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Minimal invasive biopsy of intraconal expansion by PET/CT/MRI image-guided navigation: A new method
Abstract Intraorbital tumours are often undetected for a long period and may lead to compression of the optic nerve and loss of vision. Although CT, MRI's and ultrasound can help in determining the probable diagnosis, most orbital tumours are only diagnosed by surgical biopsy. In intraconal les...
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| Published in: | Journal of cranio-maxillo-facial surgery 2014-10, Vol.42 (7), p.1184-1189 |
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| description | Abstract Intraorbital tumours are often undetected for a long period and may lead to compression of the optic nerve and loss of vision. Although CT, MRI's and ultrasound can help in determining the probable diagnosis, most orbital tumours are only diagnosed by surgical biopsy. In intraconal lesions this may prove especially difficult as the expansions are situated next to sensitive anatomical structures (eye bulb, optic nerve). In search of a minimally invasive access to the intraconal region, we describe a method of a three-dimensional, image-guided biopsy of orbital tumours using a combined technique of hardware fusion between18 F-FDG Positron Emission Tomography (18 F-FDG PET), magnetic resonance imaging (MRI) and Computed Tomography (CT). Method and material We present 6 patients with a total of 7 intraorbital lesions, all of them suffering from diplopia and/or exophthalmos. There were 3 female and 3 male patients. The patients age ranged from 20 to 75 years. One of the patients showed beginning loss of vision. Another of the patients had lesions in both orbits. The decision to obtain image-guided needle biopsies for treatment planning was discussed and decided at an interdisciplinary board comprising other sub-specialities (ophthalmology, neurosurgery, maxillofacial surgery, ENT, plastic surgery). All patients underwent 3D imaging preoperatively (18 F-FDG PET/CT or18 F-FDG PET/CT plus MRI). Data was transferred to 3D navigation system. Access to the lesions was planned preoperatively on a workstation monitor. Biopsy-needles were then calibrated intraoperatively and all patients underwent three-dimensional image-guided needle biopsies under general anaesthesia. Results 7 biopsies were performed. The histologic subtype was idiopathic orbital inflammation in 2 lesions, lymphoma in 2, Merkel cell carcinoma in 1, hamartoma in 1 and 1 malignant melanoma. The different pathologies were subsequently treated in consideration of the actual state of the art. In cases where surgical removal of the lesion was performed the histological diagnosis was confirmed in all cases. Conclusion There is a wide range of possible treatment modalities for orbital tumours depending on the nature of the lesion. Histological diagnosis is mandatory to select the proper management and operation. The presented method allows minimal-invasive biopsy even in deep intraconal lesions, enabling the surgeon to spare critical anatomical structures. Vascular lesions such as cavernous haemangi |
| doi_str_mv | 10.1016/j.jcms.2014.02.006 |
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Although CT, MRI's and ultrasound can help in determining the probable diagnosis, most orbital tumours are only diagnosed by surgical biopsy. In intraconal lesions this may prove especially difficult as the expansions are situated next to sensitive anatomical structures (eye bulb, optic nerve). In search of a minimally invasive access to the intraconal region, we describe a method of a three-dimensional, image-guided biopsy of orbital tumours using a combined technique of hardware fusion between18 F-FDG Positron Emission Tomography (18 F-FDG PET), magnetic resonance imaging (MRI) and Computed Tomography (CT). Method and material We present 6 patients with a total of 7 intraorbital lesions, all