Pediatric Radiology

, Volume 46, Issue 3, pp 407–412 | Cite as

MR cone-beam CT fusion image overlay for fluoroscopically guided percutaneous biopsies in pediatric patients

  • Avnesh S. ThakorEmail author
  • Premal A. Patel
  • Richard Gu
  • Vanessa Rea
  • Joao Amaral
  • Bairbre L. Connolly
Technical Innovation


Lesions only visible on magnetic resonance (MR) imaging cannot easily be targeted for image-guided biopsy using ultrasound or X-rays but instead require MR guidance with MR-compatible needles and long procedure times (acquisition of multiple MR sequences). We developed an alternative method for performing these difficult biopsies in a standard interventional suite, by fusing MR with cone-beam CT images. The MR cone-beam CT fusion image is then used as an overlay to guide a biopsy needle to the target area under live fluoroscopic guidance. Advantages of this technique include (i) the ability for it to be performed in a conventional interventional suite, (ii) three-dimensional planning of the needle trajectory using cross-sectional imaging, (iii) real-time fluoroscopic guidance for needle trajectory correction and (iv) targeting within heterogeneous lesions based on MR signal characteristics to maximize the potential biopsy yield.


Biopsy Bone Children Cone-beam computed tomography Image fusion Magnetic resonance imaging Soft tissue 


Compliance with ethical standards

Conflicts of interest



  1. 1.
    Jelinek JS, Murphey MD, Welker JA et al (2002) Diagnosis of primary bone tumors with image-guided percutaneous biopsy: experience with 110 tumors. Radiology 223:731–737CrossRefPubMedGoogle Scholar
  2. 2.
    Abi-Jaoudeh N, Venkatesan AM, Van der Sterren W et al (2015) Clinical experience with cone-beam CT navigation for tumor ablation. J Vasc Interv Radiol 26:214–219PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    Hwang T, Kurzendorfer T, Girard E et al (2014) First experience with iGuide navigational software application for bone biopsies in pediatric interventional radiology. J Vasc Interv Radiol 25:S131–S132CrossRefGoogle Scholar
  4. 4.
    Fritz J, Tzaribachev N, Thomas C et al (2012) Magnetic resonance imaging-guided osseous biopsy in children with chronic recurrent multifocal osteomyelitis. Cardiovasc Intervent Radiol 35:146–153CrossRefPubMedGoogle Scholar
  5. 5.
    Johnson C, Martin-Carreras T, Rabinowitz D (2014) Pediatric interventional radiology and dose-reduction techniques. Semin Ultrasound CT MR 35:409–414CrossRefPubMedGoogle Scholar
  6. 6.
    Amalou H, Wood BJ (2012) Multimodality fusion with MRI, CT, and ultrasound contrast for ablation of renal cell carcinoma. Case Rep Urol 2012:390912PubMedCentralPubMedGoogle Scholar
  7. 7.
    Aigner F, De Zordo T, Pallwein-Prettner L et al (2015) Applications of technical fusion in uroradiology. Röfo 187:331–337PubMedGoogle Scholar
  8. 8.
    Fritz J, U-Thainual P, Ungi T et al (2013) Augmented reality visualization using image overlay technology for MR-guided interventions: cadaveric bone biopsy at 1.5 T. Invest Radiol 48:464–470CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Avnesh S. Thakor
    • 1
    • 2
    Email author
  • Premal A. Patel
    • 1
  • Richard Gu
    • 1
  • Vanessa Rea
    • 1
  • Joao Amaral
    • 1
  • Bairbre L. Connolly
    • 1
  1. 1.Image Guided Therapy, The Hospital for Sick ChildrenUniversity of TorontoTorontoCanada
  2. 2.Division of Interventional Radiology, Department of Radiology, Lucile Packard Children’s HospitalStanford UniversityPalo AltoUSA

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