Track sealing in CT-guided lung biopsy using gelatin sponge slurry versus saline in reducing post-biopsy pneumothorax: a prospective randomised study.

PURPOSE: To compare the efficacy of two track sealing techniques following CT-guided lung biopsy, using either gelatin sponge slurry (GSS) or saline to reduce the rate of post-biopsy pneumothorax. MATERIALS AND METHODS: In this prospective study, patients referred for a CT-guided lung biopsy, in whom the needle would pass through aerated lung, were randomly assigned to receive either GSS or saline track sealing technique in a 1:1 ratio. All biopsies were performed using a 19-gauge coaxial needle in a tertiary hospital by one of four interventional radiologists with varying levels of experience. The outcomes were pneumothorax occurrence, pneumothorax-related intervention (simple aspiration and/or drainage) and biopsy-related hospital stay length. RESULTS: A total of 266 patients (median age, 66.2 years; range, 25.5-89.2 years; 150 men) were included between July 2019 and January 2023 and randomly distributed to either GSS (n=132) or saline (n=134) groups. Pneumothorax rates were 12.1% in the GSS group and 24.6% in the saline group (p=.008). Hospital length of stay was significantly shorter in the GSS group (p=.003). There was no significant difference in pneumothorax-related intervention between the groups (6.8% vs. 12.7%; p=.107). In the multiple logistic regression analysis, track sealing with GSS was a protective factor for pneumothorax (OR: 0.44, 95%CI: 0.22-0.87; p=.019), and emphysema was associated with higher risk of pneumothorax (OR: 2.67, 95%CI: 1.31-5.44; p=.007). CONCLUSION: Track sealing with GSS following a CT-guided lung biopsy is significantly more efficient than saline in reducing post-biopsy pneumothorax, and results in shorter hospital stay.

[Mispositioned central line with catheterization of partial anomalous pulmonary venous return]. / Voie centrale mal positionnée avec cathétérisme d'un retour veineux pulmonaire anormal partiel.

Central venous access is common practice in intensive care, anesthesia and emergency departments. It is, however, a delicate technical procedure, prone to complications. We present a case report on the placement of a left jugular central venous line in the emergency room, which was thought to be a routine procedure. However, the operator observed arterial blood during sampling, and the central line was described as poorly positioned on the control X-ray. After verification and other examinations, the existence of a vertical vein was discovered in this patient, connecting the left superior pulmonary vein to the brachiocephalic trunk. A poorly positioned central venous line can therefore lead to the discovery of asympomatic congenital vascular anomalies, unrelated to the clinical context. This case study illustrates the various tools available to ensure the correct position of a central venous line, and their clinical implications.

La mise en place d'une voie veineuse centrale est de pratique courante aux soins intensifs, en anesthésie et aux urgences. Il s'agit cependant d'un acte technique relativement invasif, délicat et potentiellement sujet à complications. Nous présentons un cas clinique relatant la mise en place d'une voie veineuse centrale jugulaire gauche en salle de déchocage, manœuvre réputée banale. Cependant, l'opérateur objective visuellement du sang d'allure artérielle lors du prélèvement sanguin sur le cathéter. En outre, l'imagerie par radiographie thoracique décrit une malposition de ce dispositif. Après vérifications et examens complémentaires, nous découvrons finalement l'existence d'une veine verticale chez ce patient, reliant la veine pulmonaire supérieure gauche au tronc brachio-céphalique. Une voie veineuse centrale, apparemment mal positionnée, peut, dès lors, conduire à la découverte d'anomalies vasculaires congénitales asymptomatiques, sans lien nécessaire avec le contexte clinique sous-jacent. Ce cas clinique nous permet d'aborder les différents outils à notre disposition actuelle afin de déterminer le positionnement adéquat d'une voie veineuse centrale et les implications cliniques qui en découlent.

Prefemoral Fat Pad Impingement Syndrome: Correlation between Ultrasonography and Magnetic Resonance Imaging.

Teaching point: Prefemoral fat pad impingement syndrome is one of the fat pad impingements of the knee and can be assessed with ultrasonography.

Radiomics and Delta-Radiomics Signatures to Predict Response and Survival in Patients with Non-Small-Cell Lung Cancer Treated with Immune Checkpoint Inhibitors.

The aim of our study was to determine the potential role of CT-based radiomics in predicting treatment response and survival in patients with advanced NSCLC treated with immune checkpoint inhibitors. We retrospectively included 188 patients with NSCLC treated with PD-1/PD-L1 inhibitors from two independent centers. Radiomics analysis was performed on pre-treatment contrast-enhanced CT. A delta-radiomics analysis was also conducted on a subset of 160 patients who underwent a follow-up contrast-enhanced CT after 2 to 4 treatment cycles. Linear and random forest (RF) models were tested to predict response at 6 months and overall survival. Models based on clinical parameters only and combined clinical and radiomics models were also tested and compared to the radiomics and delta-radiomics models. The RF delta-radiomics model showed the best performance for response prediction with an AUC of 0.8 (95% CI: 0.65-0.95) on the external test dataset. The Cox regression delta-radiomics model was the most accurate at predicting survival with a concordance index of 0.68 (95% CI: 0.56-0.80) (p = 0.02). The baseline CT radiomics signatures did not show any significant results for treatment response prediction or survival. In conclusion, our results demonstrated the ability of a CT-based delta-radiomics signature to identify early on patients with NSCLC who were more likely to benefit from immunotherapy.