Volatile Anesthetic Use Versus Total Intravenous Anesthesia for Patients Undergoing Heart Valve Surgery: A Nationwide Population-Based Study.

BACKGROUND: Many studies have suggested that volatile anesthetic use may improve postoperative outcomes after cardiac surgery compared to total intravenous anesthesia (TIVA) owing to its potential cardioprotective effect. However, the results were inconclusive, and few studies have included patients undergoing heart valve surgery. METHODS: This nationwide population-based study included all adult patients who underwent heart valve surgery between 2010 and 2019 in Korea based on data from a health insurance claim database. Patients were divided based on the use of volatile anesthetics: the volatile anesthetics or TIVA groups. After stabilized inverse probability of treatment weighting (IPTW), the association between the use of volatile anesthetics and the risk of cumulative 1-year all-cause mortality (the primary outcome) and cumulative long-term (beyond 1 year) mortality were assessed using Cox regression analysis. RESULTS: Of the 30,755 patients included in this study, the overall incidence of 1-year mortality was 8.5%. After stabilized IPTW, the risk of cumulative 1-year mortality did not differ in the volatile anesthetics group compared to the TIVA group (hazard ratio, 0.98; 95% confidence interval, 0.90-1.07; P = .602), nor did the risk of cumulative long-term mortality (hazard ratio, 0.98; 95% confidence interval, 0.93-1.04; P = .579) at a median (interquartile range) follow-up duration of 4.8 (2.6-7.6) years. CONCLUSIONS: Compared with TIVA, volatile anesthetic use was not associated with reduced postoperative mortality risk in patients undergoing heart valve surgery. Our findings indicate that the use of volatile anesthetics does not have a significant impact on mortality after heart valve surgery. Therefore, the choice of anesthesia type can be based on the anesthesiologists' or institutional preference and experience.

Effectiveness of COVID-19 Vaccines Over Time Against Clinical and Radiologic Outcomes Related to Severe SARS-CoV-2 Infection.

Background The impact of waning vaccine effectiveness on the severity of COVID-19-related findings discovered with radiologic examinations remains underexplored. Purpose To evaluate the effectiveness of vaccines over time against severe clinical and radiologic outcomes related to SARS-CoV-2 infections. Materials and Methods This multicenter retrospective study included patients in the Korean Imaging Cohort of COVID-19 database who were hospitalized for COVID-19 between June 2021 and December 2022. Patients who had received at least one dose of a SARS-CoV-2 vaccine were categorized based on the time elapsed between diagnosis and their last vaccination. Adjusted multivariable logistic regression analysis was used to estimate vaccine effectiveness against a composite of severe clinical outcomes (invasive ventilation, extracorporeal membrane oxygenation, or in-hospital death) and severe radiologic pneumonia (≥25% of lung involvement), and odds ratios (ORs) were compared between patients vaccinated within 90 days of diagnosis and those vaccinated more than 90 days before diagnosis. Results Of 4196 patients with COVID-19 (mean age, 66 years ± 17 [SD]; 2132 [51%] women, 2064 [49%] men), the ratio of severe pneumonia since their most recent vaccination was as follows: 90 days or less, 18% (277 of 1527); between 91 and 120 days, 22% (172 of 783); between 121 and 180 days, 27% (274 of 1032); between 181 and 240 days, 32% (159 of 496); and more than 240 days, 31% (110 of 358). Patients vaccinated more than 240 days before diagnosis showed increased odds of severe clinical outcomes compared with patients vaccinated within 90 days (OR = 1.94 [95% CI: 1.16, 3.24]; P = .01). Similarly, patients vaccinated more than 240 days before diagnosis showed increased odds of severe pneumonia on chest radiographs compared with patients vaccinated within 90 days (OR = 1.65 [95% CI: 1.13, 2.40]; P = .009). No difference in odds of severe clinical outcomes (P = .13 to P = .68) or severe pneumonia (P = .15 to P = .86) were observed between patients vaccinated 91-240 days before diagnosis and those vaccinated within 90 days of diagnosis. Conclusion Vaccine effectiveness against severe clinical outcomes and severe pneumonia related to SARS-CoV-2 infection gradually declined, with increased odds of both observed in patients vaccinated more than 240 days before diagnosis. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Wells in this issue.

Prognostic value of CT-defined ground-glass opacity in early-stage lung adenocarcinomas: a single-center study and meta-analysis.

