Percutaneous CT-Guided Biopsies of the Cervical Spine: Technique, Histopathologic and Microbiologic Yield, and Safety at a Single Academic Institution

A 70-year-old woman with a history of lung cancer and a new right C5 mass extending into the adjacent soft tissues. A, Axial T1 fat-suppressed postcontrast MR image with a large right C5 mass (black asterisk) extending into the adjacent soft tissues and vertebral canal. B, Intraprocedural CT angiogram with the patient in a left lateral decubitus position shows the mass (white asterisk) and adjacent vascular structures (vertebral artery, white arrow; common carotid artery, white oval; jugular vein, black oval). C, Intraprocedural CT image with the patient in the left lateral decubitus position demonstrates the biopsy using a coaxial soft-tissue biopsy needle passing between vascular structures (vertebral artery, white arrow; common carotid artery, white oval; jugular vein, black oval) into the mass (white asterisk) using a lateral approach. The surgical pathology result was metastatic lung adenocarcinoma.

A 55-year-old woman with right neck and arm pain. A, Axial T2-weighted MR image with a large right C2 vertebral mass (black asterisk) surrounding the vertebral artery (white arrow). B, Intraprocedural CT angiogram soft-tissue-windowed image with the patient prone shows the mass (white asterisk) and adjacent vascular structures (deep cervical vein, white oval; vertebral artery, black oval). C, Intraprocedural CT bone-windowed image with the patient prone demonstrates the bone-access needle (white arrow) in the posterolateral right lamina of C2 and a soft-tissue biopsy needle (dashed white arrow) placed coaxially into the mass (white asterisk), using a posterolateral approach. The surgical pathology result was chordoma.