Photon-counting CT-guided bone biopsy with real-time bone marrow edema mapping
Abstract
OBJECTIVE: Computed tomography-guided biopsies are needed to diagnose bone lesions, but can sometimes be challenging. We evaluated the feasibility and usefulness of photon-counting computed tomography (PCCT)-guided bone biopsies, focusing on real-time bone marrow oedema (BME) mapping to optimise diagnostic yield.
MATERIALS AND METHODS: This retrospective single-centre study included procedures performed from September 2024 to May 2025 using a first-generation dual-source PCCT scanner with Quantum HD mode. Ten consecutive patients underwent PCCT-guided bone biopsy with real-time BME reconstructions. The reference standard was established using histopathology or microbiological confirmation when available; clinical and ≥ 3-month radiologic follow-up for nondiagnostic or discordant results. Statistical analysis included descriptive statistics, independent unpaired t-tests, and correlation analysis (SPSS v22.0, RStudio).
RESULTS: Ten patients, five women and five men, aged 60.5 ± 13.5 years (mean ± standard deviation), were included in the final analysis. The overall diagnostic yield was 70% (7/10), with a diagnostic accuracy of 87.5% (7/8) for cases with a definitive reference standard. Final diagnoses comprised tumour bone metastases (n = 7, 70%), bone osteomyelitis (n = 1, 10%), and bone marrow deposition disease (n = 2, 20%). Mean radiation dose (dose-length product) was 644.5 ± 112.1 mGy·cm. Monoenergetic 70-keV imaging showed significant differences between mean HU values…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 7 participants or records.
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