OBJECTIVES: The prognostic value of ground-glass opacity at preoperative chest CT scans in early-stage lung adenocarcinomas is a matter of debate. We aimed to clarify the existing evidence through a single-center, retrospective cohort study and to quantitatively summarize the body of literature by conducting a meta-analysis. METHODS: In a retrospective cohort study, patients with clinical stage I lung adenocarcinoma were identified, and the prognostic value of ground-glass opacity was analyzed using multivariable Cox regression. Commercial artificial intelligence software was adopted as the second reader for the presence of ground-glass opacity. The primary end points were freedom from recurrence (FFR) and lung cancer-specific survival (LCSS). In a meta-analysis, we systematically searched Embase and OVID-MEDLINE up to December 30, 2021, for the studies based on the eighth-edition staging system. The pooled hazard ratios (HRs) of solid nodules (i.e., absence of ground-glass opacity) for various end points were calculated with a multi-level random effects model. RESULTS: In a cohort of 612 patients, solid nodules were associated with worse outcomes for FFR (adjusted HR, 1.98; 95% CI: 1.17-3.51; p = 0.01) and LCSS (adjusted HR, 1.937; 95% CI: 1.002-4.065; p = 0.049). The artificial intelligence assessment and multiple sensitivity analyses revealed consistent results. The meta-analysis included 13 studies with 12,080 patients. The pooled HR of solid nodules was 2.13 (95% CI: 1.69-2.67; I2 = 30.4%) for overall survival, 2.45 (95% CI: 1.52-3.95; I2 = 0.0%) for FFR, and 2.50 (95% CI: 1.28-4.91; I2 = 30.6%) for recurrence-free survival. CONCLUSIONS: The absence of ground-glass opacity in early-stage lung adenocarcinomas is associated with worse postoperative survival. CLINICAL RELEVANCE STATEMENT: Early-stage lung adenocarcinomas manifesting as solid nodules at preoperative chest CT, which indicates the absence of ground-glass opacity, were associated with poor postoperative survival. There is room for improvement of the clinical T categorization in the next edition staging system. KEY POINTS: • In a retrospective study of 612 patients with stage I lung adenocarcinoma, solid nodules were associated with shorter freedom from recurrence (adjusted hazard ratio [HR], 1.98; p = 0.01) and lung cancer-specific survival (adjusted HR, 1.937; p = 0.049). • Artificial intelligence-assessed solid nodules also showed worse prognosis (adjusted HR for freedom from recurrence, 1.94 [p = 0.01]; adjusted HR for lung cancer-specific survival, 1.93 [p = 0.04]). • In meta-analyses, the solid nodules were associated with shorter freedom from recurrence (HR, 2.45) and shorter overall survival (HR, 2.13).

Effects of Fasting versus Non-Fasting on Emetic Complications in Radiological Examinations Using Intravascular Non-Ionic Iodinated Contrast Media: A Systematic Review and Meta-Analysis.

OBJECTIVE: To compare the incidence of aspiration pneumonia, nausea, and vomiting after intravascular administration of non-ionic iodinated contrast media (ICM) between patients who fasted before contrast injection and those who did not. MATERIALS AND METHODS: Ovid-MEDLINE and Embase databases were searched from their inception dates until September 2022 to identify original articles that met the following criteria: 1) randomized controlled trials or observational studies, 2) separate reports of the incidence of aspiration pneumonia, nausea, and vomiting after intravascular injection of non-ionic ICM, and 3) inclusion of patients undergoing radiological examinations without fasting. A bivariate beta-binomial model was used to compare the risk difference in adverse events between fasting and non-fasting groups. The I² statistic was used to assess heterogeneity across the studies. RESULTS: Ten studies, encompassing 308013 patients (non-fasting, 158442), were included in this meta-analysis. No cases of aspiration pneumonia were reported. The pooled incidence of nausea was 4.6% (95% confidence interval [CI]: 1.4%, 7.8%) in the fasting group and 4.6% (95% CI: 1.1%, 8.1%) in the non-fasting group. The pooled incidence of vomiting was 2.1% (95% CI: 0.0%, 4.2%) in the fasting group and 2.5% (95% CI: 0.7%, 4.2%) in the non-fasting group. The risk difference (incidence in the non-fasting group-incidence in the fasting group) in the incidence of nausea and vomiting was 0.0% (95% CI: -4.7%, 4.7%) and 0.4% (95% CI: -2.3%, 3.1%), respectively. Heterogeneity between the studies was low (I² = 0%-13.5%). CONCLUSION: Lack of fasting before intravascular administration of non-ionic ICM for radiological examinations did not increase the risk of emetic complications significantly. This finding suggests that hospitals can relax fasting policies without compromising patient safety.

Effect of Human-AI Interaction on Detection of Malignant Lung Nodules on Chest Radiographs.

