Image-guided percutaneous cutting needle biopsy in difficult locations.

During the last 30 years, the techniques of percutaneous biopsy have evolved dramatically and its indications have expanded accordingly. Additionally, recent treatments in oncology have made it necessary to use larger cutting needles in biopsies for tissue analysis. These developments force radiologists to perform biopsies in areas they are not very familiar with. However, lesions in such organs and regions are traditionally considered to be dangerous because of the risk of bleeding and trauma to the critical structures along the needle tract. As a result, radiologists are generally reluctant to perform image-guided biopsies in such locations particularly using cutting needles. We present the images of nine cases from our archive, in whom we performed image-guided percutaneous cutting needle biopsy (PCNB) for lesions located in larynx, tongue, intestines, stomach, deep pelvis, uterus, pancreas, penis and spleen. For each specific location, we also mention alternative biopsy methods, the indications of PCNB, its potential risks and special techniques to avoid complications.

Quantitative assessment of temporomandibular disc and masseter muscle with shear wave elastography.

PURPOSE: To assess the normal stiffness values of temporomandibular joint disc (TMJ) and masseter muscle by shear wave elastography (SWE) in a healthy adult population. This may be helpful in diagnosing and understanding the mechanism of temporomandibular disorders (TMD). METHODS: This prospective study evaluated a total of 160 healthy adult volunteers (77 males, 83 females). The stiffness values of anterior, intermediate and posterior parts of the TMJ disc and masseter muscle were measured. Study cohort was classified into four groups based on age. Additionally, we investigated the changes in mean shear wave elasticity (kPa) and shear wave velocity(m/s) values of disc parts and masseter muscle in closed and open mouth positions, and the correlation of these SWE values with age and gender. RESULTS: Mean stiffness values of the disc were 37.02 ± 23.75 kPa and 3.28 ± 1.09 m/s in the anterior part, 30.47 ± 18.89 kPa and 2.97 ± 1.04 m/s in the intermediate part, 22.61 ± 13.97 kPa and 2.55 ± 0.88 m/s in the posterior part. Stiffness values showed significant decrease in the posterior part compared to the rest of the disc both in males and females. No significant differences in mean stiffness values of masseter muscle related to mouth position, age or gender. CONCLUSION: This study provides the normative quantitative elasticity values of disc and masseter muscle which could be a reference point for upcoming studies. Disc elasticity values are higher in women than men. Maybe this is one of the reason why TMD is more common in women. TMJ disc stiffness was significantly lower in the posterior part. SWE is a useful imaging method that can be used with routine ultrasonography in evaluation of the TMJ disc and masticatory muscles .