Real-time CT/MR fusion imaging-guided core needle biopsy: enhancing diagnostic precision in head and neck lesions

Abstract Objectives To establish an intraoperative CT/MR fusion imaging (FI)-guided core needle biopsy (CNB) approach for head and neck lesions and to evaluate its diagnostic performance in comparison with conventional CT-guided biopsy. Material and methods This retrospective study included patients undergoing CT-guided or FI-guided CNB for head and neck lesions between January 2020 and December 2024. Clinical information was collected, including demographics, lesion size, needle insertion depth, number of biopsy cores obtained, and complications. Diagnostic performance was evaluated at both the case-based and core-based levels by comparing biopsy histopathology with the final diagnosis. Subgroup analyses were performed according to lesion size, needle insertion depth, and pathological type. Results A total of 152 patients with 426 biopsy cores were included, comprising 66 patients (183 cores) in the CT-guided group and 86 patients (243 cores) in the FI-guided group. At the case-based level, FI-guided biopsy demonstrated significantly higher diagnostic accuracy than CT-guided biopsy (98.8% vs 90.9%, p = 0.04), particularly for lesions < 3.7 cm and non-squamous cell carcinoma (non-SCC) lesions. At the core-based level, FI-guided biopsy also achieved higher accuracy (96.3% vs 73.2%, p < 0.001) and sensitivity (93.8% vs 65.0%, p < 0.001), with consistent advantages across all predefined subgroups. No major procedure-related complications were observed. Conclusions FI-guided CNB is a safe and feasible technique for head and neck lesions that improves diagnostic accuracy compared with conventional CT guidance. Key Points Question Can CT/MR FI overcome the limitations of conventional CT guidance for precise targeting and accurate biopsy of anatomically complex head and neck lesions? Findings CT/MR FI-guided biopsy demonstrated higher diagnostic accuracy at both case-based and core-based analyses than conventional CT-guided biopsy for complex head and neck lesions. Critical relevance statement This study provides evidence that CT/MR fusion-guided biopsy improves targeting precision and diagnostic performance compared with conventional CT-guided biopsy, supporting its application for complex head and neck lesions in clinical radiology practice.