Background The factors affecting radiologists' diagnostic determinations in artificial intelligence (AI)-assisted image reading remain underexplored. Purpose To assess how AI diagnostic performance and reader characteristics influence detection of malignant lung nodules during AI-assisted reading of chest radiographs. Materials and Methods This retrospective study consisted of two reading sessions from April 2021 to June 2021. Based on the first session without AI assistance, 30 readers were assigned into two groups with equivalent areas under the free-response receiver operating characteristic curve (AUFROCs). In the second session, each group reinterpreted radiographs assisted by either a high or low accuracy AI model (blinded to the fact that two different AI models were used). Reader performance for detecting lung cancer and reader susceptibility (changing the original reading following the AI suggestion) were compared. A generalized linear mixed model was used to identify the factors influencing AI-assisted detection performance, including readers' attitudes and experiences of AI and Grit score. Results Of the 120 chest radiographs assessed, 60 were obtained in patients with lung cancer (mean age, 67 years ± 12 [SD]; 32 male; 63 cancers) and 60 in controls (mean age, 67 years ± 12; 36 male). Readers included 20 thoracic radiologists (5-18 years of experience) and 10 radiology residents (2-3 years of experience). Use of the high accuracy AI model improved readers' detection performance to a greater extent than use of the low accuracy AI model (area under the receiver operating characteristic curve, 0.77 to 0.82 vs 0.75 to 0.75; AUFROC, 0.71 to 0.79 vs 0.7 to 0.72). Readers who used the high accuracy AI showed a higher susceptibility (67%, 224 of 334 cases) to changing their diagnosis based on the AI suggestions than those using the low accuracy AI (59%, 229 of 386 cases). Accurate readings at the first session, correct AI suggestions, high accuracy Al, and diagnostic difficulty were associated with accurate AI-assisted readings, but readers' characteristics were not. Conclusion An AI model with high diagnostic accuracy led to improved performance of radiologists in detecting lung cancer on chest radiographs and increased radiologists' susceptibility to AI suggestions. © RSNA, 2023 Supplemental material is available for this article.

Diagnostic performance of standardized typical CT findings for COVID-19: a systematic review and meta-analysis.

OBJECTIVE: To meta-analyze diagnostic performance measures of standardized typical CT findings for COVID-19 and examine these measures by region and national income. METHODS: MEDLINE and Embase were searched from January 2020 to April 2022 for diagnostic studies using the Radiological Society of North America (RSNA) classification or the COVID-19 Reporting and Data System (CO-RADS) for COVID-19. Patient and study characteristics were extracted. We pooled the diagnostic performance of typical CT findings in the RSNA and CO-RADS systems and interobserver agreement. Meta-regression was performed to examine the effect of potential explanatory factors on the diagnostic performance of the typical CT findings. RESULTS: We included 42 diagnostic performance studies with 6777 PCR-positive and 9955 PCR-negative patients from 18 developing and 24 developed countries covering the Americas, Europe, Asia, and Africa. The pooled sensitivity was 70% (95% confidence interval [CI]: 65%, 74%; I2 = 92%), and the pooled specificity was 90% (95% CI 86%, 93%; I2 = 94%) for the typical CT findings of COVID-19. The sensitivity and specificity of the typical CT findings did not differ significantly by national income and the region of the study (p > 0.1, respectively). The pooled interobserver agreement from 19 studies was 0.72 (95% CI 0.63, 0.81; I2 = 99%) for the typical CT findings and 0.67 (95% CI 0.61, 0.74; I2 = 99%) for the overall CT classifications. CONCLUSION: The standardized typical CT findings for COVID-19 provided moderate sensitivity and high specificity globally, regardless of region and national income, and were highly reproducible between radiologists. CRITICAL RELEVANCE STATEMENT: Standardized typical CT findings for COVID-19 provided a reproducible high diagnostic accuracy globally. KEY POINTS: Standardized typical CT findings for COVID-19 provide high sensitivity and specificity. Typical CT findings show high diagnosability regardless of region or income. The interobserver agreement for typical findings of COVID-19 is substantial.

Impact of Enhanced in-Hospital Infection Prevention During the COVID-19 Pandemic on Postoperative Pneumonia in Older Surgical Patients.

Purpose: We aimed to investigate the impact of enhanced in-hospital infection prevention during the coronavirus disease 2019 (COVID-19) pandemic on postoperative pneumonia in older surgical patients. Patients and Methods: We retrospectively reviewed the electronic medical records of consecutive patients ≥70 years who underwent elective surgery between 2017 and 2021 at our institution. All perioperative variables were retrieved from the electronic medical records. The primary outcome was new-onset postoperative pneumonia during the hospitalization period. Since February 2020, our institution implemented a series of policies to enhance infection prevention, hence patients were divided into groups according to whether they underwent surgery before or during the COVID-19 pandemic. An interrupted time series analysis was performed to evaluate the difference between pre- and post-intervention slopes of the primary outcome. Results: Among the 29,387 patients included in the study, 10,547 patients underwent surgery during the COVID-19 pandemic. Although there was a decreasing trend of the monthly incidence rate of postoperative pneumonia compared to before the COVID-19 pandemic, there was no statistical significance in the trend (slope before COVID-19 period: ß-coefficient, -0.007; 95% CI, -0.022 to 0.007). Conclusion: Our study revealed that enhanced in-hospital infection prevention implemented to manage the COVID-19 pandemic did not significantly affect the decreasing trend of postoperative pneumonia at our institution.

CT analysis of thoracolumbar body composition for estimating whole-body composition.

