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.

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.