Image-guided percutaneous procedures in deep pelvic sites: review of the main approaches

Image-guided percutaneous procedures have increasingly been established as safe and effective interventional tools in the diagnosis and management of masses and collections in several body segments. However, lesions in deep pelvic sites still pose a challenge for radiologists because of overlying anatomic structures. The success of a percutaneous biopsy depends on a safe access route planning based on a deep understanding of cross sectional anatomy of the pelvis. Anterior and lateral transabdominal, anterolateral extraperitoneal, transvaginal, transrectal and transgluteal approaches are described. The present study was aimed at reviewing the normal pelvic cross-sectional anatomy, demonstrating the different access routes for ultrasonography and computed tomography guided pelvic biopsies and drainages as well as discussing the main advantages and complications associated with these approaches. (author)