BACKGROUND: To evaluate the correlation between single- and multi-slice cross-sectional thoracolumbar and whole-body compositions. METHODS: We retrospectively included patients who underwent whole-body PET-CT scans from January 2016 to December 2019 at multiple institutions. A priori-developed, deep learning-based commercially available 3D U-Net segmentation provided whole-body 3D reference volumes and 2D areas of muscle, visceral fat, and subcutaneous fat at the upper, middle, and lower endplate of the individual T1-L5 vertebrae. In the derivation set, we analyzed the Pearson correlation coefficients of single-slice and multi-slice averaged 2D areas (waist and T12-L1) with the reference values. We then built prediction models using the top three correlated levels and tested the models in the validation set. RESULTS: The derivation and validation datasets included 203 (mean age 58.2 years; 101 men) and 239 patients (mean age 57.8 years; 80 men). The coefficients were distributed bimodally, with the first peak at T4 (coefficient, 0.78) and the second peak at L2-3 (coefficient 0.90). The top three correlations in the abdominal scan range were found for multi-slice waist averaging (0.92) and single-slice L3 and L2 (0.90, each), while those in the chest scan range were multi-slice T12-L1 averaging (0.89), single-slice L1 (0.89), and T12 (0.86). The model performance at the top three levels for estimating whole-body composition was similar in the derivation and validation datasets. CONCLUSIONS: Single-slice L2-3 (abdominal CT range) and L1 (chest CT range) analysis best correlated with whole-body composition around 0.90 (coefficient). Multi-slice waist averaging provided a slightly higher correlation of 0.92.

A Critical Systematic Review for Inhaled Corticosteroids on Lung Cancer Incidence: Not Yet Concluded Story.

BACKGROUND: To systematically review studies on inhaled corticosteroids (ICS) and lung cancer incidence in chronic airway disease patients. METHODS: We conducted electronic bibliographic searches on OVID-MEDLINE, EM- BASE, and the Cochrane Database before May 2020 to identify relevant studies. Detailed data on the study population, exposure, and outcome domains were reviewed. RESULTS: Of 4,058 screened publications, 13 eligible studies in adults with chronic obstructive pulmonary disease (COPD) or asthma evaluated lung cancer incidence after ICS exposure. Pooled hazard ratio and odds ratio for developing lung cancer in ICS exposure were 0.81 (95% confidence interval, 0.64 to 1.02; I2=95.7%) from 10 studies and 1.02 (95% confidence interval 0.50 to 2.07; I2=94.7%) from three studies. Meta-regression failed to explain the substantial heterogeneity of pooled estimates. COPD and asthma were variously defined without spirometry in 11 studies. Regarding exposure assessment, three and 10 studies regarded ICS exposure as a time-dependent and fixed variable, respectively. Some studies assessed ICS use for the entire study period, whereas others assessed ICS use for 6 months to 2 years within or before study entry. Smoking was adjusted in four studies, and only four studies introduced 1 to 2 latency years in their main or subgroup analysis. CONCLUSION: Studies published to date on ICS and lung cancer incidence had heterogeneous study populations, exposures, and outcome assessments, limiting the generation of a pooled conclusion. The beneficial effect of ICS on lung cancer incidence has not yet been established, and understanding the heterogeneities will help future researchers to establish robust evidence on ICS and lung cancer incidence.

Deep Learning for Estimating Lung Capacity on Chest Radiographs Predicts Survival in Idiopathic Pulmonary Fibrosis.

Background Total lung capacity (TLC) has been estimated with use of chest radiographs based on time-consuming methods, such as planimetric techniques and manual measurements. Purpose To develop a deep learning-based, multidimensional model capable of estimating TLC from chest radiographs and demographic variables and validate its technical performance and clinical utility with use of multicenter retrospective data sets. Materials and Methods A deep learning model was pretrained with use of 50 000 consecutive chest CT scans performed between January 2015 and June 2017. The model was fine-tuned on 3523 pairs of posteroanterior chest radiographs and plethysmographic TLC measurements from consecutive patients who underwent pulmonary function testing on the same day. The model was tested with multicenter retrospective data sets from two tertiary care centers and one community hospital, including (a) an external test set 1 (n = 207) and external test set 2 (n = 216) for technical performance and (b) patients with idiopathic pulmonary fibrosis (n = 217) for clinical utility. Technical performance was evaluated with use of various agreement measures, and clinical utility was assessed in terms of the prognostic value for overall survival with use of multivariable Cox regression. Results The mean absolute difference and within-subject SD between observed and estimated TLC were 0.69 L and 0.73 L, respectively, in the external test set 1 (161 men; median age, 70 years [IQR: 61-76 years]) and 0.52 L and 0.53 L in the external test set 2 (113 men; median age, 63 years [IQR: 51-70 years]). In patients with idiopathic pulmonary fibrosis (145 men; median age, 67 years [IQR: 61-73 years]), greater estimated TLC percentage was associated with lower mortality risk (adjusted hazard ratio, 0.97 per percent; 95% CI: 0.95, 0.98; P < .001). Conclusion A fully automatic, deep learning-based model estimated total lung capacity from chest radiographs, and the model predicted survival in idiopathic pulmonary fibrosis. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Sorkness in this issue.

