Skeletal Radiology

, Volume 47, Issue 5, pp 661–669 | Cite as

CT-guided percutaneous biopsy of sclerotic bone lesions: diagnostic outcomes

  • I-Yuan Joseph Chang
  • Hakan Ilaslan
  • Murali Sundaram
  • Jean Schils
  • Naveen Subhas
Scientific Article



To determine the diagnostic yield of CT-guided percutaneous biopsy of densely sclerotic bone lesions.

Materials and methods

We retrospectively analyzed CT-guided percutaneous bone biopsies performed at our institution from September 2008 through August 2011 (329 cases) and from September 2012 through August 2015 (324 cases) after adoption of a battery-powered drill system (OnControl). Bone lesions were included in the analysis if they were >70% sclerotic by visual inspection, had a density > 2 times that of adjacent trabecular bone, and had an attenuation of ≥250 HU. Pathological fractures, diskitis–osteomyelitis, and osteoid osteomas were excluded. Eligible cases were characterized by lesion location, maximum lesion diameter, mean density, biopsy needle type and gauge, reported complications, and histological diagnosis. Clinical and imaging follow-up was used to confirm histological diagnosis. Cases in which a benign histological diagnosis could not be confirmed by imaging over a minimum period of 1 year were excluded.


A total of 37 biopsies of sclerotic bone lesions met the inclusion criteria, 17 of which were performed with a power drill needle and 20 of which were performed with a manually driven needle. The mean lesion density was 604.1 HU. The overall diagnostic yield was 78.4%; overall diagnostic accuracy was 94.6%, and the false-negative rate was 5.4%. Diagnostic yield and accuracy were 82.4% and 100% respectively, with a power drill and 75% and 90% respectively, with a manual device. Diagnostic yield for lesions ≥700 HU was 90% (9 out of 10).


Densely sclerotic bone lesions are amenable to percutaneous needle biopsy.


CT-guided Percutaneous biopsy Sclerotic bone lesion Drill Needle Diagnostic yield Accuracy Sensitivity False-negative 



We would like to thank Megan Griffiths for her help with editing the manuscript and Jennifer Bullen for her help with the statistical analysis.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards for the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.


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Copyright information

© ISS 2017

Authors and Affiliations

  • I-Yuan Joseph Chang
    • 1
  • Hakan Ilaslan
    • 2
  • Murali Sundaram
    • 2
  • Jean Schils
    • 2
  • Naveen Subhas
    • 2
  1. 1.Department of RadiologyTexas Scottish Rite Hospital for ChildrenDallasUSA
  2. 2.Imaging InstituteCleveland ClinicClevelandUSA

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