E1270. CT-Guided Bone Marrow Aspiration and Biopsy: What Radiologists Need to Know
  1. Cesar Alvarado; NYU Long Island School of Medicine
  2. Micheal Brooks; NYU Long Island School of Medicine
  3. Christopher Foresto; NYU Long Island School of Medicine
  4. Costas Stavrakis; NYU Long Island School of Medicine
  5. Vivek Joshi; NYU Long Island School of Medicine
Bone marrow aspiration and bone biopsy is performed to aid in the diagnosis and management of hematologic diseases and other systemic conditions. Although often performed by a hematologist/oncologist using a blind approach with palpation, there has been an increasing number of referrals to radiology for image-guided bone marrow aspiration in recent years. Some of the reason for referral to radiology include inability to obtain an adequate sample, challenging patient anatomy, inadequate control of pain, or patient preference. Bone marrow aspirations performed under CT guidance are safe, efficacious and are often able to overcome some of the challenges encountered during a blind approach. The purpose of this exhibit is to review the CT-guided technique for successful bone marrow aspiration and biopsy.

Educational Goals / Teaching Points
There are three main teaching goals for this presentation. The first is to discuss the preprocedural evaluation of patients. The second is to review the aspiration/biopsy instruments and specimen collection equipment. The third is to discuss the procedural technique, including positioning, site selection, and technique for obtaining a successful bone marrow aspirate and core biopsy.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Coagulation abnormalities are routinely encountered in patients with hematological disorders. While CT-guided bone marrow aspiration and bone core biopsies have a low bleeding risk, it is important be familiar with preprocedural evaluation for this procedure. This exhibit will discuss some of the published coagulation guidelines for this procedure. Most commonly, CT-guided bone marrow aspiration and bone core biopsies are performed with the patient prone along the posterior superior iliac spine. However, a variety of patient characteristics (e.g., inability to lay prone, overlying infection, anesthesia requirements, and previously irradiated bone) may alter this technique. This review will also showcase scenarios that may affect technique, positioning, and site of aspiration.

Radiology referrals for CT-guided bone marrow aspirations are on the rise and it is important for radiologists to be familiar with optimal technique. A strong relationship and open communication with referring hematologist/oncologists is vital to ensure optimal procedural outcome.