Low-contrast-dose liver CT using low monoenergetic images with deep learning-based denoising for assessing hepatocellular carcinoma: a randomized controlled noninferiority trial.

OBJECTIVE: Low monoenergetic images obtained using noise-reduction techniques may reduce CT contrast media requirements. We aimed to investigate the effectiveness of low-contrast-dose CT using dual-energy CT and deep learning-based denoising (DLD) techniques in patients at high risk of hepatocellular carcinoma (HCC). METHODS: We performed a prospective, randomized controlled noninferiority trial at a tertiary hospital between June 2019 and August 2020 (NCT04027556). Patients at high risk of HCC were randomly assigned (1:1) to the standard-contrast-dose group or low-contrast-dose group, which targeted a 40% reduction in contrast medium dose based on lean body weight. HCC conspicuity on arterial phase images was the primary endpoint with a noninferiority margin of 0.2. Images were independently assessed by three radiologists; model-based iterative reconstruction (MBIR) images of the standard-contrast-dose group and low monoenergetic (50-keV) DLD images of the low-contrast-dose group were compared using a generalized estimating equation. RESULTS: Ninety participants (age 59 ± 10 years; 68 men) were analyzed. Compared with the standard-contrast-dose group (n = 47), 40% less contrast media was used in the low-contrast-dose group (n = 43) (107.0 ± 17.1 mL vs. 64.5 ± 11.3 mL, p < 0.001). In the arterial phase, HCC conspicuity on 50-keV DLD images in the low-contrast-dose group was noninferior to that of MBIR images in the standard-contrast-dose group (2.92 vs. 2.56; difference, 0.36; 95% confidence interval, -0.13 to ∞; p = 0.013). CONCLUSIONS: The contrast dose in liver CT can be reduced by 40% without impairing HCC conspicuity when using 50-keV and DLD techniques. KEY POINTS: • In the arterial phase, hepatocellular carcinoma conspicuity on 50-keV deep learning-based denoising images in the low-contrast-dose group was noninferior to that of model-based iterative reconstruction images in the standard-contrast-dose group. • HCC detection was comparable between 50-keV deep learning-based denoising images in the low-contrast-dose group and model-based iterative reconstruction images in the standard-contrast-dose group.

Abbreviated Screening MRI for Women with a History of Breast Cancer: Comparison with Full-Protocol Breast MRI.

Background Few studies have compared abbreviated breast MRI with full-protocol MRI in women with a personal history of breast cancer (PHBC), and they have not adjusted for confounding variables. Purpose To compare abbreviated breast MRI with full-protocol MRI in women with PHBC by using propensity score matching to adjust for confounding variables. Materials and Methods In this single-center retrospective study, women with PHBC who underwent full-protocol MRI (January 2008-August 2017) or abbreviated MRI (September 2017-April 2019) were identified. With use of a propensity score-matched cohort, screening performances were compared between the two MRI groups with the McNemar test or a propensity score-adjusted generalized estimating equation. The coprimary analyses were sensitivity and specificity. The secondary analyses were the cancer detection rate, interval cancer rate, positive predictive value for biopsies performed (PPV3), and Breast Imaging Reporting and Data System (BI-RADS) category 3 short-term follow-up rate. Results There were 726 women allocated to each MRI group (mean age ± SD, 50 years ± 8 for both groups). Abbreviated MRI and full-protocol MRI showed comparable sensitivity (15 of 15 cancers [100%; 95% CI: 78, 100] vs nine of 13 cancers [69%; 95% CI: 39, 91], respectively; P = .17). Abbreviated MRI showed higher specificity than full-protocol MRI (660 of 711 examinations [93%; 95% CI: 91, 95] vs 612 of 713 examinations [86%; 95% CI: 83, 88], respectively; P < .001). The cancer detection rate (21 vs 12 per 1000 examinations), interval cancer rate (0 vs five per 1000 examinations), and PPV3 (61% [14 of 23 examinations] vs 41% [nine of 22 examinations]) were comparable (all P < .05). The BI-RADS category 3 short-term follow-up rate of abbreviated MRI was less than half that of full-protocol MRI (5% [36 of 726 examinations] vs 12% [84 of 726 examinations], respectively; P < .001). Ninety-three percent (14 of 15) of cancers detected at abbreviated MRI were node-negative T1-invasive cancers (n = 6) or ductal carcinoma in situ (n = 8). Conclusion Abbreviated breast MRI showed comparable sensitivity and superior specificity to full-protocol MRI in breast cancer detection in women with a personal history of breast cancer. © RSNA, 2022 Online supplemental material is available for this article.

