Percutaneous Magnetic Resonance Image–Guided Biopsy and Aspiration in the Head and Neck

Abstract

Objective/Hypothesis: To test the hypotheses that 1) magnetic resonance imaging (MRI)-guided biopsy and aspiration with an open 0.2-T system (Magnetom Open, Siemens, Erlangen, Germany) in the head and neck is feasible and successful and 2) procedure times can be sufficiently short to be well tolerated by the patient. Methods: Sixty-one MRI-guided procedures were performed in 47 patients (ages, 6 mo-88 y) in the head and neck, including the mucosal sites and masticator and parapharyngeal spaces (n ‫؍‬ 23), parotid space (n ‫؍‬ 6), submandibular space (n ‫؍‬ 2), cervical vertebral column/paraspinal tissues (n ‫؍‬ 8), skull base (n ‫؍‬ 3), larynx or hypopharynx (n ‫؍‬ 3), and infrahyoid nodal chains and surrounding tissues (n ‫؍‬ 16). A clinical C-arm imaging system was used, supplemented by an in-room radiofrequency-shielded liquid crystal monitor, rapid gradient echo sequences for needle guidance, and MRI-compatible anesthesia, monitoring, and surgical lighting equipment. Tissue sampling included fine-needle aspiration (n ‫؍‬ 58) and cutting-needle core biopsy (n ‫؍‬ 27), with 24 patients undergoing both procedures. Procedures were evaluated for success of needle placement, procedure time, and complications. Results: Successful needle placement was accomplished in all cases without complication, with tissue sufficient for pathological diagnosis obtained for all but five patients with an average of 2.1 passes per patient. For fine-needle aspiration, average instrument time was 7.8 minutes per pass, and average cutting-needle core biopsy time was 9.2 minutes. Conclusions: Interactive MRI guidance for needle biopsy and aspiration of deep head and neck lesions is feasible, successful, and safe. Procedure times are sufficiently short to be well tolerated by the patient.

MRI-guided biopsy and aspiration in the head and neck: evaluation of 77 patients

“…However, the limited contrast resolution of soft tissues, exposure to ionizing radiation, and potential requirement of iodine contrast enhancement for lesion delineation can be limitations of CT guidance. We found that interventional MRI guidance provided excellent visualization of critical structures and allowed for optimization of needle paths resulting in easy and safe lesion access, which is in accordance with previous reports [7,24,25].…”

“…Ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) have been used successfully for image-guided head and neck biopsies [4][5][6][7]. However, depending on the imaging technique used, different efficacies and limitations apply.…”

“…Because of the combination of favorable attributes including excellent tissue contrast, true multi-planar imaging capabilities, good vessel depiction, sufficient spatial resolution, and the absence of ionizing radiation, attention and interest in MRI-guided procedures continue to increase [8][9][10][11][12]. However, the available information about diagnostic performance of MRI-guided percutaneous biopsy and aspiration in the head and neck region is limited [7,[13][14][15][16].…”

Percutaneous Biopsy of Head and Neck Lesions with CT Guidance: Various Approaches and Relevant Anatomic and Technical Considerations

“…Magnetic resonance (MR) imaging guidance has also been used for biopsies of head and neck lesions (4,6,17). The potential advantages of MR imaging as a guidance modality include its high contrast resolution, its multiplanar imaging capacity allowing the use of double oblique approaches, and its ability to demonstrate vessels without a contrast agent.…”

“…Percutaneous needle biopsy with imaging guidance is a well-established technique for diagnosis of head and neck lesions (1)(2)(3)(4)(5)(6)(7)(8). Computed tomography (CT)-guided biopsies of deep-seated head and neck lesions are challenging because major vessels, nerves, the airway, or osseous structures often intervene in the projected needle path.…”