Imaging and Clinical Parameters for Distinction between Infected and Non-Infected Fluid Collections in CT: Prospective Study Using Extended Microbiological Approach.

The aim of this investigation was to evaluate predictive CT imaging features and clinical parameters to distinguish infected from sterile fluid collections. Detection of infectious agents by advanced microbiological analysis was used as the reference standard. From April 2018 to October 2019, all patients undergoing CT-guided drainages were prospectively enrolled, if drainage material volume was at least 5 mL. Univariate analysis revealed attenuation (p = 0.001), entrapped gas (p < 0.001), fat stranding (p < 0.001), wall thickness (p < 0.001) and enhancement (p < 0.001) as imaging biomarkers and procalcitonin (p = 0.003) as clinical predictive parameters for infected fluid collections. On multivariate analysis, attenuation > 10 HU (p = 0.038), presence of entrapped gas (p = 0.027) and wall enhancement (p = 0.028) were independent parameters for distinguishing between infected and non-infected fluids. Gas entrapment had high specificity (93%) but low sensitivity (48%), while wall enhancement had high sensitivity (91%) but low specificity (50%). CT attenuation > 10 HU showed intermediate sensitivity (74%) and specificity (70%). Evaluation of the published proposed scoring systems did not improve diagnostic accuracy over independent predictors in our study. In conclusion, this prospective study confirmed that CT attenuation > 10 HU, entrapped gas and wall enhancement are the key imaging features to distinguish infected from sterile fluid collections on CT.

How to Handle CT-Guided Abscess Drainages in Microbiological Analyses? Sterile Vials vs. Blood Culture Bottles for Transport and Processing.

The aim of this investigation was to compare microbiological analyses of 100 computed tomography-guided drainages from infectious foci (thoracic, abdominal, musculoskeletal), transported and analyzed by two widely established techniques, that are (i) sterile vials or (ii) inoculated blood culture bottles. The mean number of detected microorganisms from blood culture (aerobic/anaerobic) or conventional method (sterile vial, solid and broth media) per specimen were comparable with 1.29 and 1.41, respectively (p = 1.0). The conventional method showed a trend towards shorter time-to-result (median 28.62 h) in comparison to blood culture incubation (median 43.55 h) (p = 0.0722). Of note, detection of anaerobes (13% vs. 36%) and the number of detected microorganisms in polymicrobial infections (2.76 vs. 3.26) differed significantly with an advantage towards conventional techniques (p = 0.0015; p = 0.035), especially in abdominal aspirations. Despite substantially overlapping results from both techniques, the conventional approach includes some benefits which justify its role as standard approach.

Criteria-Based Imaging and Response Evaluation of Lymphoma 20 Years After Cheson: What is New? / Kriterien-basierte Bildgebung und Responsebeurteilung bei Lymphomen 20 Jahre nach Cheson: Was gibt es Neues?

BACKGROUND: The rapid progress in oncology research requires numerous new scientific publications. This article aims to provide an overview of criteria-based imaging and response evaluation of lymphoma according to the current status of knowledge. In fact, common criteria for evaluating data, especially imaging response evaluation, are essential for comparability of studies. While criteria-based classifications of solid tumors have been established for some time, there are now increasing classifications of lymphoma diseases. The purpose of this review is to describe the development of criteria-based evaluation of lymphoma diseases with a special focus on imaging up to current guidelines. METHODS: Literature review based on PubMed including the languages English and German was performed. This review article includes the most important criteria-based response evaluations of lymphoma published between January 1999 and July 2019. RESULTS AND CONCLUSION: The two latest classifications of response evaluation of lymphoma are: The Lugano classification, which has been steadily developed over the past 20 years and has been specially adapted to technical progress, as well as the evaluation method RECIL (Response Evaluation Criteria In Lymphoma), which is based on the RECIST (Response Evaluation Criteria in Solid Tumors) classification already established for solid tumors. Significant imaging components of both classifications are the anatomical measurement and measurement of the metabolic response of the manifestation of lymphoma using positron emission tomography (PET/CT). KEY POINTS: · Standardized criteria-based response evaluations are essential for the objective and comparable analysis of new drugs for the treatment of lymphoma diseases.. · The latest classification RECIL has significantly simplified treatment evaluation and has established a better comparability to the therapeutic evaluation of solid tumors according to RECIST.. · Further studies will show the most appropriate classifications depending on study settings.. CITATION FORMAT: · Skusa C, Weber M, Böttcher S et al. Criteria-Based Imaging and Response Evaluation of Lymphoma 20 Years After Cheson: What is New?. Fortschr Röntgenstr 2020; 192: 657 - 667.