Deep learning-based fully automated body composition analysis of thigh CT: comparison with DXA measurement.

OBJECTIVES: To compare volumetric CT with DL-based fully automated segmentation and dual-energy X-ray absorptiometry (DXA) in the measurement of thigh tissue composition. METHODS: This prospective study was performed from January 2019 to December 2020. The participants underwent DXA to determine the body composition of the whole body and thigh. CT was performed in the thigh region; the images were automatically segmented into three muscle groups and adipose tissue by custom-developed DL-based automated segmentation software. Subsequently, the program reported the tissue composition of the thigh. The correlation and agreement between variables measured by DXA and CT were assessed. Then, CT thigh tissue volume prediction equations based on DXA-derived thigh tissue mass were developed using a general linear model. RESULTS: In total, 100 patients (mean age, 44.9 years; 60 women) were evaluated. There was a strong correlation between the CT and DXA measurements (R = 0.813~0.98, p < 0.001). There was no significant difference in total soft tissue mass between DXA and CT measurement (p = 0.183). However, DXA overestimated thigh lean (muscle) mass and underestimated thigh total fat mass (p < 0.001). The DXA-derived lean mass was an average of 10% higher than the CT-derived lean mass and 47% higher than the CT-derived lean muscle mass. The DXA-derived total fat mass was approximately 20% lower than the CT-derived total fat mass. The predicted CT tissue volume using DXA-derived data was highly correlated with actual CT-measured tissue volume in the validation group (R2 = 0.96~0.97, p < 0.001). CONCLUSIONS: Volumetric CT measurements with DL-based fully automated segmentation are a rapid and more accurate method for measuring thigh tissue composition. KEY POINTS: • There was a positive correlation between CT and DXA measurements in both the whole body and thigh. • DXA overestimated thigh lean mass by 10%, lean muscle mass by 47%, but underestimated total fat mass by 20% compared to the CT method. • The equations for predicting CT volume (cm3) were developed using DXA data (g), age, height (cm), and body weight (kg) and good model performance was proven in the validation study.

No Prognostic Impact of Staging Brain MRI in Patients with Stage IA Non-Small Cell Lung Cancer.

Background Although various guidelines discourage performing brain MRI for staging purposes in asymptomatic patients with clinical stage IA non-small cell lung cancer (NSCLC), evidence regarding their postoperative survival is lacking. Purpose To investigate the survival benefit of performing brain MRI in asymptomatic patients with early-stage NSCLC. Materials and Methods Patients who underwent curative resection between February 2009 and March 2016 for clinical TNM stage T1N0M0 NSCLC were retrospectively included. Patient survival and development of brain metastasis during postoperative surveillance were documented. The cumulative survival rate and incidence of brain metastasis were compared between patients who underwent surgery with or without staging brain MRI by using Cox regression and a Fine-Gray subdistribution hazard model, respectively, for multivariable adjustment. Propensity score matching and inverse probability of treatment weighting were applied for confounder adjustment. Results A total of 628 patients (mean age, 64 years ± 10 [SD]; 319 men) were included, of whom 53% (331 of 628) underwent staging brain MRI. In the multivariable analyses, brain MRI did not show prognostic benefits for brain metastasis-free survival (hazard ratio [HR], 1.06; 95% CI: 0.69, 1.63; P = .79), time to brain metastasis (HR, 1.60; 95% CI: 0.70, 3.94; P = .29), and overall survival (HR, 0.86; 95% CI, 0.54, 1.37; P = .54). Consistent results were obtained after propensity score matching (brain metastasis-free survival [HR, 0.97; 95% CI: 0.60, 1.57; P = .91], time to brain metastasis [HR, 1.29; 95% CI: 0.50, 3.33; P = .60], and overall survival [HR, 0.89; 95% CI: 0.53, 1.51; P = .67]) and inverse probability of treatment weighting. Conclusion No difference was observed between asymptomatic patients with clinical stage IA non-small cell lung cancer who underwent staging brain MRI and those who did not in terms of brain metastasis-free survival, time to brain metastasis, and overall survival. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Bizzi and Pascuzzo in this issue.

Performance of the ACEF and ACEF II risk scores in predicting mortality after off-pump coronary artery bypass grafting.

