Short-Course Versus Prolonged-Course Antimicrobial Therapy in Adults With Catheter-Related Septic Thrombosis: A Propensity-Weighted Retrospective Study.

Background: Optimal duration of antimicrobial therapy (AT) for catheter-related septic deep venous thrombosis (DVT) is unknown. We aimed to compare the outcomes of patients receiving short-course AT (≤21 days) versus prolonged-course AT (>21 days). Methods: This was a monocentric retrospective study comparing adults with catheter-related septic DVT from 2015 to 2020 treated with short- or prolonged-course AT. A propensity score-weighted analysis was used to mitigate potential bias. The primary outcome was a composite of all-cause mortality or recurrent bloodstream infection 30 days after AT discontinuation. Results: Of 172 patients with catheter-related septic DVT, 104 were treated with prolonged-course AT and 68 with short-course AT. In the propensity score analysis, we found no significant difference in 30-day all-cause mortality or relapse between the 2 groups (inverse probability of treatment weighted hazard ratio [wHR], 2.16 [95% confidence interval {CI}, .68-6.88]; P = .192). No differences in 90-day all-cause mortality and 90-day relapse were observed between the treatment groups (wHR, 1.01 [95% CI, .49-2.05], P = .987 and 1.13 [95% CI, .08-15.62], P = .928, respectively). Conclusions: A 21-day AT could be an effective and safe option to treat catheter-related septic DVT. Further randomized studies are needed to establish the optimal duration of AT for patients with catheter-related septic DVT.

Fusion imaging for pulmonary artery embolization: impact on fluoroscopy duration and contrast agent exposure.

OBJECTIVES: To assess the impact of fusion imaging guidance on fluoroscopy duration and volume of contrast agent used for pulmonary artery embolization. METHODS: Thirty-four consecutive patients who underwent pulmonary artery embolization for pulmonary arterio-venous malformation (n = 28) or hemoptysis (n = 6) were retrospectively included. In the experimental group (n = 15), patients were treated using fusion imaging with 2D/3D registration. In the control group (n = 19), no fusion imaging has been used. Fluoroscopy duration and amount of contrast used were measured and intergroup comparison was performed. RESULTS: The average volume of contrast agent used for embolization in the fusion group (118.3 ml) was significantly lower than in the control group (285.3 ml) (p < 0.002). The mean fluoroscopy duration was not significantly different between both groups (19.5 min in the fusion group vs 31.4 min in the control group (p = 0.10)). No significant difference was observed regarding the average X-ray exposure (Air Kerma) (p = 0.68 in the univariate analysis). Technical success rate was 100% for both groups. CONCLUSION: Fusion imaging significantly reduces contrast medium volumes needed to perform pulmonary artery embolization. The fluoroscopy duration and the X-ray exposure did not vary significantly. ADVANCES IN KNOWLEDGE: CTA-based fusion imaging using 2D-3D registration is a valuable tool for performing pulmonary artery embolization, helpful for planning and guiding catheterization.Compared to the traditional imaging guidance, fusion imaging reduces the volume of contrast agent used.

Applicability of the Edinburgh CT Criteria for Lobar Intracerebral Hemorrhage Associated with Cerebral Amyloid Angiopathy.

OBJECTIVE: Based on histopathology, Edinburgh diagnostic criteria were proposed to consider a nontraumatic intracerebral lobar hemorrhage (ICH) as related to cerebral amyloid angiopathy (CAA) using the initial computed tomography (CT) scan and the APOE genetic status. We aimed to externally validate the Edinburgh prediction model, excluding the APOE genotyping and based on the modified Boston criteria on the MRI for CAA diagnosis METHODS: We included patients admitted for spontaneous lobar ICH in the emergency department between 2016 and 2019 who underwent noncontrast CT scan and MRI. According to the MRI, patients were classified into the CAA group or into the non-CAA group in the case of other causes of ICH. Two neuroradiologists, blinded to the final retained diagnosis, rated each radiological feature on initial CT scan described in the Edinburgh study on initial CT scan RESULTS: A total of 102 patients were included, of whom 36 were classified in the CAA group, 46 in the non-CAA causes group and 20 of undetermined cause (excluded from the primary analysis). The Edinburgh prediction model, including finger-like projections and subarachnoid extension showed an area under receiver operating characteristic curves (AUC) of 0.760 (95% confidence interval, CI: 0.660-0.859) for the diagnosis of CAA. The AUC reached 0.808 (95% CI: 0.714-0.901) in a new prediction model integrating a third radiologic variable: the ICH cortical involvement. CONCLUSION: Using the Boston MRI criteria as a final assessment, we provided a new external confirmation of the radiological Edinburgh CT criteria, which are directly applicable in acute settings of spontaneous lobar ICH and further proposed an original 3­set model considering finger-like projections, subarachnoid extension, and cortical involvement that may achieve a high discrimination performance.

