Does Ipsilateral-Dependent Positioning During Percutaneous Lung Biopsy Decrease the Risk of Pneumothorax?

OBJECTIVE: The purpose of this study is to determine whether placing patients in an ipsilateral-dependent position during percutaneous CT-guided transthoracic biopsy reduces the pneumothorax rate. MATERIALS AND METHODS: Between July 2013 and August 2017, a total of 516 patients (317 men and 199 women; mean age, 66.4 years) underwent core needle biopsies performed using 17- and 18-gauge needles. The overall pneumothorax rate and the rate of pneumothorax requiring drainage catheter insertion were compared between group A (patients placed in an ipsilateral-dependent position) and group B (patients placed in a position other than the ipsilateral-dependent position), with use of a chi-square test or Fisher exact test, as appropriate. Linear regression analysis and multiple regression analysis were performed for risk factors of pneumothorax, including patient characteristics (e.g., emphysema along the needle track), lesion characteristics (e.g., size and position), and biopsy technique characteristics (e.g., needle path length, needle-pleura angle, and fissure crossing). RESULTS: For patients in group A and group B, the overall pneumothorax rate (21/94 [22.3%] and 95/422 [22.5%], respectively; p = 0.97) and the rate of pneumothorax requiring drainage catheter insertion (6/94 [6.4%] and 28/422 [6.6%], respectively; p = 0.90) were not statistically different. After multiple regression analysis, the only independent risk factors for pneumothorax and insertion of a drainage catheter were needle path length (p < 0.001 and p = 0.02, respectively), emphysema along the needle track (p = 0.01 and p < 0.001, respectively), and fissure crossing (p = 0.04 and p < 0.001, respectively). CONCLUSION: Even though the pneumothorax rate does not appear to be reduced, with the limits of a retrospective evaluation considered, other advantages of the ipsilateral decubitus position exist, including protection of the contralateral lung in patients with severe hemoptysis.

AI-driven quantification, staging and outcome prediction of COVID-19 pneumonia.

Coronavirus disease 2019 (COVID-19) emerged in 2019 and disseminated around the world rapidly. Computed tomography (CT) imaging has been proven to be an important tool for screening, disease quantification and staging. The latter is of extreme importance for organizational anticipation (availability of intensive care unit beds, patient management planning) as well as to accelerate drug development through rapid, reproducible and quantified assessment of treatment response. Even if currently there are no specific guidelines for the staging of the patients, CT together with some clinical and biological biomarkers are used. In this study, we collected a multi-center cohort and we investigated the use of medical imaging and artificial intelligence for disease quantification, staging and outcome prediction. Our approach relies on automatic deep learning-based disease quantification using an ensemble of architectures, and a data-driven consensus for the staging and outcome prediction of the patients fusing imaging biomarkers with clinical and biological attributes. Highly promising results on multiple external/independent evaluation cohorts as well as comparisons with expert human readers demonstrate the potentials of our approach.

High-resolution lung MRI with Ultrashort-TE: 1.5 or 3 Tesla?

PURPOSE: To assess the influence of magnetic field strength and additionally of acquisition and reconstruction parameters on the quality of high-resolution lung MRI, using a prototype Ultrashort-TE (UTE) sequence. MATERIALS AND METHODS: This prospective study received ethical approval and all participants provided written informed consent. From January to February 2018, images were obtained in 10 healthy volunteers at 1.5 T and 3 T with a prototypical free-breathing UTE spiral 3D-GRE sequence with volumetric interpolation (VIBE) sequence and near-millimeter resolution. Five sequences were acquired to assess the effects of magnetic field strength (1.5 vs 3 T), voxel resolution (1.2 vs 1.0mm3), number of spiral interleaves (464 vs 264) and iterative reconstruction (iterative self-consistent parallel imaging reconstruction [SPIRiT] versus Non-Uniform Fourier Transform [NUFFT]) on image quality. Image quality was assessed by two independent observers. They evaluated the proportion of detected airways from the trachea down to the subsegmental level and placed ROI in the lung parenchyma, airways and vessels to calculate signal-to noise (SNR) and contrast-to-noise (CNR) ratios. Continuous variables were expressed as mean ±â€¯standard deviation and were compared by t-test. RESULTS: Nearly complete visualization of the segmental bronchi (94 ±â€¯12 to 99 ±â€¯3%) was obtained with all sequences. Acquisition at 3 T (p < 0.001), use of a fewer spiral interleaves (p < 0.001) and NUFFT reconstruction (p < 0.001) all resulted in a significantly lower visibility of the subsegmental bronchi, while a smaller voxel size improved their visibility (p = 0.001). SNR and CNR were significantly lower at 3 T (140.2 ±â€¯19.9 vs 190.2 ±â€¯34.8, p < 0.001; and 5.7 ±â€¯2.4vs 10.8 ±â€¯2.8, p < 0.001, respectively). CONCLUSIONS: Using equivalent acquisition and reconstruction parameters, image quality was lower at 3 T than at 1.5 T with decreased visibility of the subsegmental bronchi and lower SNR and CNR values.

CT-guided percutaneous core biopsy for assessment of morphologically normal adrenal glands showing high FDG uptake in patients with lung cancer.

OBJECTIVE:: Increased fludeoxyglucose (FDG) uptake in morphologically normal adrenal glands on positron emission tomography-CT (PET-CT) is a diagnostic challenge with major implications on treatment. The purpose of this retrospective study was to report our experience of CT-guided percutaneous core biopsy of morphologically normal adrenal glands showing increased FDG uptake in a context of lung cancer. METHODS:: Biopsies for non-enlarged adrenal glands showing increased FDG uptake in lung cancer patients performed at our institution from December 2014 to December 2016 were retrospectively analyzed. Six biopsies were performed in five patients during the study period. All procedures were performed with the patients in the prone position, using a posterior approach and coaxial 17-gauge needles with 18-gauge automated cutting needles. Patient characteristics, procedural details and final pathological diagnosis were analyzed, as well as the duration of hospitalization. RESULTS:: Five of the six biopsies (83.3%) confirmed adrenal metastasis from the primary lung cancer. No complications were reported and the patients were discharged the day after the procedure. CONCLUSION:: The high confirmation rate of metastasis and lack of complications support performing CT-guided percutaneous biopsy of non-enlarged adrenal glands showing increased FDG uptake, for optimal management in lung cancer patients. ADVANCES IN KNOWLEDGE:: Morphologically normal adrenal glands showing high FDG uptake in patients with lung cancer are metastasis. This manuscript shows that CT-guided percutaneous biopsy should be proposed. Increased FDG uptake in morphologically normal adrenal glands may indicate metastasis.