STUDY OBJECTIVE: The age, creatinine, and ejection fraction (ACEF) I and II scores are known to predict operative mortality after cardiac surgery. However, data from few cases of off-pump coronary artery bypass grafting (OPCAB) were considered during the development of these scores. This study aimed to validate and update the ACEF I and II scores for the prediction of in-hospital mortality after OPCAB. DESIGN: Single-center retrospective observational study. SETTING: Tertiary university hospital. PATIENTS: All adult patients (≥18 years) who underwent isolated OPCAB between 2011 and 2020 were included in our analysis. MEASUREMENTS: Predicted in-hospital mortality after OPCAB was calculated using ACEF and ACEF II scores. Performance of ACEF I and II scores in predicting in-hospital mortality after OPCAB was evaluated using receiver operating characteristics curves and calibration plots. Scores were recalibrated and modified using the closed testing procedure and multivariable fractional polynomial analysis. MAIN RESULTS: In total, 1450 patients were analyzed. The ACEF I and II scores discriminated in-hospital mortality with the c-statistics of 0.86 and 0.83, respectively. The calibration plots revealed that both scores overestimated the risk of in-hospital mortality. The ACEF I score was recalibrated by re-estimating only the model intercept. The ACEF II score was modified by substituting hematocrit with left main coronary artery disease. The c-statistic of the updated ACEF II score increased to 0.86. Both the updated ACEF I and II scores were well-calibrated. CONCLUSIONS: The ACEF I and II scores discriminated in-hospital mortality after OPCAB with excellent accuracy, although calibration properties were suboptimal. The updated scores showed even better discrimination and calibration. Thus, the ACEF I and ACEF II scores can be relatively straightforward and useful tools for prognostication of patients undergoing OPCAB.

Percutaneous transthoracic catheter drainage for lung abscess: a systematic review and meta-analysis.

OBJECTIVES: To evaluate the outcomes of patients receiving image-guided percutaneous catheter drainage (PCD) for lung abscesses in terms of treatment success, major complications, and mortality as well as the predictors of those outcomes. METHODS: Embase and OVID-MEDLINE databases were searched to identify studies on lung abscesses treated with PCD that had extractable outcomes. The outcomes were pooled using a random-intercept logistic regression model. Multivariate Firth's bias-reduced penalised-likelihood logistic regression analyses were performed to identify predictors of treatment success and complications. Methodological quality was assessed by summing scores of binary responses to items regarding selection, ascertainment of exposure and outcome, causality of follow-up duration, and reporting. RESULTS: From 26 studies with acceptable methodological quality (median score, 4; range, 3-5), 194 patients were included. The pooled rates of treatment success and major complications were 86.5% (95% confidence interval [CI], 78.5-91.8%; I2 = 23%) and 8.1% (95% CI, 4.1-15.3%; I2 = 26%), respectively. Four patients eventually died from uncontrolled lung abscesses (pooled rate, 1.5%; 95% CI, 0.2-11.1%; I2 = 36%). Malignancy-related abscess (odds ratio [OR], 0.129; 95% CI, 0.024-0.724; p = .022) and the occurrence of a major complication (OR, 0.065; 95% CI, 0.02-0.193; p < .001) were significant predictors of treatment failure. Traversing normal lung parenchyma was the only significant risk factor for major complications (OR, 27.69; 95% CI, 7.196-123.603; p < .001). CONCLUSION: PCD under imaging guidance was effective for lung abscess treatment, with a low complication rate. Traversal of normal lung parenchyma was the sole risk factor for complications, and malignancy-related abscesses and the occurrence of major complications were predictors of treatment failure. KEY POINTS: • The pooled treatment success rate of PCD for lung abscess was reasonably high (86.5%); malignancy-related abscesses and the occurrence of a major complication were predictors of treatment failure. • The pooled rate of percutaneous transthoracic catheter drainage-related major complications was 8.1% and traversing normal lung parenchyma by the catheter was the only risk factor. • The pooled mortality rate from uncontrolled lung abscesses with percutaneous transthoracic catheter drainage was low.

Tissue Adequacy and Safety of Percutaneous Transthoracic Needle Biopsy for Molecular Analysis in Non-Small Cell Lung Cancer: A Systematic Review and Meta-analysis.

OBJECTIVE: We conducted a systematic review and meta-analysis of the tissue adequacy and complication rates of percutaneous transthoracic needle biopsy (PTNB) for molecular analysis in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: We performed a literature search of the OVID-MEDLINE and Embase databases to identify original studies on the tissue adequacy and complication rates of PTNB for molecular analysis in patients with NSCLC published between January 2005 and January 2020. Inverse variance and random-effects models were used to evaluate and acquire meta-analytic estimates of the outcomes. To explore heterogeneity across the studies, univariable and multivariable meta-regression analyses were performed. RESULTS: A total of 21 studies with 2232 biopsies (initial biopsy, 8 studies; rebiopsy after therapy, 13 studies) were included. The pooled rates of tissue adequacy and complications were 89.3% (95% confidence interval [CI]: 85.6%-92.6%; I² = 0.81) and 17.3% (95% CI: 12.1%-23.1%; I² = 0.89), respectively. These rates were 93.5% and 22.2% for the initial biopsies and 86.2% and 16.8% for the rebiopsies, respectively. Severe complications, including pneumothorax requiring chest tube placement and massive hemoptysis, occurred in 0.7% of the cases (95% CI: 0%-2.2%; I² = 0.67). Multivariable meta-regression analysis showed that the tissue adequacy rate was not significantly lower in studies on rebiopsies (p = 0.058). The complication rate was significantly higher in studies that preferentially included older adults (p = 0.001). CONCLUSION: PTNB demonstrated an average tissue adequacy rate of 89.3% for molecular analysis in patients with NSCLC, with a complication rate of 17.3%. PTNB is a generally safe and effective diagnostic procedure for obtaining tissue samples for molecular analysis in NSCLC. Rebiopsy may be performed actively with an acceptable risk of complications if clinically required.

