Pneumothorax risk reduction during CT-guided lung biopsy - Effect of fluid application to the pleura before lung puncture and the gravitational effect of pleural pressure.

PURPOSE: This study investigated strategies to reduce pneumothorax risk in CT-guided lung biopsy. The approach involved administering 10 ml of 1 % lidocaine fluid in the subpleural or pleural space before lung puncture and utilizing the gravitational effect of pleural pressure with specific patient positioning. METHOD: We retrospectively analyzed 72 percutaneous CT-guided lung biopsies performed at a single center between January 2020 and April 2023. These were grouped based on fluid administration during the biopsy and whether the biopsies were conducted in dependent or non-dependent lung regions. Confounding factors like patient demographics, lesion characteristics, and procedural details were assessed. Patient characteristics and the occurrence of pneumothoraces were compared using a Kurskal-Wallis test for continuous variables and a Fisher's exact test for categorical variables. Multivariable logistic regression was used to identify potential confounders. RESULTS: Subpleural or pleural fluid administration and performing biopsies in dependent lung areas were significantly linked to lower peri-interventional pneumothorax incidence (n = 15; 65 % without fluid in non-dependent areas, n = 5; 42 % without fluid in dependent areas, n = 5; 36 % with fluid in non-dependent areas,n = 0; 0 % with fluid in dependent areas; p = .001). Even after adjusting for various factors, biopsy in dependent areas and fluid administration remained independently associated with reduced pneumothorax risk (OR 0.071, p<=.01 for lesions with fluid administration; OR 0.077, p = .016 for lesions in dependent areas). CONCLUSIONS: Pre-puncture fluid administration to the pleura and consideration of gravitational effects during patient positioning can effectively decrease pneumothorax occurrences in CT-guided lung biopsy.

Antibacterial Effects of X-ray and MRI Contrast Media: An In Vitro Pilot Study.

Some radiological contrast agents have been shown to have effects on bacterial growth. In this study, the antibacterial effect and mechanism of action of iodinated X-ray contrast agents (Ultravist 370, Iopamiro 300, Telebrix Gastro 300 and Visipaque) and complexed lanthanide MRI contrast solutions (MultiHance and Dotarem) were tested against six different microorganisms. Bacteria with high and low concentrations were exposed to media containing different contrast media for various lengths of time and at pH 7.0 and 5.5. The antibacterial effect of the media was examined in further tests using agar disk diffusion analysis and the microdilution inhibition method. Bactericidal effects were found for microorganisms at low concentrations and low pH. Reductions were confirmed for Staphylococcus aureus and Escherichia coli.

2D shear wave elastography of the rectus femoris muscle in patients with cirrhosis: Feasibility and clinical findings. A pilot study.

BACKGROUND AND AIMS: Frailty is frequent in cirrhosis and associated with skeletal muscle abnormalities and worse prognosis. 2D shear-wave elastography (2D-SWE) could mirror biomechanical properties of skeletal muscle reflecting muscle quality. However, there is no data on 2D-SWE on skeletal muscle stiffness assessment in cirrhosis and on frailty. METHODS: Outpatients with cirrhosis were prospectively included in a single center. Skeletal muscle stiffness was studied at the rectus femoris by 2D-SWE. Ileo-psoas area and index (area/height2), and antero-posterior diameter of rectus femoris (RF) was measured on ultrasound. RESULTS: We included 44 patients (24 male, age 59 [IQR 49-66]) with a median liver frailty index (LFI) of 3.7 (IQR 3.2-4.0). Measurement of RF muscle stiffness (RFMS) was feasible in all with high inter-measurement reproducibility. RFMS did not correlate with LFI, liver function and skeletal muscle diameters. Ileo-psoas index was lower in frail patients (1.7 vs 1.0 cm2/m2, p = 0.024). RF antero-posterior diameter inversely correlated with LFI (r -0.578: p<0.001). CONCLUSION: RFMS by 2D-SWE is feasible and reproducible in cirrhosis and is independent of liver function and LFI, and warrants further studies in this setting. RF antero-posterior diameter could be reported as an objective parameter mirroring sarcopenia and frailty.

Full core technology versus notch sampling technology: evaluation of the diagnostic accuracy and the risk of a pneumothorax after transthoracic needle biopsy of suspicious lung lesions.

BACKGROUND: Percutaneous needle biopsy of the lung (PCBL) under image guidance has become a safe and effective minimal invasive method to obtain a specimen related histological diagnosis of pulmonary lesions. PURPOSE: To evaluate the diagnostic yield and safety of two different coaxial biopsy technologies: full core and notch sampling technology. The former allowing the removal of full punch cylinders and the latter using a cutting-edge mechanism. MATERIAL AND METHODS: A retrospective analysis of 48 consecutive PCBL procedures has been carried out for this prognostic study, involving patients with a documented pulmonary nodule or mass lesion on previous computed tomography (CT) scans. The study population included 38 men and 10 women (mean age = 67 years). Of these 48 patients who underwent a procedure with a co-axial cutting system, 24 have been performed with notch sampling technology and 24 with full core technology. RESULTS: Out of the 48 biopsy procedures, 46 yielded specimens were adequate for histopathological evaluation, consistent with a technical success rate of 96%. The most common induced image-guided biopsy complication was a pneumothorax, occurring in 14 patients (35%). Seven patients with a pneumothorax were attributed to the full core technology and seven to the notch sampling technology (odds ratio = 1, 95% confidence interval = 0.28-3.51, P = 1). CONCLUSION: In the setting of full core versus notch sampling percutaneous CT-guided coaxial needle biopsy of the lung, no significant difference in the diagnostic accuracy and the incidence of pneumothoraces could be shown, while both technologies have an excellent diagnostic performance.

