagnosis of PACNS is challenging, and a de nite diagnosis can only be made using biopsy ndings after brain surgery [7][8][9][10][11][12][13][14] or stereotactic biopsy 15 . However, there are no reports of specialized methods based on radiological features to guide stereotactic biopsy for the diagnosis of PACNS.…”