Diagnostic yield and efficacy of CT-guided percutaneous biopsy in diagnosis of sclerotic bone lesions

Purpose: to determine the diagnostic yield and efficacy of CT-guided percutaneous biopsy of sclerotic bone lesions

Materials and Methods: we performed a prospective study of 26 patients with sclerotic bone lesions whom underwent CT-guided percutaneous biopsy over a 20- month period. A tryphine Ostycut needle, combined Ostycut/Trucut, or combined Ostycut/ fine needle aspiration biopsy [FNAB] were used to obtain a specimens for histopathological examination. Bone biopsy results were analyzed to yield diagnostic efficacy according to needle type, site of the lesion as well as final pathological diagnosis

Results: all twenty-six sclerotic bone lesions were biopsed under CT guidance. Ten of them affected the axial skeleton and 16 affected long bones. Metastatic deposits were detected in five patients, oestosarcoma [n = 7], chnodrosarcoma [n = 2], Ewing's [n = 3], osteomyelitis [n= 4] and lymphoma, chordoma, synovioma, bone infarcts, and oestoblastoma each [n = 1]. The diagnostic efficacy according to used needle was Ostycut needle 83%, combined Ostycut/ Tru-cut needles 100% and combined Ostycut/ FNAB 80%. Diagnostic efficacy according to site of the lesion was 80% in the axial skeleton and 93.7% in the long bones. Efficacy of CT-guided bone biopsy according to pathological type of lesion was 83% for metastatic deposits, 83% for oestosarcoma and 50% for chordoma. It was I 00 for chondrosarcoma, lymphoma , Ewing's, synovioma, bone infarcts, osteomyelitis, and Ostoblastoma. The overall diagnostic efficacy and yield for CT-guided bone biopsy of sclerotic bony lesions was 85% after 1st biopsy and increased to 86.6% after 2nd biopsy

Conclusion: percutaneous CT- guided biopsy of sclerotic bone lesions is an important tool in the evaluation of sclerotic bone lesions. It is a reliable procedure and yields diagnostic information in a high proportion of patients. It has several advantages over an open bone biopsy

Role of HRCT chest in evaluation of radiation-induced parenchymal lung diseases primed by radiation therapy to the breast

Thirty consecutive breast cancer patients receiving tangential field radiation therapy underwent clinical examination followed by high resolution CT [HRCT] aiming to evaluate the accuracy of HRCT in diagnosis of radiation-induced parenchymal lung diseases. Thin section 1-mm HRCT images were obtained at identical levels at a 250 - mm filed of view, 120 KV and 200 mA settings. HRCT was performed during 4-12 weeks and 12 months after the completion of radiotherapy. Pathological changes were detected in 10 out of 30 examined patients [33%]. Acute radiation-induced parenchymal lung diseases were detected in 7 [23%] patients. Out of those 7 patients 4 [13%] patients showed ground glass opacity appeared in a period ranged from 4-10 weeks after radiation therapy. Minimal alveolar filling [minimal acinar nodules], septal thickening and parenchymal consolidation each was detected in one patient [3%] for each HRCT pathological pattern. Chronic radiation-induced parenchymal lung diseases were detected in 4 [13%] patients, axial interstitial thickening with fibrotic bands were detected in 2 [6%] patients. Cylindrical brocnh-ciatesis was detected in one patient [3%], it involves peripheral bronchi and associated with bronchial wall thickening. In another one patient [3%] and non septal subpleuaral linear opacity is observed. All above HRCT changes were detected in the territory of the beam boundaries. The study concluded that HRCT yield good quality images of subtle radiation induced injuries. The use of tangential fields limits radiological changes that can be detected only by HRCT examination and may not associated with clinical symptoms

Comparison between target-controlled infusion of propofol, desflurane and locoregional anaesthesia for transvaginal oocyte retrieval: anaesthetic and reproductive outcome

Target controlled intravenous anaesthesia using propofol was compared with inhalational anaesthesia using desflurane and paracervical block with bupivacaine in relation to the reproductive outcome after in-vitro fertilization and embryo transfer. Data were collected prospectively on 60 women presenting for oocyte retrieval. All patients received ovarian stimulation treatment. Patients were allocated randomly to three equal groups. In both groups 1 and 2, induction of anaesthesia consisted of 0.5 mg alfentanil and 2mg /kg propofol intravenously. In group 1, anaesthesia was maintained with target controlled infusion of propofol [4 mu g/ml]. In group 2, the anaesthesia was maintained with desflurane 3%. In group 3, a paracervical block using 20 ml of 0.25% bupivacaine was performed. The results showed that there was a haemodynamic stability in the three groups. Emergence from anaesthesia occurred significantly earlier after desflurane group compared with propofol group, but complete recovery occurred significantly faster in the propofol group because of a reduced incidence of post-operative nausea and vomiting. There was no significant difference in the reproductive outcome. As regards fertilization and cleavage rates, the implantation rate was slightly lower in the propofol group but with no significant difference

Comparison between gated SPECT and echocardiography in evaluation of left ventricular ejection fraction

Gated SPECT myocardial perfusion imaging has be-come an established routine procedure in almost all nuclear medicine departments. It has many advantages: it allows evaluation of myocardial wall motion, wall thickening, and calculation of left ventricular ejection fraction. This information helps to differentiate attenuation artifacts of breast tissue or diaphragm from true ischemic changes. The degree of wall thickening and increase in count density reflect myocardial viability. To test the validity of LVEF by Gated SPECT and correlate it with echocardiographic results. 63 patients [39 males 24 females] were imaged according to the following protocol. Detectors are 90 angle, cardiac leads and gated device activated, 64 x 64 x 16 matrix, 8 slices per cardiac cycle. 16 projections per detector for a total of 32 projections, covering from right anterior oblique to the left posterior oblique. Time of acquisition per projection is 40 seconds. We gated both early and delayed thallium studies. Early images began within 5-8 minutes of dose injection. Gated SPECT study, was usually completed in 20 minutes. The first part of the study was usually finished in less than 40 minutes from the time of injection. We correlated end diastolic volume, end systolic volume and LVEF calculated from gated thallium SPECT with echocardiography done immediately following thallium study. For gated SPECT, the mean LVEF was S 1.4 +/- 9, LV EDV of 96 +/- 22ml and ESV of 47.3 +/- 9m1. These were comparable to Echo result with correlation coefficient of 0.89 for LVEF. Gated SPECT changed the result of the test by 14% [from positive to negative] in 9/63 patients, 7 cases due to diaphragmatic attenuation and 2 due to breast artifact, and increasing the overall accuracy of the test. Gated SPECT is a good reproducible method to assess LVEF. Correlation of LVEF with 2D Echo is very high [0.89]. This proves the validity of GSPECT tecimique. Since thallium-201 chloride is preferred for myocardial imaging because it is more physiological and one injection is required in the presence of new true digital detectors gamma camera systems