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Magnetic Resonance Imaging–Guided Percutaneous Biopsy of Mediastinal Masses: Diagnostic Performance and Safety

Lü, Yubo MD*; Fritz, Jan MD; Li, Chengli MD, PhD*; Liu, Ming MD*; Lee, Pearlene MD; Wu, Lebin MD*; Carrino, John A. MD, MPH

doi: 10.1097/RLI.0b013e31827a4a17
Original Articles
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Objective The objective of this study was to evaluate the diagnostic performance and safety of magnetic resonance (MR) imaging–guided percutaneous mediastinal biopsy procedures using a 0.23-T open MR system with optical tracking navigation.

Materials and Methods A retrospective analysis of 59 participants (38 males and 21 females; mean age, 45 years; range, 16–73 years) who underwent MR imaging–guided percutaneous mediastinal biopsy procedures was performed. The access techniques included extrapleural (40 of 59; 67.8%) and transpulmonary (19 of 59; 32.2%) needle paths. Tissue sampling techniques included fine-needle aspiration (22 of 59; 37.3%) and core-needle biopsy (37 of 59; 62.7%). Histopathological analysis of surgical specimen and clinical and imaging follow-ups were used as the reference standard. The procedures were evaluated for technical success rate, number of biopsy passes, diagnostic performance, procedure time, and complications.

Results Technical success was achieved in 57 of the 59 procedures (96.6%). For the fine-needle aspiration, a mean of 3 passes (range, 2–4 passes) was performed. For the core-needle biopsy, a mean of 4 passes (range, 3–6 passes) was performed. Pathological and cytological analysis of biopsy specimens showed 41 of 57 malignant lesions (71.9%) and 16 of 57 benign lesions (28.1%), with a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 93.2% (41 of 44), 100% (13 of 13), 100% (41 of 41), 81.2% (13 of 16), and 94.7% (54 of 57), respectively. Procedure time was 30 minutes (range, 20–50 minutes). Mild hemoptysis occurred in 3 cases, and in 2 cases, a small pneumothorax occurred.

Conclusions Magnetic resonance imaging–guided biopsy of mediastinal masses has a high diagnostic performance and is safe for use in clinical practice.

From the *Shandong Medical Imaging Research Institute, Shandong University, Jinan, China; and †Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD.

Received for publication April 22, 2012; and accepted for publication, after revision,October 18, 2012.

Conflicts of interest and sources of funding: Yubo Lü is currently receiving a grant (ZR2009CZ013) from the natural science foundation of Shandong province. This research was supported by this grant. For the remaining authors, none were declared.

Reprints: Chengli Li, MD, PhD, Shandong Medical Imaging Research Institute, Shandong University, 324 Jingwu Rd, Jinan, China 250021. E-mail: lichenglichina@mail.com.

© 2013 by Lippincott Williams & Wilkins