Korean J Radiol.  2006 Mar;7(1):28-34. 10.3348/kjr.2006.7.1.28.

Interventional Procedures in Superficial Lesions: The Value of 2D with Additional Coronal Reformatted 4D Ultrasonography Guidance

• Chang CY
• Wang HK
• Chiou HJ
• Chou YH
• Chen TH
• Chiou SY

• KMID: 753913
• DOI: http://doi.org/10.3348/kjr.2006.7.1.28

Abstract

OBJECTIVE
We wanted to assess the usefulness of four-dimensional (4D) ultrasonography (US), i.e., real-time three-dimensional US, as an adjunct for performing various US-guided interventional procedures in superficial lesions. MATERIALS AND METHODS: Thirty-three patients were referred for US-guided interventional procedures for superficial lesions, including core biopsy in 19, fine-needle aspiration in eight, therapeutic drug injection in four and needle puncture in two. The procedures were performed under 4D US guidance. We reviewed the pathologic/cytologic results of the core biopsies or needle aspirations, and also the outcomes of drug injection or needle puncture. RESULTS: For all the patients who underwent 4D US-guided core biopsy, the specimens were adequate for making the pathological diagnosis, and specimens were successfully obtained for those patients who underwent 4D US-guided aspiration. The patients treated with 4D US-guided therapeutic drug injection or needle puncture had a good response. No major procedure-related complications occurred. The procedural times were similar to those procedural times with using two-dimensional US. CONCLUSION: Combining the two dimensional and 4D US techniques aids the physician when performing US-guided interventional procedures for the superficial lesions.

Keyword

Ultrasound (US); Interventional procedure; 3D ultrasonography; 4D ultrasonography

MeSH Terms

Ultrasonography, Interventional/*methods
Punctures/*methods
Neoplasms/pathology
Middle Aged
Male
Injections/*methods
*Imaging, Three-Dimensional
Humans
Female
Aged, 80 and over
Aged
Adult
Adolescent

Figure

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  Fig. 1 A 78-year-old woman with a history of surgery for colon cancer developed an enlarged, left inguinal lymph node. During the four-dimensional US-guided biopsy, the needle did not show up on the two-dimensional axial image (left), indicating that it had deviated out of plane. The real-time volume-rendered image in the coronal reformatted plane (right) clearly showed that the needle (arrowheads) was basically in the center of the lesion.

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  Fig. 2 A 21-year-old man suffering with osteogenic sarcoma in the left distal femur received neoadjuvant chemotherapy and surgical resection of the tumor. An enlarged, left inguinal lymph node was palpated. A. Color Doppler US showed the enlarged node with a prominent cortex of increased vascularity. The proposed optimal site for the needle aspiration was in the cortical portion of the node (arrowheads). B. Four-dimensional US-guided fine-needle aspiration was performed. Axial 2D image (left) showed that the needle (arrowheads) had penetrated into the cortex of the node. Real-time volume-rendered imaging in the coronal reformatted plane (right) showed the needle tip (arrow) in the central cortical portion of the node. By combining information from both images, we confirmed that the needle tip was in the central cortical portion of the node in all three orthogonal planes.

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  Fig. 3 A 41-year-old woman presented with a nodule on the right side of her neck. A. The image showed the nodule with central cystic change in the right lobe of the thyroid. The solid parts were mainly at the periphery (arrowheads). B. Four-dimensional US-guided fine-needle aspiration of the nodule was performed. The axial two-dimensional image (left) did not show the needle because it had deviated out of the central plane. The real-time volume-rendered image in the coronal reformatted plane (right) showed the needle tip (arrows) in the periphery of the nodule, which was the desired location for tissue sampling.

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