Objectives
To evaluate the safety, feasibility and diagnostic performance of real-time MR-guided brain biopsy using a 1.0-T open MRI scanner.

Methods
Medical records of 86 consecutive participants who underwent brain biopsy under the guidance of a 1.0-T open MRI scanner with real-time and MR fluoroscopy techniques were evaluated retrospectively. All procedures were performed under local anaesthesia and intravenous conscious sedation. Diagnostic yield, diagnostic accuracy, complication rate and procedure duration were assessed. The lesions were divided into two groups according to maximum diameters: ≤ 1.5 cm (n = 16) and > 1.5 cm (n = 70). The two groups were compared using Fisher’s exact test.

Results
Diagnostic yield and diagnostic accuracy were 95.3% and 94.2%, respectively. The diagnostic yield of lesions ≤ 1.5 cm and > 1.5 cm were 93.8% and 95.7%, respectively. There was no significant difference in diagnostic yield between the two groups (p > 0.05). Mean procedure duration was 41 ± 5 min (range 33–49 min). All biopsy needles were placed with one pass. Complication rate was 3.5% (3/86). Minor complications included three cases of a small amount of haemorrhage. No serious complications were observed.

Conclusions
Real-time MR-guided brain biopsy using a 1.0-T open MRI scanner is a safe, feasible and accurate diagnostic technique for pathological diagnosis of brain lesions. The procedure duration is shortened and biopsy work flow is simplified. It could be considered as an alternative for brain biopsy.