Objective: Accurate image guidance is an essential component of percutaneous procedures in the head and neck. The combination of preprocedural magnetic resonance imaging (MRI) with cone-beam computed tomography (CBCT) and real-time fluoroscopy (the "triple-overlay" technique) could be useful in image-guided targeting of lesions in the head and neck.
Methods: Three patients underwent percutaneous diagnostic or therapeutic procedures of head and neck lesions (mean, 2.3 ± 2.4 cm). One patient presented for biopsy of a small lesion in the infratemporal fossa only visible on MRI, one presented for preoperative embolization of a nasal tumor, and one presented for sclerotherapy of a parotid hemangioma. Preprocedural MRI for each case was merged with CBCT to create a three-dimensional volume for procedural planning. This was then combined with real-time fluoroscopy to create a triple-overlay for needle trajectory and real-time guidance.
Results: The registration of MRI, CBCT, and fluoroscopy was successful for all three procedures, allowing 3D manipulation of the combined images. Percutaneous procedures were successful in all patients without complications.
Conclusions: The combination of MRI, CBCT, and real-time fluoroscopy provides detailed anatomical information for 3D image-guided percutaneous procedures of the head and neck, especially for small lesions or lesions with features visible only by MRI.
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