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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04), particularly for lesions &lt;\u20093.7\u2009cm 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%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and sensitivity (93.8% vs 65.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), with consistent advantages across all predefined subgroups. No major procedure-related complications were observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>FI-guided CNB is a safe and feasible technique for head and neck lesions that improves diagnostic accuracy compared with conventional CT guidance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>Question<\/jats:bold>\n                      Can CT\/MR FI overcome the limitations of conventional CT guidance for precise targeting and accurate biopsy of anatomically complex head and neck lesions?\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>Findings<\/jats:bold>\n                      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.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>Critical relevance statement<\/jats:bold>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13244-026-02426-x","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:06:38Z","timestamp":1791565598000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-time CT\/MR fusion imaging-guided core needle biopsy: enhancing diagnostic precision in head and neck lesions"],"prefix":"10.1186","volume":"17","author":[{"given":"Xing","family":"Liang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiliang","family":"Ren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gongxin","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiqing","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6958-5022","authenticated-orcid":false,"given":"Ying","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"2426_CR1","doi-asserted-by":"publisher","first-page":"2289","DOI":"10.1016\/S0140-6736(21)01550-6","volume":"398","author":"MD Mody","year":"2021","unstructured":"Mody MD, Rocco JW, Yom SS et al (2021) Head and neck cancer. 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