Interactive Magnetic Resonance Imaging‐Guided Biopsy in the Head and Neck: Initial Patient Experience

Abstract

Because of its excellent soft tissue resolution, magnetic resonance imaging (MRI) can optimize image guidance for interventional and surgical procedures. Notably, needle biopsy of head and neck lesions has been used for years, deeper lesions often requiring some form of image guidance. The closed space of diagnostic MRI scanners proves cumbersome for intervention. The authors report on the first head and neck image-guided biopsies performed in a new, investigational "open configuration" intraoperative MRI scanner. Vertical space between the scanner's upright coils gives access to the patient while imaging; image acquisition is as fast as 2 sec/image. Biopsies were performed on seven patients (parotid, parapharyngeal space, second cervical vertebra); five specimens were diagnostic. Both general anesthesia and intravenous sedation were used. The procedures were without complications. Imaging provided definition of anatomy to direct needle placement. Access to the patient allowed for both percutaneous and transoral approaches. The environment of the open magnet is well suited for biopsy of the head and neck, and near real-time intraoperative MRI has promise for guiding more complex head and neck procedures. Further study should optimize the quality of the images and the interactibility of localization and targeting and fully utilize MRI's three-dimensional imaging capabilities.

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

“…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.…”

Computed Tomography–Guided Needle Biopsy of Head and Neck Lesions

“…Magnetic resonance imagingassisted needle biopsy has been performed by Fried et al, 6,7 with good results and minimal morbidity. Drawbacks include the need for special nonmagnetic instruments that are compatible for use with the strong magnetic field.…”

Transcutaneous Fine Needle Aspiration Biopsy of the Preepiglottic Space

“…18 It was also compared with MRI for detecting malignancies of the head and neck segment in general. 19 Our objective was to study the value of transcutaneous fine needle aspiration biopsy of the preepiglottic space as an auxiliary staging method in supraglottic squamous cell carcinoma and morbidity from the procedure as well.…”