of them suffering from diplopia and/or exophthalmos. There were 3 female and 3 male patients. The patients age ranged from 20 to 75 years. One of the patients showed beginning loss of vision. Another of the patients had lesions in both orbits. The decision to obtain image-guided needle biopsies for treatment planning was discussed and decided at an interdisciplinary board comprising other sub-specialities (ophthalmology, neurosurgery, maxillofacial surgery, ENT, plastic surgery). All patients underwent 3D imaging preoperatively (18 F-FDG PET/CT or18 F-FDG PET/CT plus MRI). Data was transferred to 3D navigation system. Access to the lesions was planned preoperatively on a workstation monitor. Biopsy-needles were then calibrated intraoperatively and all patients underwent three-dimensional image-guided needle biopsies under general anaesthesia. Results 7 biopsies were performed. The histologic subtype was idiopathic orbital inflammation in 2 lesions, lymphoma in 2, Merkel cell carcinoma in 1, hamartoma in 1 and 1 malignant melanoma. The different pathologies were subsequently treated in consideration of the actual state of the art. In cases where surgical removal of the lesion was performed the histological diagnosis was confirmed in all cases. Conclusion There is a wide range of possible treatment modalities for orbital tumours depending on the nature of the lesion. Histological diagnosis is mandatory to select the proper management and operation. The presented method allows minimal-invasive biopsy even in deep intraconal lesions, enabling the surgeon to spare critical anatomical structures. Vascular lesions such as cavernous haemangioma, tumour of the lacrimal gland or dermoid cysts present a contraindication and have to be excluded.</description><identifier>ISSN: 1010-5182</identifier><identifier>EISSN: 1878-4119</identifier><identifier>DOI: 10.1016/j.jcms.2014.02.006</identifier><identifier>PMID: 24726395</identifier><language>eng</language><publisher>Scotland: Elsevier Ltd</publisher><subject>Adult ; Aged ; Carcinoma, Merkel Cell - diagnosis ; Carcinoma, Merkel Cell - pathology ; Dentistry ; Diplopia - diagnosis ; Exophthalmos - diagnosis ; Female ; Fluorodeoxyglucose F18 ; Hamartoma - diagnosis ; Hamartoma - pathology ; Humans ; Image-Guided Biopsy - methods ; Image-guided surgery ; Imaging, Three-Dimensional - methods ; Intraconal lesion ; Lymphoma - diagnosis ; Lymphoma - pathology ; Magnetic Resonance Imaging - methods ; Male ; Melanoma - diagnosis ; Melanoma - pathology ; Middle Aged ; Minimal invasive biopsy ; Minimally Invasive Surgical Procedures - methods ; Multimodal Imaging - methods ; Orbital ; Orbital Diseases - diagnosis ; Orbital Diseases - pathology ; Orbital Neoplasms - diagnosis ; Orbital Neoplasms - pathology ; Patient Care Planning ; Positron-Emission Tomography - methods ; Radiopharmaceuticals ; Surgery ; Tomography, X-Ray Computed - methods ; Young Adult</subject><ispartof>Journal of cranio-maxillo-facial surgery, 2014-10, Vol.42 (7), p.1184-1189</ispartof><rights>European Association for Cranio-Maxillo-Facial Surgery</rights><rights>2014 European Association for Cranio-Maxillo-Facial Surgery</rights><rights>Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c481t-edb1155d2eeaac4be1e8a61fcefc1d474e000db292dedaf4c7f3e0c0ae0093c13</citedby><cites>FETCH-LOGICAL-c481t-edb1155d2eeaac4be1e8a61fcefc1d474e000db292dedaf4c7f3e0c0ae0093c13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24726395$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Reinbacher, Knut E</creatorcontrib><creatorcontrib>Pau, Mauro</creatorcontrib><creatorcontrib>Wallner, Jürgen</creatorcontrib><creatorcontrib>Zemann, Wolfgang</creatorcontrib><creatorcontrib>Klein, Angelika</creatorcontrib><creatorcontrib>Gstettner, Christian</creatorcontrib><creatorcontrib>Aigner, Reingard M</creatorcontrib><creatorcontrib>Feichtinger, Matthias</creatorcontrib><title>Minimal invasive biopsy of intraconal expansion