An ultra-low-dose protocol for computed tomography-guided lung radiofrequency ablations.

To evaluate the safety and efficacy of ultra-low-dose (ULD) protocol for computed tomography (CT)-guided lung radiofrequency ablation (RFA). Patients who had undergone lung RFA between November 2017 and January 2021 were consecutively and retrospectively included. Thirty patients were treated using a conventional standard protocol (SP), including helical acquisitions with mA automatic adjustment and sequential CT at 80 kVp; and 31, with a ULD protocol defined with helical acquisitions with fixed mA and sequential series at 100 kVp. These parameters were selected from those used for a diagnostic lung low-dose CT scanner. Patient characteristics, dose indicators, technical efficacy (minimal margin [MM], recurrence during follow-up), and complications (pneumothorax, alveolar haemorrhage, and haemoptysis) were recorded. We included 61 patients (median age, 65 [54-73] and 33 women), with no significant differences according to the type of protocol, except for the type of anaesthesia. Even if the number of helical acquisitions did not significantly change, all dose indicators significantly decreased by 1.5-fold-3-fold. The median dose-length-product and effective dose, with their ranges, respectively, were 465 mGy cm (315-554) and 6.5 mSv (4.4-7.8) in the SP group versus 178 mGy cm (154-267) and 2.5 mSv (2.2-3.7) in the ULD group, (p< 001). The ULD group exhibited lower intraoperator variability and better interoperator alignment than those of the SP group. The MM was not significantly different between the two groups (4.6 mm versus 5 mm,p= 16). One local recurrence was observed in each group at 8 months in the SP and at one year in the ULD group (p= 1). The complication rates did not differ significantly. Implementing an ULD protocol during lung RFA may provide similar efficacy, a reduction of dose indicators, and intra- and interoperator variability, without increasing complication rates, compared to those associated with an SP.

Image-guided Percutaneous Fixation with Internal Cemented Screws of Impending Femoral Neck Pathologic Fractures in Patients with Metastatic Cancer: Safety, Efficacy, and Durability.

Background Prophylactic image-guided procedures performed by interventional radiologists for impending pathologic fractures are becoming more pertinent, as patients with metastatic cancer have extended overall survival because of advanced therapies. Purpose To evaluate the efficacy, safety, and palliative durability of collimated-beam CT-guided percutaneous fixation with internal cemented screws (FICS) for impending pathologic fractures of the femoral neck. Materials and Methods This single-institute retrospective study examined all patients with metastatic cancer treated between February 2010 and October 2019 with collimated-beam CT-guided percutaneous FICS procedures for preventive consolidation of impending femoral neck pathologic fractures. The short-term palliative efficacy was assessed through comparison of visual analog scale (VAS) scores before and 1 month after FICS. A review of cross-section imaging and clinic reports identified any procedural complications. Long-term consolidation efficacy was defined as the absence of any screw dislodgement or development of a pathologic fracture at completion of the study. The Wilcoxon test was used for the mean comparison of paired nonparametric variables. Results Sixty-one consecutive patients (mean age, 59 years ± 11 [standard deviation]; 35 women) underwent preventive FICS for consolidation of impending pathologic femoral neck fracture with a mean follow-up of 533 days ± 689. Two patients died of cancer within the first month. Complications were limited to three self-resolving hematomas. The mean VAS score decreased 1 month after FICS from 4.2 ± 3.2 to 1.8 ± 2.0 (P < .001). The long-term consolidation efficacy was 92% (54 of 59 patients), with three of 59 patients (5%) subsequently developing fractures despite FICS and an additional two of 59 patients (3%) with durable FICS undergoing definitive total hip arthroplasty surgery because of local tumor progression. Conclusion Percutaneous fixation with internal cemented screws as performed by the interventional radiologist is a safe nonsurgical treatment that provides an effective palliative result and durable prevention for impending pathologic fractures of the femoral neck. © RSNA, 2020 Online supplemental material is available for this article.

Evaluation of preventive tract embolization with standardized gelatin sponge slurry on chest tube placement rate after CT-guided lung biopsy: a propensity score analysis.

BACKGROUND: To evaluate the effect of tract embolization (TE) with gelatin sponge slurries during a percutaneous lung biopsy on chest tube placement and to evaluate the predictive factors of chest tube placement. METHODS: Percutaneous CT-guided lung biopsies performed with (TE) or without (non-TE) tract embolization or between June 2012 and December 2021 at three referral tertiary centers were retrospectively analyzed. The exclusion criteria were mediastinal biopsies, pleural tumors, and tumors adjacent to the pleura without pleural crossing. Variables related to patients, tumors, and procedures were collected. Univariable and multivariable analyses were performed to determine risk factors for chest tube placement. Furthermore, the propensity score matching analysis was adopted to yield a matched cohort. RESULTS: A total of 1157 procedures in 1157 patients were analyzed, among which 560 (48.4%) were with TE (mean age 66.5 ± 9.2, 584 men). The rates of pneumothorax (44.9% vs. 26.1%, respectively; p < 0.001) and chest tube placement (4.8% vs. 2.3%, respectively; p < 0.001) were significantly higher in the non-TE group than in the TE group. No non-targeted embolization or systemic air embolism occurred. In the whole population, two protective factors for chest tube placement were found in univariate analysis: TE (OR 0.465 [0.239-0.904], p < 0.05) and prone position (OR 0.212 [0.094-0.482], p < 0.001). These data were confirmed in multivariate analysis (p < 0.001 and p < 0.0001 respectively). In the propensity matched cohort, TE reduces significatively the risk of chest tube insertion (OR = 0.44 [0.21-0.87], p < 0.05). CONCLUSIONS: The TE technique using standardized gelatin sponge slurry reduces the need for chest tube placement after percutaneous CT-guided lung biopsy. CRITICAL RELEVANCE STATEMENT: The tract embolization technique using standardized gelatin sponge slurry reduces the need for chest tube placement after percutaneous CT-guided lung biopsy. KEY POINTS: 1. Use of tract embolization with gelatine sponge slurry during percutaneous lung biopsy is safe. 2. Use of tract embolization significantly reduces the risk of chest tube insertion. 3. This is the first multicenter study to show the protective effect of tract embolization on chest tube insertion.