Nursing staff factors influencing pain management in the emergency department: Both quantity and quality matter.

BACKGROUND: Abdominal pain is one of the most common symptoms for presentation to the emergency department (ED). However, administration of analgesics is often delayed and pain reassessment is often missed. We investigated the effect of several nursing staff factors on the time to administer analgesics and pain reassessment in ED. METHOD: This retrospective descriptive study was conducted in a tertiary hospital in Korea. The subjects were adult patients who visited the ED for abdominal pain and received analgesics in 2019. Nursing staff factors were defined as the nurse-to-patient ratio and the nurse's experience in the ED. Reassessment was classified into three groups: non-reassessment, reassessment in ≤ 1 h, and reassessment in ≥ 1 h. Patient characteristics and the analgesics' name were collected. The effect of nursing staff factors on the administration time was analyzed using a linear mixture model, and the differences in the nurse, and patient characteristics in the three reassessment groups were evaluated using generalized estimating equations. RESULTS: A total of 1428 cases were included, 54.1% of which received opioids. The median time from prescription to administration (TTA) was 16 min, and pain reassessment was conducted in 55.0%. TTA tended to increase as the nurse-to-patient ratio increased. Nurses in the two reassessment groups had more experience than those in the non-assessment group. CONCLUSION: Both the nurse-to-patient ratio and experience in the ED had a significant impact on pain management. Therefore, appropriate ED nurse staffing levels considering the unpredictable and fluctuating number of patients, and nurse retention strategies are needed.

A systematic review and meta-analysis of regional risk factors for critical outcomes of COVID-19 during early phase of the pandemic.

The mortality rates of COVID-19 vary across the globe. While some risk factors for poor prognosis of the disease are known, regional differences are suspected. We reviewed the risk factors for critical outcomes of COVID-19 according to the location of the infected patients, from various literature databases from January 1 through June 8, 2020. Candidate variables to predict the outcome included patient demographics, underlying medical conditions, symptoms, and laboratory findings. The risk factors in the overall population included sex, age, and all inspected underlying medical conditions. Symptoms of dyspnea, anorexia, dizziness, fatigue, and certain laboratory findings were also indicators of the critical outcome. Underlying respiratory disease was associated higher risk of the critical outcome in studies from Asia and Europe, but not North America. Underlying hepatic disease was associated with a higher risk of the critical outcome from Europe, but not from Asia and North America. Symptoms of vomiting, anorexia, dizziness, and fatigue were significantly associated with the critical outcome in studies from Asia, but not from Europe and North America. Hemoglobin and platelet count affected patients differently in Asia compared to those in Europe and North America. Such regional discrepancies should be considered when treating patients with COVID-19.

Pleural recurrence after transthoracic needle lung biopsy in stage I lung cancer: a systematic review and individual patient-level meta-analysis.

INTRODUCTION: Conflicting results exist regarding whether preoperative transthoracic biopsy increases the risk of pleural recurrence in early lung cancer. We conducted a systematic, patient-level meta-analysis to evaluate the risk of pleural recurrence in stage I lung cancer after percutaneous transthoracic lung biopsy. METHODS: A systematic search of OVID-MEDLINE, Embase and the Cochrane Database of Systematic Reviews was performed through October 2018. Eligible studies were original articles on the risk of pleural recurrence in stage I lung cancer after transthoracic biopsy. We contacted the corresponding authors of eligible studies to obtain individual patient-level data. We used the Fine-Gray model for time to recurrence and lung cancer-specific survival and a Cox proportional hazards model for overall survival. RESULTS: We analysed 2394 individual patient data from 6 out of 10 eligible studies. Compared with other diagnostic procedures, transthoracic biopsy was associated with a higher risk for ipsilateral pleural recurrence, which manifested solely (subdistribution HR (sHR), 2.58; 95% CI 1.15 to 5.78) and concomitantly with other metastases (sHR 1.99; 95% CI 1.14 to 3.48). In the analysis of secondary outcomes considering a significant interaction between diagnostic procedures and age groups, reductions of time to recurrence (sHR, 2.01; 95% CI 1.11 to 3.64), lung cancer-specific survival (sHR 2.53; 95% CI 1.06 to 6.05) and overall survival (HR 2.08; 95% CI 1.12 to 3.87) were observed in patients younger than 55 years, whereas such associations were not observed in other age groups. DISCUSSION: Preoperative transthoracic lung biopsy was associated with increased pleural recurrence in stage I lung cancer and reduced survival in patients younger than 55 years.