Number of biopsies in diagnosing pulmonary nodules.

PURPOSE: To determine the number of specimens to be obtained from pulmonary lesions to get the highest possible accuracy in histological work-up. MATERIALS AND METHODS: A retrospective evaluation (January 1999 to April 2004) covered 260 patients with thoracic lesions who underwent computer tomography (CT)-guided core-cut biopsy in coaxial technique. All biopsies were performed utilizing a 19 gauge introducer needle and a 20 gauge core-cut biopsy needle. In all, 669 usable biopsies were taken (from 1-5 biopsies in each setting). The specimens were marked sequentially and each biopsy was worked up histologicaly. The biopsy results were correlated to histology after surgery, clinical follow-up or autopsy. The number of biopsies was determined that is necessary to achieve the highest possible accuracy in diagnosing pulmonary lesions. RESULTS: In 591 of 669 biopsies (88.3%), there were correct positive results. The overall accuracy was 87.4%. In 193 of 260 (74.2%) patients, a suspected malignancy was confirmed. In 50 of 260 (19.2%) patients, a benign lesion was correctly diagnosed. Seventeen (6.5%) patients were lost to follow-up. The first, second and third biopsies had cumulative accuracies of 63.6%, 89.2% and 91.5%, respectively (P < 0.02). More biopsies did not show any higher impact on accuracy. CONCLUSION: For the highest possible accuracy in diagnosing pulmonary lesions by CT-guided core-cut biopsy, at least three usable specimens are recommended to be taken.

Management of pancreatic trauma and its consequences--guidelines or individual therapy?

BACKGROUND/AIMS: Diagnosis of pancreatic trauma and its complications may be difficult due to non-specific signs and symptoms and treatment recommendations are not unequivocal. METHODOLOGY: Clinical data of a series of 47 patients with pancreatic trauma were analyzed; most of them were polytraumatized and treated by an interdisciplinary team. RESULTS: The most common causes were traffic accidents and sport injuries with 66% and 15%, respectively. Concomitant injuries were seen in 96% (nonpancreatic intra-abdominal injuries 85% including spleen 38% and liver 34%, extra-abdominal injuries 70%). Concomitant liver injuries were treated conservatively in 31% and operatively in 69% (including hepatic packing in 38%). Concomitant splenic injuries were usually very severe and could be managed conservatively in only 11%. All patients with pancreatic injuries grade III, IV or V (17%) according to the American Association of Surgical Trauma Classification required surgery, endoscopic treatment or interventional radiology. The most common posttraumatic complications were necrotizing pancreatitis (15%), pseudocyst formation (9%), abscesses (6%) and fistulas (4%). CONCLUSIONS: The status of the pancreatic duct is the crucial point for management of pancreatic trauma and should be assessed as early as possible. Treatment has to be tailored to the individual situation, especially in patients with severe concomitant injuries or prolonged course.

Serum osteoprotegerin is a major determinant of bone density development and prevalent vertebral fracture status following cardiac transplantation.

Osteoprotegerin (OPG) is an antiresorptive cytokine and a key regulator of osteoclastogenesis and activity. Since OPG is downregulated by glucocorticoids and cyclosporine A in vitro we examined whether immunosuppressive therapy would play a role in the development of transplantation osteoporosis. We enrolled 57 cardiac transplant recipients (median time since transplantation, 3.2 years (1.1-11.5 years)) in this cross-sectional study. Standardized spinal X-rays as well as hip bone density measurements were performed in all patients. Serum OPG was determined using a commercially available ELISA. Vertebral fractures were present in 56% of the patients. Bone densities of all femoral neck subregions were correlated to serum OPG concentrations (r values between 0.40 and 0.48, all P < 0.005). Multiple regression analysis revealed OPG levels to be independently correlated to femoral neck Z scores (r = 0.49, P = 0.002). After adjustment for age, BMI, neck Z score, renal function, and months since transplantation, serum OPG was the only significant predictor of prevalent vertebral fractures (P = 0.001). In a separate 6-month prospective study of 14 heart transplant recipients receiving calcium and vitamin D serum OPG levels fell by 41% (P = 0.0004) after 3 months and 47% (P = 0.0001) after 6 months following cardiac transplantation. Bone loss at the lumbar spine and femoral neck after 6 months was correlated to the decrease in serum OPG at 6 months (r = 0.82, P < 0.0001, and r = 0.60, P = 0.02, respectively) as well as 3 months after cardiac transplantation (r = 0.65, P = 0.01, and r = 0.69, P = 0.006, respectively). Serum OPG alone accounted for 67% of the variance of lumbar spine bone density changes over the first 6 months posttransplantation. We conclude that serum OPG levels decline consistently in all patients following initiation of immunosuppressive therapy and are independently correlated with changes in bone density. We hypothesize that OPG plays a major role in the development of transplantation osteoporosis.

[The value of different spiral CT phases in the detection of liver metastases]. / Der Wert unterschiedlicher Spiral-CT-Phasen in der Suche nach Lebermetastasen.

PURPOSE: To assess the value of the non-contrast phase (NCP), hepatic-arterial phase (HAP) and portal-venous phases (PVP) for the detection of liver metastases by spiral CT. METHODS: In order to detect liver metastases, 119 patients (58 women, 61 men; mean age: 62 years) underwent triphasic spiral CT (8 mm collimation, 12 mm table increment/rotation, 7 mm reconstruction increment). NCP, HAP (20 s delay) and PVP (70 s delay) scans were acquired (contrast medium injection rate: 4 ml/s). CT analysis comprised independent evaluation of the three scan series for detection and conspicuity of liver metastases (conspicuity score: 0 = not visible, 1 = barely visible, 2 = clearly visible, 3 = distinctly visible). RESULTS: In 83 of the 119 patients, 478 liver metastases were detected (110 hypervascular and 368 hypovascular lesions). 285 (60 %) metastases were detected on NCP scans. Significantly more lesions were seen on HAP (n = 375, 78 %) and on PVP (n = 428, 90 %). No lesion was detected on NCP studies alone. For all detected metastases, mean conspicuity was 1.2 +/- 0.4 on NCP, 1.8 +/- 0.8 on HAP and 2.2 +/- 0.8 PVP. Hypervascular lesions were best seen on HAP with a conspicuity score of 2.0 +/- 0.8 versus 1.3 +/- 0.5 on NCP and 1.5 +/- 0.8 on PVP. Hypovascular lesions reached the highest conspicuity on PVP with 2.4 +/- 0.8 versus 1.2 +/- 0.4 on NCP and 1.7 +/- 0.7 on HAP. CONCLUSION: For detection of liver metastases with spiral CT, contrast series seem to be sufficient. For tumors likely to seed hypervascular metastases, HAP scans should be applied in addition to the PVP.

CT number variations due to different image acquisition and reconstruction parameters: a thorax phantom study.

A humanoid thorax phantom containing six compartments was scanned with two different computed tomography (CT) scanners using various image acquisition and reconstruction parameters. The differences of CT numbers were statistically significant between the two CT scanners for each compartment (p<0.001) except for the "air" compartment. The variabilities of the CT numbers are described for the different parameters. The mean CT numbers of the "water" compartment, for instance, ranged from 1 to 15HU (Hounsfield Units), those of the "air" compartment varied from -962 to -990HU. Knowledge of these CT number variabilities is necessary when CT numbers are used for tissue characterization.