Last week, I went to a great symposium about osteoporosis and renal osteodystrophy, organized by Andreas Jehle at the University Hospital of Basel. There were several interesting talks. What really struck me as extraordinary, though, was the suggestion of doing bone biopsies with CT-guidance.
Getting enough trabecular bone is a critical and apparently common technical problem, when doing biopsies for metabolic bone diseases. C. Zech, an interventional radiologist, demonstrated conclusively how CT-guidance can assist in correct positioning and angulation of the bone biopsy needle, to get as much spongiosa as possible. Targeting the crista iliaca from a posterior approach, he uses only an 8 Gauge needle (outer diameter 4.2mm), which renders the whole procedure essentially identical to a bone marrow biopsy for hematological purposes (apart from the CT, of course). This approach appeals to me much more than commonly described techniques (e.g. Chappard, Hernandez), which seem to be more invasive and requiring special expertise.
As the team in Basel is just starting with their program, I would be very interested in hearing, whether someone else has experiences with CT-guided bone biopsies in the assessment of patients with renal osteodystrophy. Please leave a comment, send me an email (email@example.com), or contact me via twitter!