Medical adhesive vs hookwire for computed tomography-guided preoperative localization and risk factors of major complications.

OBJECTIVE: To compare the efficacy of medical adhesive and hookwire as CT-guided non-palpable pulmonary nodule (NPN) localization methods before video-assisted thoracoscopic surgery (VATS) resection, and determine the risk factors for common complications during localization. METHODS: This was a single-center non-randomized retrospective study. 102 consecutive patients with 109 NPNs were divided into Group A (medical adhesive, 66 patients, 72 nodules) and Group B (hookwire, 36 patients, 37 nodules) before VATS. Patient- and nodule-based characteristics were compared. Logistic regression was performed to identify the risk factors for complications. RESULTS: Localization was successfully performed in all the NPNs. For Group A, the rate of pneumothorax immediately after localization was lower (p = 0.049) and the localization-to-surgery interval was longer (p = 0.011) than Group B. There was no significant difference in rates of hemorrhage after needle withdrawal between the two groups (p = 0.198). Hookwire ( vs medical adhesive) (ß = 1.12, p = 0.018), total insertion depth (ß = -0.41, p = 0.013), pleura-needle angle (ß = -0.04, p = 0.025) and grade of hemorrhage after needle withdrawal (ß = -0.96, p = 0.030) were independently associated with pneumothorax, while age (ß = -0.94, p = 0.018), tumor size (ß = 0.29, p = 0.007) and its distance from the pleural surface (ß = 0.14, p = 0.004) were associated with higher grade hemorrhage after needle withdrawal. CONCLUSION: Compared with hookwire, localization with medical adhesive excelled in lower risk of pneumothorax, a more flexible localization-to-surgery interval, and had similar rates of hemorrhage after needle withdrawal. Hookwire is an independent risk factor of pneumothorax immediately after localization. ADVANCES IN KNOWLEDGE: This study added new clinical evidence to the efficacy of medical adhesive in pre-operative CT-guided NPN localization.

Ultra-low-dose multiphase CT angiography derived from CT perfusion data in patients with middle cerebral artery stenosis.

PURPOSE: Computed tomography (CT) perfusion (CTP) source images contain both brain perfusion and cerebrovascular information, and may allow a dynamic assessment of collaterals. The purpose of the study was to compare the image quality and the collaterals identified on multiphase CT angiography (CTA) derived from CTP datasets (hereafter called CTPA) reconstructed with iterative model reconstruction (IMR) algorithm in patients with middle cerebral artery (MCA) steno-occlusion with those of routine CTA. METHODS: Consecutive patients with a unilateral MCA steno-occlusion underwent non-contrast CT (NCCT), CTP, and CTA. CTPA images were reconstructed from CTP datasets. The vascular attenuation, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of routine CTA and CTPA were measured and analyzed by Student's t test. Subjective image quality and collaterals were scored and compared using the Wilcoxon signed-rank test. RESULTS: Fifty-eight patients (mean age 61.7 years, 78% males, median National Institutes of Health Stroke Scale score = 12) were included. The effective radiation dose of CTP was 1.28 mSv. The vascular attenuation, SNR, CNR, and the image quality of CTPA were considerably higher than that of CTA (all, p < 0.001). Collaterals were rated higher on CTPA compared with CTA (1.79 ± 0.64 vs. 1.22 ± 0.84, p < 0.001). Fifty-three percent of patients with poor collaterals assessed on single-phase CTA had good collaterals on CTPA. CONCLUSION: CTPA derived from CTP datasets reconstructed with IMR algorithm offers image quality comparable to routine CTA and provides time-resolved evaluation of collaterals in patients with MCA ischemic disease.