Photon-counting CT-guided bone biopsy with real-time bone marrow edema mapping

Area of Science:

• Radiology
• Oncology
• Orthopedics

Background:

• Computed tomography (CT)-guided bone biopsies are crucial for diagnosing bone lesions but can be technically challenging.
• Optimizing diagnostic yield and accuracy in bone biopsies remains an area of active research.

Purpose of the Study:

• To evaluate the feasibility and usefulness of photon-counting computed tomography (PCCT)-guided bone biopsies.
• To assess the role of real-time bone marrow oedema (BME) mapping in optimizing diagnostic yield.

Main Methods:

• Retrospective study of ten patients undergoing PCCT-guided bone biopsy with real-time BME reconstructions.
• Reference standard established by histopathology/microbiology or clinical/radiologic follow-up.
• Analysis of diagnostic yield, accuracy, and radiation dose; correlation of monoenergetic imaging with lesion morphology.

Main Results:

• Overall diagnostic yield was 70% (7/10), with 87.5% accuracy for cases with a definitive reference standard.
• PCCT identified bone metastases, osteomyelitis, and marrow deposition diseases.
• Monoenergetic 70-keV imaging differentiated lytic and sclerotic lesions (p=0.009) with strong negative correlation (r=-0.84, p=0.002).

Conclusions:

• PCCT-guided bone biopsy with real-time BME mapping is feasible and demonstrates encouraging diagnostic performance in this exploratory cohort.
• Further larger validation studies are required to confirm these findings.
• PCCT enhances lesion visualization, operator confidence, and procedural safety for bone biopsies.