Orlando Catalano, Abstract Co-Author: Nothing to Disclose

Antonio Nunziata MD, Presenter: Nothing to Disclose

Fabio Sandomenico MD, Abstract Co-Author: Nothing to Disclose

Luigi A Illiano MD, Abstract Co-Author: Nothing to Disclose

Elisabetta de Lutio di Castelguidone MD, Abstract Co-Author: Nothing to Disclose

Alfredo Siani, Abstract Co-Author: Nothing to Disclose

Bone marrow biopsy is a safe and well-established procedure, although some cases of retroperitoneal bleeding have been reported. By assessing lymphomatous disease in hematology patients with MSCT we have noted how the biopsy path was excellently depicted. Hence, he carried out a study to analyze all possible needle paths.

We reviewed the MSCT studies of 80 consecutive patients (47 M, 33 F, 18-76 years, mean 48) with lymphomatous disease having previously undergone iliac biopsy. Axial as well as coronal, sagittal, and oblique reformatted images were reviewed to define biopsy path detectability, orientation, depth, and course. Involvement of anterior (deep) bone cortex was also recorded. A correlation with patient self-assessed local pain could be obtained in 71/80 patients.

Bone biopsy had been performed 4 to 105 days prior to MSCT (mean, 27 days). Biopsy path was recognizable in 77/80 subjects. It appeared as two parallel and straight dense lines. Orientation was classified as ascending in 25/77, descending in 13/77, and perpendicular in 49/77. Depth overcame 50% of bone thickness in 69/77 cases. Biopsy course was within the posterior iliac bone in 59/77 cases, within the sacral wing in 4/77 and crossing the sacroiliac joint in 14. Anterior bone cortex appeared as interrupted in 16/77 cases. Local pain was described as absent in 29/71 patients, mild in 31/71, moderate in 10/71, and severe in 1/71. Pain self-grading did not correlate with time from biopsy. A deep needle path with involvement of the anterior cortex was especially noted in postmenopausal women, probably because of increased bone porosity. Additionally, a correlation between pain and intrasacral or trans-sacroiliac course was noted.

MSCT allows an optimal depiction of bone marrow biopsy needle path. Although no major complication occurred in our series, we could note that biopsy path has frequently a “non expected” course, clearly correlated with patient self-reported, persistent local pain.

Radiologists should evaluate the needle path of bone marrow biopsy and report an eventual abnormal course. Hematologists should consider a more careful approach, especially in elder women.

Catalano, O, Nunziata, A, Sandomenico, F, A Illiano, L, de Lutio di Castelguidone, E, Siani, A, Needle Path from Iliac Bone Marrow Biopsy: Assessment with Multislice CT (MSCT).  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5014136.html