Abdominopelvic CT-scan in emergency departments for patients with suspected complications of Crohn's disease: a single tertiary center experience.

BACKGROUND: Crohn's disease (CD) is a chronic disorder with frequent complications. The objective of this study was to assess the predictive factors of finding a complication of CD using abdominopelvic CT-scan in patients with a visit to the emergency department. METHODS: Patients with at least one visit to the gastroenterology department of our University hospital during the year with a CD were retrospectively included. All visits to the emergency department of the hospital during the follow-up of these patients were identified. RESULTS: A total of 638 patients were included and 318 (49.8%) had at least one visit to the emergency department since the beginning of their follow-up. Abdominopelvic CT-scan was performed in 141 (23.7%) of the 595 visits for digestive symptoms. Only 4.3% of these CT-scans were considered as normal; there was luminal inflammation without complication in 24.8%, abscess, fistula or perforation in 22.7%, mechanical bowel obstruction in 36.9% and diagnosis unrelated to CD in 11.3%. In univariate analysis, stricturing phenotype (OR, 2.48; 95% CI, 1.16-5.29; p = 0.02) and previous surgery (OR, 2.90; 95% CI, 1.37-6.14; p = 0.005) were predictive factors of finding a complication of CD using abdominopelvic CT-scan, whereas no independent predictive factor was statistically significant in multivariate analysis. CONCLUSION: In CD patients consulting in emergency department, CT-scan examination was performed in 24% of visits for digestive symptoms and complications of CD were found in 60%. Complications were more frequent in patients with stricturing phenotype and previous surgery.

Magnetic resonance imaging assessment of body composition parameters in Crohn's disease.

BACKGROUND: Body composition, currently evaluated by computed tomography scan, is related to poor evolution and severity of Crohn's disease (CD). Few MRI studies have been performed, yet it is the most commonly used imaging modality for the surveillance of the disease. AIM: Evaluate the feasibility of MRI body composition measurement and compare the variation according to the activity of the disease. METHODS: A cohort of 132 consecutive patients was studied. The visceral adiposity index (VAI), subcutaneous adiposity index (SAI) and skeletal muscle index (SMI) were measured. Patients were divided into 2 groups according to disease activity. Sarcopenic status was defined according to the cut off value (SMI < 38.9 cm2/m2 in women and < 54.4 cm2/m2 in men). RESULTS: MRI measurements of body composition parameters were feasible and reproducible. After adjustment, sarcopenia was more common (2.07 [1.02; 4.27], p = 0.046), and the SMI (-4.90 [-9.36; -0.431], p = 0.032) was lower in active disease. The SAI was lower (-14.7 [-29.8; 0.258], p = 0.054) in active disease. The VAI tended to be higher with active disease (3.91 [-3.50; 11.9], p = 0.34), and the VAI/SAI+VAI ratio was higher (9.40 [4.72; 14.1], p<0.001). CONCLUSION: Assessment of body composition is feasible and reproducible in routine MR and parameters are related to disease activity.

Deep remission on magnetic resonance imaging impacts outcomes of perianal fistulizing Crohn's disease.

BACKGROUND: The long-term management of perianal Crohn's disease for patients on anti-TNF-α therapy remains challenging. AIM: To evaluate the long-term course and complications of patients with perianal fistulas treated with anti-TNF-α based on their clinical remission and healing on MRI. METHODS: Patients were evaluated clinically and by MRI. Deep remission was defined as clinical remission associated with the absence of contrast enhancement and T2 hyperintensity on MRI. Flare-free survival, surgery and hospitalizations were compared based on the presence or not of deep remission. RESULTS: Forty-eight consecutive patients were included with a median follow-up of 62 months after anti-TNF-α first administration. Deep remission was observed in 16 patients (33.4%). For patients in deep remission, the median time to any perianal event was 116 months (95-130) versus 42 months (8-72) in patients with pathological MRI (p < 0.001). Sixteen patients (50%) with pathological MRI had perianal surgery versus 2 (12.5%) in the deep remission group (p < 0.05). The mean duration of cumulative hospital stays was 0.75 ±â€¯0.52 days in the deep remission group versus 19.7 ±â€¯7.4 in the pathological group (p < 0.05). CONCLUSIONS: Higher flare-free survival and lower rates of surgery and hospitalization were found in patients achieving deep remission.