by PET/CT/MRI image-guided navigation: A new method</title><title>Journal of cranio-maxillo-facial surgery</title><addtitle>J Craniomaxillofac Surg</addtitle><description>Abstract Intraorbital tumours are often undetected for a long period and may lead to compression of the optic nerve and loss of vision. Although CT, MRI's and ultrasound can help in determining the probable diagnosis, most orbital tumours are only diagnosed by surgical biopsy. In intraconal lesions this may prove especially difficult as the expansions are situated next to sensitive anatomical structures (eye bulb, optic nerve). In search of a minimally invasive access to the intraconal region, we describe a method of a three-dimensional, image-guided biopsy of orbital tumours using a combined technique of hardware fusion between18 F-FDG Positron Emission Tomography (18 F-FDG PET), magnetic resonance imaging (MRI) and Computed Tomography (CT). Method and material We present 6 patients with a total of 7 intraorbital lesions, all of them suffering from diplopia and/or exophthalmos. There were 3 female and 3 male patients. The patients age ranged from 20 to 75 years. One of the patients showed beginning loss of vision. Another of the patients had lesions in both orbits. The decision to obtain image-guided needle biopsies for treatment planning was discussed and decided at an interdisciplinary board comprising other sub-specialities (ophthalmology, neurosurgery, maxillofacial surgery, ENT, plastic surgery). All patients underwent 3D imaging preoperatively (18 F-FDG PET/CT or18 F-FDG PET/CT plus MRI). Data was transferred to 3D navigation system. Access to the lesions was planned preoperatively on a workstation monitor. Biopsy-needles were then calibrated intraoperatively and all patients underwent three-dimensional image-guided needle biopsies under general anaesthesia. Results 7 biopsies were performed. The histologic subtype was idiopathic orbital inflammation in 2 lesions, lymphoma in 2, Merkel cell carcinoma in 1, hamartoma in 1 and 1 malignant melanoma. The different pathologies were subsequently treated in consideration of the actual state of the art. In cases where surgical removal of the lesion was performed the histological diagnosis was confirmed in all cases. Conclusion There is a wide range of possible treatment modalities for orbital tumours depending on the nature of the lesion. Histological diagnosis is mandatory to select the proper management and operation. The presented method allows minimal-invasive biopsy even in deep intraconal lesions, enabling the surgeon to spare critical anatomical structures. Vascular lesions such as cavernous haemangioma, tumour of the lacrimal gland or dermoid cysts present a contraindication and have to be excluded.</description><subject>Adult</subject><subject>Aged</subject><subject>Carcinoma, Merkel Cell - diagnosis</subject><subject>Carcinoma, Merkel Cell - pathology</subject><subject>Dentistry</subject><subject>Diplopia - diagnosis</subject><subject>Exophthalmos - diagnosis</subject><subject>Female</subject><subject>Fluorodeoxyglucose F18</subject><subject>Hamartoma - diagnosis</subject><subject>Hamartoma - pathology</subject><subject>Humans</subject><subject>Image-Guided Biopsy - methods</subject><subject>Image-guided surgery</subject><subject>Imaging, Three-Dimensional - methods</subject><subject>Intraconal lesion</subject><subject>Lymphoma - diagnosis</subject><subject>Lymphoma - pathology</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Melanoma - diagnosis</subject><subject>Melanoma - pathology</subject><subject>Middle Aged</subject><subject>Minimal invasive biopsy</subject><subject>Minimally Invasive Surgical Procedures - methods</subject><subject>Multimodal Imaging - methods</subject><subject>Orbital</subject><subject>Orbital Diseases - diagnosis</subject><subject>Orbital Diseases - pathology</subject><subject>Orbital Neoplasms - diagnosis</subject><subject>Orbital