Nuevos factores de riesgo de hemorragia pulmonar que complican la biopsia pulmonar guiada por TC en técnica coaxial / Novel risk factors of pulmonary hemorrhage complicating CT-guided lung biopsy in coaxial technique

Objetivos: Evaluar la frecuencia y gravedad de la hemorragia parenquimatosa pulmonar tras la biopsia pulmonar con aguja transtorácica coaxial, según factores de procedimiento, aún no descritos en la literatura. El objetivo de este estudio fue determinar si la elección de la tecnología de biopsia coaxial, el posicionamiento del paciente y la dignidad de la lesión son tres nuevas variables que influyen en el riesgo de hemorragia parenquimatosa tras biopsias coaxiales de pulmón. Métodos: Se revisaron retrospectivamente los registros de 117 pacientes que se sometieron a biopsias con aguja transtorácica del pulmón entre enero de 2018 y abril de 2020. El resultado primario fue la hemorragia pulmonar. Se ha utilizado un sistema de clasificación para clasificar la hemorragia parenquimatosa pulmonar: Grado 0 - Grado 3. Se evaluaron tres variables novedosas relacionadas con el paciente, la técnica y la lesión como predictores de hemorragia pulmonar: tecnología de biopsia coaxial, posición del paciente y dignidad de la lesión. Resultados: De los 117 pacientes, 18 (15,4%) pacientes con tecnología de biopsia coaxial de corte, versus 29 (24,8%) pacientes con tecnología coaxial de núcleo completo mostraron hemorragia significativa en las exploraciones de control posteriores a la biopsia. (IC del 95% 0,06-0,33, p <0,0001). No hubo diferencias significativas en la hemorragia pulmonar entre el diagnóstico histológico benigno y maligno (IC 95% 0,84-4,44, p = 0,1199) y la posición del paciente en decúbito prono o supino (IC 95%: 0,57-2,57, p = 0,6232). Conclusiones: La incidencia y gravedad de la hemorragia pulmonar depende de la tecnología de biopsia coaxial utilizada; siendo mayor en pacientes sometidos a una biopsia con tecnología full-core y menor después del uso de tecnología de corte. En este estudio de pronóstico no se estableció una correlación significativa entre la hemorragia pulmonar parenquimatosa y la posición del paciente o la dignidad de la lesión

Objectives: To evaluate the frequency and severity of pulmonary parenchymal hemorrhage after coaxial transthoracic needle biopsy of the lung, according to procedural factors, not yet described in literature. The aim of this study was to determine whether the choice of the coaxial biopsy technology, patient positioning and the lesion dignity are three new variables influencing the risk of parenchymal hemorrhage after coaxial biopsies of the lung. Methods: Records from 117 patients who underwent transthoracic needle biopsies of the lung between January 2018 and April 2020 have been retrospectively reviewed. The primary outcome was pulmonary hemorrhage. A grading system has been used to classify pulmonary parenchymal hemorrhage: Grade 0 ­ Grade 3. Three novel patient, technique and lesion-related variables were evaluated as predictors of pulmonary hemorrhage: coaxial biopsy technology, patient positioning and lesion dignity. Results: Out of the 117 patients, 18 (15,4%) patients with cutting coaxial biopsy technology, versus 29 (24,8%) patients with full core coaxial technology showed significant hemorrhage on the post-biopsy control scans. (95% CI 0,06-0,33, p<0,0001). No significant difference in pulmonary hemorrhage between benign and malignant histological diagnosis (95% CI 0,84-4,44, p=0,1199) and prone or supine patient positioning (95% CI: 0,57-2,57, p= 0,6232) was found. Conclusions: The incidence and severity of pulmonary hemorrhage depends on the coaxial biopsy technology used; being higher in patients undergoing a biopsy with full-core technology and lower after the use of cutting technology. No significant correlation between parenchymal pulmonary hemorrhage and patient positioning or lesion dignity was established in this prognostic study.

Radiologists and nuclear medicine physicians are looking forward to a cross-curricular training.

OBJECTIVES: To obtain an overview of the attitudes toward interdisciplinary further education of residents and consultants in radiology and nuclear medicine and preferences regarding a future joint training curriculum in Switzerland. METHODS: A 34-item questionnaire was sent electronically (SurveyMonkey online survey tool) to 1244 radiologists and nuclear physicians (residents and consultants) in Switzerland. The items asked about the motivation for further education in each other's specialty and preferences regarding a joint further education curriculum in radiology and nuclear medicine. RESULTS: Overall, 370 questionnaires were analyzed (370/1244, 30%). There were 280 (76%) board-certified physicians in either radiology (238/370, 64%) or nuclear medicine (42/370, 12%) and 65 (18%) residents (radiology 54/370, 15%; nuclear medicine 11/370, 3%). More than half of all residents (34/65, 52%) stated their conviction that a wide range of expertise in both disciplines could be fully guaranteed through adequate cross-curricular training. For responders already at a consultant level in radiology or nuclear medicine, the willingness to undergo further training in each other's specialty significantly increased with a shorter training period. The preferred option for a possible future joint training curriculum was a combination of a 5-year radiology training program with 2 years of further training in nuclear medicine. CONCLUSIONS: Both residents and board-certified physicians in Switzerland are highly interested in a cross-curricular training curriculum in radiology and nuclear medicine. KEY POINTS: • A systematic survey was conducted to obtain information on interest in cross-curricular training in radiology and nuclear medicine and preferences regarding a future joint training curriculum. • More than half of radiology and nuclear medicine residents would be interested in further training in the other specialty. • There is a strong desire for a shorter training program when combining training in both radiology and nuclear medicine.