Efficacy of Tract Embolization After Percutaneous Pulmonary Radiofrequency Ablation.

PURPOSE: To evaluate the efficacy of tract embolization technique using gelatin sponge slurry with iodinated contrast medium (GSSI) to reduce the incidence of pneumothorax and chest tube placement after computed tomography-guided lung radiofrequency ablation (RFA). MATERIALS AND METHODS: In this single-institute retrospective study, we examined all patients with metastatic cancer treated from January 2016 to December 2019 by interventional radiologists with computed tomography-guided lung RFA. Since 2017 in our institution, we have applied a tract embolization technique using GSSI for all RFA. Patients were included into those who underwent lung RFA performed either with GSSI (Group A) or without GSSI (Group B). Univariate and multivariate analyses were performed between the two groups to identify risk factors for pneumothorax and chest tube placement, including patient demographics and lesion characteristics. RESULTS: This study included 116 patients (54 men, 62 women; mean age, 65 ± 11 years) who underwent RFA. Group A comprised 71 patients and Group B comprised 45 patients. Patients who underwent tract embolization had a significantly lower incidence of pneumothorax (Group A, 34% vs. Group B, 62%; p < 0.001) and chest tube insertion (Group A, 10% vs. Group B, 29%; p < 0.01). No embolic complications occurred. The hospitalization stay was significantly shorter in patients who underwent tract embolization (mean, 1.04 ± 0.2 days; p = 0.02). CONCLUSION: Tract embolization after percutaneous lung RFA significantly reduced the rate of post-RFA pneumothorax and chest tube placement and was safer than the standard lung RFA technique.

Utility of a Suture-Mediated Closure System for Large Bore Arterial Access During Challenging Liver Intra-Arterial Catheters Implantation.

PURPOSE: To describe and study the utility of vascular suture-mediated closure systems for large bore arterial access during challenging implantation of liver intra-arterial catheters taking as a reference the conventional procedure involving patients without challenging anatomy. MATERIALS AND METHODS: Between January 2017 and January 2019, 61 consecutive patients underwent 65 intra-arterial catheter IAC implantations for colorectal cancer. Twenty-three procedures (35%) considered by the operators with challenging coeliac trunk angulations were treated using a vascular suture technique where a 6-F introducer was used, the other patients were treated with a conventional 4F access technique. Clinical and radiological characteristics of patients, technical success (implantation of catheters allowing safe infusion of chemotherapy) and complications (Common Terminology Criteria for Adverse Events, CTCAE 5.0) were recorded. RESULTS: Mean coeliac trunk angulations were 36.3° (± 14.3) for the vascular closure group and 49.6° (± 17.1) for the conventional group. Technical success of the procedures was 100% for the vascular closure group and 80% in the conventional group (p < .05). Four patients with technical failure in the conventional group had a successful IAC implantation on the second attempt using the vascular closure technique. The use of a suture-mediated closure system for large bore arterial access allowed more frequent positioning of the distal tip into the gastro duodenal artery (GDA) (p = .01). No major complication occurred. CONCLUSION: The use of a large bore arterial access combined with a suture-mediated closure system may be useful for challenging IAC implantation without major complications.

Prevalence and risk factors for lung involvement on low-dose chest CT (LDCT) in a paucisymptomatic population of 247 patients affected by COVID-19.

BACKGROUND: Low-dose chest CT (LDCT) showed high sensitivity and ability to quantify lung involvement of COVID-19 pneumopathy. The aim of this study was to describe the prevalence and risk factors for lung involvement in 247 patients with a visual score and assess the prevalence of incidental findings. METHODS: For 12 days in March 2020, 250 patients with RT-PCR positive tests and who underwent LDCT were prospectively included. Clinical and imaging findings were recorded. The extent of lung involvement was quantified using a score ranging from 0 to 40. A logistic regression model was used to explore factors associated with a score ≥ 10. RESULTS: A total of 247 patients were analyzed; 138 (54%) showed lung involvement. The mean score was 4.5 ± 6.5, and the mean score for patients with lung involvement was 8.1 ± 6.8 [1-31]. The mean age was 43 ± 15 years, with 121 males (48%) and 17 asymptomatic patients (7%). Multivariate analysis showed that age > 54 years (odds ratio 4.4[2.0-9.6] p < 0.001) and diabetes (4.7[1.0-22.1] p = 0.049) were risk factors for a score ≥ 10. Multivariate analysis including symptoms showed that only age > 54 years (4.1[1.7-10.0] p = 0.002) was a risk factor for a score ≥ 10. Rhinitis (0.3[0.1-0.7] p = 0.005) and anosmia (0.3[0.1-0.9] p = 0.043) were protective against lung involvement. Incidental imaging findings were found in 19% of patients, with a need for follow-up in 0.6%. CONCLUSION: The prevalence of lung involvement was 54% in a predominantly paucisymptomatic population. Age ≥ 55 years and diabetes were risk factors for significant parenchymal lung involvement. Rhinitis and anosmia were protective against LDCT abnormalities.