Neoplasms - pathology</subject><subject>Patient Care Planning</subject><subject>Positron-Emission Tomography - methods</subject><subject>Radiopharmaceuticals</subject><subject>Surgery</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Young Adult</subject><issn>1010-5182</issn><issn>1878-4119</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><recordid>eNp9kUFv1DAQhS0EoqXwBzggH7kk63G82QQhpGpVaKVWrWA5W449WRySeBsnW_bfM9G2PXDgZGv8vbHee4y9B5GCgHzRpI3tYioFqFTIVIj8BTuFYlUkCqB8SXcBIllCIU_YmxgbQYQoytfsRKqVzLNyecrsje99Z1ru-72Jfo-88mEXDzzUNBoHY0NPr_hnZ_roQ8-rA7-72CzWm8XN9ytO0i0m28k7dLw3e781I1Gf-Dnv8YF3OP4K7i17VZs24rvH84z9_HqxWV8m17ffrtbn14lVBYwJugpguXQS0RirKgQsTA61xdqCUyuFZMBVspT0mamVXdUZCisMzcvMQnbGPh737oZwP2EcdeejxbY1PYYpashlWea5VDmh8ojaIcQ4YK13A3kZDhqEnsPVjZ7D1XO4WkhN0ZHow-P-qerQPUue0iTg8xFAcrn3OOhoPfYWnR_QjtoF___9X_6R25basab9jQeMTZgG6oJ86EgC_WOud24X1NxsnmV_AeqYoPA</recordid><startdate>20141001</startdate><enddate>20141001</enddate><creator>Reinbacher, Knut E</creator><creator>Pau, Mauro</creator><creator>Wallner, Jürgen</creator><creator>Zemann, Wolfgang</creator><creator>Klein, Angelika</creator><creator>Gstettner, Christian</creator><creator>Aigner, Reingard M</creator><creator>Feichtinger, Matthias</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20141001</creationdate><title>Minimal invasive biopsy of intraconal expansion by PET/CT/MRI image-guided navigation: A new method</title><author>Reinbacher, Knut E ; Pau, Mauro ; Wallner, Jürgen ; Zemann, Wolfgang ; Klein, Angelika ; Gstettner, Christian ; Aigner, Reingard M ; Feichtinger, Matthias</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c481t-edb1155d2eeaac4be1e8a61fcefc1d474e000db292dedaf4c7f3e0c0ae0093c13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Carcinoma, Merkel Cell - diagnosis</topic><topic>Carcinoma, Merkel Cell - pathology</topic><topic>Dentistry</topic><topic>Diplopia - diagnosis</topic><topic>Exophthalmos - diagnosis</topic><topic>Female</topic><topic>Fluorodeoxyglucose F18</topic><topic>Hamartoma - diagnosis</topic><topic>Hamartoma - pathology</topic><topic>Humans</topic><topic>Image-Guided Biopsy - methods</topic><topic>Image-guided surgery</topic><topic>Imaging, Three-Dimensional - methods</topic><topic>Intraconal lesion</topic><topic>Lymphoma - diagnosis</topic><topic>Lymphoma - pathology</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Melanoma - diagnosis</topic><topic>Melanoma - pathology</topic><topic>Middle Aged</topic><topic>Minimal invasive biopsy</topic><topic>Minimally Invasive Surgical Procedures - methods</topic><topic>Multimodal Imaging - methods</topic><topic>Orbital</topic><topic>Orbital Diseases - diagnosis</topic><topic>Orbital Diseases - pathology</topic><topic>Orbital Neoplasms - diagnosis</topic><topic>Orbital Neoplasms - pathology</topic><topic>Patient Care Planning</topic><topic>Positron-Emission Tomography - methods</topic><topic>Radiopharmaceuticals</topic><topic>Surgery</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Reinbacher, Knut E</creatorcontrib><creatorcontrib>Pau, Mauro</creatorcontrib><creatorcontrib>Wallner, Jürgen</creatorcontrib><creatorcontrib>Zemann, Wolfgang</creatorcontrib><creatorcontrib>Klein, Angelika</creatorcontrib><creatorcontrib>Gstettner, Christian</creatorcontrib><creatorcontrib>Aigner, Reingard M</creatorcontrib><creatorcontrib>Feichtinger, Matthias</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cranio-maxillo-facial surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Reinbacher, Knut E</au><au>Pau, Mauro</au><au>Wallner, Jürgen</au><au>Zemann, Wolfgang</au><au>Klein, Angelika</au><au>Gstettner, Christian</au><au>Aigner, Reingard M</au><au>Feichtinger, Matthias</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Minimal invasive biopsy of intraconal expansion by PET/CT/MRI image-guided navigation: A new method</atitle><jtitle>Journal of cranio-maxillo-facial surgery</jtitle><addtitle>J Craniomaxillofac