European Radiology

, Volume 22, Issue 6, pp 1233–1239 | Cite as

CT-guided adrenal biopsy: comparison of ipsilateral decubitus versus prone patient positioning for biopsy approach

  • Bruno C. Odisio
  • Alda L. Tam
  • Rony Avritscher
  • Sanjay Gupta
  • Michael J. Wallace



To compare ipsilateral decubitus and prone patient positioning for performing computed tomography guided adrenal biopsy using the requirements for out-of-plane approach (OOP) and the needle insertion time (NIT) as a surrogate for procedure complexity.


The study included 106 adrenal biopsies performed in 104 patients with lesions measuring ≤4 cm that were divided into two groups: Ipsilateral decubitus (Group I) and prone (Group II) positions. The frequency of use of an OOP biopsy path and the NIT were recorded as well as diagnostic yield, adverse events and transgression of organs to approach the target lesion.


Groups I and II comprised 54 and 50 patients, respectively. The use of the OOP approach was significantly less frequent (P < 0.01) in Group I (n = 4) compared to Group II (n = 38). NIT was statistically shorter (P < 0.01) in Group I (9 min and 43 s) compared to Group II (19 min and 7 s). There were fewer organs traversed in Group I versus Group II. Diagnostic yield and post-biopsy complications were equal in both groups.


Ipsilateral adrenal biopsy approach is a less complex, equally reliable and safe compared to the prone approach based on the less frequent use of the OOP approach and the shorter NIT.

Key Points

Ipsilateral adrenal biopsy decubitus positioning provides a direct, non-transpulmonary path for sampling

Ipsilateral decubitus positioning reduces the need for potentially dangerous out-of-plane approaches (OOP)

Ipsilateral decubitus and prone positioning are equally reliable and safe techniques


Adrenal glands Biopsy Patient positioning Ipsilateral decubitus Computed tomography 


  1. 1.
    Gupta S (2006) Role of image-guided percutaneous needle biopsy in cancer staging. Semin Roentgenol 41:78–90PubMedCrossRefGoogle Scholar
  2. 2.
    Mayo-Smith WW, Boland GW, Noto RB et al (2001) State-of-the-art adrenal imaging. Radiographics 21:995–1012PubMedGoogle Scholar
  3. 3.
    Boland GW, Blake MA, Holalkere NS et al (2009) PET/CT for the characterization of adrenal masses in patients with cancer: qualitative versus quantitative accuracy in 150 consecutive patients. AJR 192:956–962PubMedCrossRefGoogle Scholar
  4. 4.
    Slapa RZ, Jakubowski W, Januszewicz A et al (2000) Discriminatory power of MRI for differentiation of adrenal non-adenomas vs adenomas evaluated by means of ROC analysis: can biopsy be obviated? Eur Radiol 10:95–104PubMedCrossRefGoogle Scholar
  5. 5.
    Welch TJ, Sheedy PF 2nd, Stephens DH, Johnson CM, Swensen SJ (1994) Percutaneous adrenal biopsy: review of a 10-year experience. Radiology 193:341–344PubMedGoogle Scholar
  6. 6.
    Mignon F, Mesurolle B (2002) CT guided adrenal biopsies: remaining indications? J Radiol 83:419–428PubMedGoogle Scholar
  7. 7.
    Silverman SG, Mueller PR, Pinkney LP et al (1993) Predictive value of image-guided adrenal biopsy: analysis of results of 101 biopsies. Radiology 187:715–718PubMedGoogle Scholar
  8. 8.
    vanSonnenberg E, Wittenber J, Ferrucci JT et al (1981) Triangulation method for percutaneous needle guidance: the angled approach to upper abdominal masses. AJR Am J Roentgenol 137:757–761PubMedGoogle Scholar
  9. 9.
    Karampekios S, Hatjidakis AA, Drositis J et al (1998) Artificial paravertebral widening for percutaneous CT-guided adrenal biopsy. J Comput Assist Tomogr 22:308–310PubMedCrossRefGoogle Scholar
  10. 10.
    Hussain S (1996) Gantry angulation in CT-guided percutaneous adrenal biopsy. AJR Am J Roentgenol 166:537–539PubMedGoogle Scholar
  11. 11.
    Arellano RS, Harisinghani MG, Gervais DA et al (2003) Image-guided percutaneous biopsy of the adrenal gland: review of indications, technique, and complications. Curr Probl Diagn Radiol 32:3–10PubMedCrossRefGoogle Scholar
  12. 12.
    Heiberg E, Wolverson MK (1985) Ipsilateral decubitus position for percutaneous CT-guided adrenal biopsy. J Comput Assist Tomogr 9:217–218PubMedCrossRefGoogle Scholar
  13. 13.
    Rozenblit AM, Tuvia J, Rozenblit GN et al (2000) CT-guided transthoracic needle biopsy using an ipsilateral dependent position. AJR Am J Roentgenol 174:1759–1764PubMedGoogle Scholar
  14. 14.
    Gupta S, Wallace MJ, Cardella JF et al (2010) Quality improvement guidelines for percutaneous needle biopsy. J Vasc Intervent Radiol 21:969–975CrossRefGoogle Scholar
  15. 15.
    Mody MK, Kazerooni EA, Korobkin M (1995) Percutaneous CT-guided biopsy of adrenal masses: immediate and delayed complications. J Comput Assist Tomogr 19:434–439PubMedCrossRefGoogle Scholar
  16. 16.
    Liessi G, Sandini F, Spaliviero B et al (1990) CT-guided percutaneous biopsy of adrenal masses. Experience of the technic in 54 neoplasm patients. La Radiologia medica 79:366–370PubMedGoogle Scholar
  17. 17.
    Klose KC, Bocking A (1991) CT-guided course-punch biopsy of the adrenals. The indications, technic and results. RoFo 155:25–31PubMedCrossRefGoogle Scholar
  18. 18.
    Quayle FJ, Spitler JA, Pierce RA et al (2007) Needle biopsy of incidentally discovered adrenal masses is rarely informative and potentially hazardous. Surgery 142:497–502PubMedCrossRefGoogle Scholar
  19. 19.
    Krishnam M, Tomasian A, Davies L et al (2008) CT-guided percutaneous transpulmonary adrenal biopsy—a technical note. Br J Radiol 81:191–193CrossRefGoogle Scholar
  20. 20.
    Covey AM, Gandhi R, Brody LA et al (2004) Factors associated with pneumothorax and pneumothorax requiring treatment after percutaneous lung biopsy in 443 consecutive patients. J Vasc Interv Radiol 15:479–483PubMedCrossRefGoogle Scholar
  21. 21.
    Koenker RM, Mueller PR, vanSonnenberg E (1988) Interventional radiology of the adrenal gland. Semin Roentgenol 22:314–322CrossRefGoogle Scholar

Copyright information

© Springer-Verlag (outside the USA) 2012

Authors and Affiliations

  • Bruno C. Odisio
    • 1
  • Alda L. Tam
    • 1
  • Rony Avritscher
    • 1
  • Sanjay Gupta
    • 1
  • Michael J. Wallace
    • 1
  1. 1.Department of Diagnostic Radiology, Section of Interventional RadiologyThe University of Texas M.D. Anderson Cancer CenterHoustonUSA

Personalised recommendations