Sidik, Che Kob
(2008)
The association study between mri and
percutaneous transpedicular biopsy (hpe)
findings in vertebral lesions.
Masters thesis, Pusat Pengajian Sains Perubatan.
Abstract
Magnetic resonance imaging (MRI) has become the instrument of choice for
disease detection in spine pathology. More recent report have questioned the
specificity of MRI detection and concluded that signal intensity change alone is
not diagnostic of metastatic lesion. The introduction of percutaneous biopsy has
substantially benefited the diagnosis of skeletal disease. It avoids the need for
open surgical biopsy in most patients. Percutaneous transpedicular biopsy for
vertebral lesions can be performed with minimal morbidity and good diagnostic
yield with accuracy up to 92% in bone metastases (Ryohei Ashizawa et al, 1999). Our main objective is to determine the sensitivity and specificity of MRI in
disease detection for vertebral spinal lesion specifically in vertebral tuberculosis
and metastases. The association between MRI findings were made with
transpedicular biopsy findings (histopathological diagnosis). The secondary
objective was to determine the correlation of transpedicular biopsy done under Carm
fluoroscopy with respect to major influencing variables such as spinal level,
tissue type (lytic and sclerotic) and ultimate tissue pathologic diagnosis (HPE). In this retrospective study case series, we reviewed 72 patients admitted to our
orthopaedic department in Hospital Kuala Lumpur and Hospital University
Science, Malaysia between January 2002 to December 2007. All patients with
suspected case of metastases, tuberculosis and pyogenic disease based on
their clinical sign, symptoms and Xray findings involving spinal vertebra who
underwent MRI and percutaneous transpedicular biopsy were included in the
study. The data collected were reviewed and all data pertaining to laboratory
investigations i.e FBC (full blood count), ESR (erythrocyte sedimentation rate),
tumor marker, Sputum AFB (acid fast bacilli), Mantoux test and PCR
(polymerase chain reaction) to assist in disease confirmation were taken to
support for clinical diagnosis. The MRI findings of each cases reported by
radiologist were reviewed to get radiological diagnosis. The HPE result from the
tissues taken through percutaneous transpedicular biopsies procedure which
were performed later to MRI to obtain histopathological diagnosis for final
disease confirmation were reviewed. The data obtained were analysed for
association. The overall HPE diagnosis obtained for disease detection through transpedicular
biopsy were 65% positive (forty seven of seventy two) and negative 34.5%
(twenty five of seventy two) for both vertebral tubeculosis and metastases. The
overall disease detection by MRI were 97.2% (seventy of seventy two ). There was no significant association between MRI findings with percutaneous
transpedicular biopsy (HPE) (p value >0.05) for disease detection. From overall
study population, the prevalence of disease detected by percutaneous
transpedicular biopsy was 0.653 ( 95%CI 0.543, 0.763 ) and the prevalence of
similar disease detected by MRI was 0.972 ( 95% Cl 0.934,1.011 ). The
sensitivity and specificity of magnetic resonance imaging (MRI) to detect the
disease compared to percutaneous transpedicular biopsy which was taken as
gold standard in this study were 0.979 (95% Cl 0.937, 1.020) and 0.040 (95% Cl
0.018, 0.062) respectively. With respect to vertebral level, there was significant
association between level of vertebra lesion involved with HPE diagnosis in
percutaneous transpedicular biopsy procedure (p value 0.021 ). For tissue type,
there was no significant association between tissue type in vertebral body lesion
with HPE obtained through transpedicular biopsy procedure (p value 0.256).Based on this study, we can conclude that MRI is highly sensitive for disease
detection in vertebral lesion. The MRI however has low specificity and not
reliable in detecting true negative disease. There is no significant association
between MRI and transpedicular biopsy method for disease detection. For
inconclusive MRI findings, transpedicular biopsy is clinically useful and reliable to
confirm the vertebral disease. For obvious MRI finding with vertebral metastases
and tuberculosis, transpedicular biopsy is reliable for confirmation disease
diagnosis.
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