Surg</addtitle><date>2014-10-01</date><risdate>2014</risdate><volume>42</volume><issue>7</issue><spage>1184</spage><epage>1189</epage><pages>1184-1189</pages><issn>1010-5182</issn><eissn>1878-4119</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Abstract Intraorbital tumours are often undetected for a long period and may lead to compression of the optic nerve and loss of vision. Although CT, MRI's and ultrasound can help in determining the probable diagnosis, most orbital tumours are only diagnosed by surgical biopsy. In intraconal lesions this may prove especially difficult as the expansions are situated next to sensitive anatomical structures (eye bulb, optic nerve). In search of a minimally invasive access to the intraconal region, we describe a method of a three-dimensional, image-guided biopsy of orbital tumours using a combined technique of hardware fusion between18 F-FDG Positron Emission Tomography (18 F-FDG PET), magnetic resonance imaging (MRI) and Computed Tomography (CT). Method and material We present 6 patients with a total of 7 intraorbital lesions, all of them suffering from diplopia and/or exophthalmos. There were 3 female and 3 male patients. The patients age ranged from 20 to 75 years. One of the patients showed beginning loss of vision. Another of the patients had lesions in both orbits. The decision to obtain image-guided needle biopsies for treatment planning was discussed and decided at an interdisciplinary board comprising other sub-specialities (ophthalmology, neurosurgery, maxillofacial surgery, ENT, plastic surgery). All patients underwent 3D imaging preoperatively (18 F-FDG PET/CT or18 F-FDG PET/CT plus MRI). Data was transferred to 3D navigation system. Access to the lesions was planned preoperatively on a workstation monitor. Biopsy-needles were then calibrated intraoperatively and all patients underwent three-dimensional image-guided needle biopsies under general anaesthesia. Results 7 biopsies were performed. The histologic subtype was idiopathic orbital inflammation in 2 lesions, lymphoma in 2, Merkel cell carcinoma in 1, hamartoma in 1 and 1 malignant melanoma. The different pathologies were subsequently treated in consideration of the actual state of the art. In cases where surgical removal of the lesion was performed the histological diagnosis was confirmed in all cases. Conclusion There is a wide range of possible treatment modalities for orbital tumours depending on the nature of the lesion. Histological diagnosis is mandatory to select the proper management and operation. The presented method allows minimal-invasive biopsy even in deep intraconal lesions, enabling the surgeon to spare critical anatomical structures. Vascular lesions such as cavernous haemangioma, tumour of the lacrimal gland or dermoid cysts present a contraindication and have to be excluded.</abstract><cop>Scotland</cop><pub>Elsevier Ltd</pub><pmid>24726395</pmid><doi>10.1016/j.jcms.2014.02.006</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Aged Carcinoma, Merkel Cell - diagnosis Carcinoma, Merkel Cell - pathology Dentistry Diplopia - diagnosis Exophthalmos - diagnosis Female Fluorodeoxyglucose F18 Hamartoma - diagnosis Hamartoma - pathology Humans Image-Guided Biopsy - methods Image-guided surgery Imaging, Three-Dimensional - methods Intraconal lesion Lymphoma - diagnosis Lymphoma - pathology Magnetic Resonance Imaging - methods Male Melanoma - diagnosis Melanoma - pathology Middle Aged Minimal invasive biopsy Minimally Invasive Surgical Procedures - methods Multimodal Imaging - methods Orbital Orbital Diseases - diagnosis Orbital Diseases - pathology Orbital Neoplasms - diagnosis Orbital Neoplasms - pathology Patient Care Planning Positron-Emission Tomography - methods Radiopharmaceuticals Surgery Tomography, X-Ray Computed - methods Young Adult |
| title | Minimal invasive biopsy of intraconal expansion by PET/CT/MRI image-guided navigation: A new method |
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