ABSTRACT
Objective@#To evaluate the feasibility, safety, and effectiveness of CT-guided microcoil localization of solitary pulmonary nodules (SPNs) for guiding video-assisted thoracoscopic surgery (VATS). @*Materials and Methods@#Between June 2016 and October 2019, 454 consecutive patients with 501 SPNs who received CTguided microcoil localization before VATS in our institution were enrolled. The diameter of the nodules was 0.93 ± 0.49 cm, and the shortest distance from the nodules to the pleura was 1.41 ± 0.95 cm. The distal end of the microcoil was placed less than 1 cm away from the nodule, and the proximal end was placed outside the visceral pleura. VATS was performed under the guidance of implanted microcoils without the aid of intraoperative fluoroscopy. @*Results@#All 501 nodules were marked with microcoils. The time required for microcoil localization was 12.8 ± 5.2 minutes. Microcoil localization-related complications occurred in 179 cases (39.4%). None of the complications required treatment. A total of 463 nodules were successfully resected under the guidance of implanted microcoils. VATS revealed 38 patients with dislocated microcoils, of which 28 underwent wedge resection (21 cases under the guidance of the bleeding points of pleural puncture, 7 cases through palpation), 5 underwent direct lobectomy, and the remaining 5 underwent a conversion to thoracotomy. In 4 cases, a portion of the microcoil remained in the lung parenchyma. @*Conclusion@#CT-guided microcoil localization of SPNs is safe and reliable. Marking the nodule and pleura simultaneously with microcoils can effectively guide the resection of SPNs using VATS without the aid of intraoperative fluoroscopy.
ABSTRACT
Objective@#To evaluate the feasibility, safety, and effectiveness of CT-guided microcoil localization of solitary pulmonary nodules (SPNs) for guiding video-assisted thoracoscopic surgery (VATS). @*Materials and Methods@#Between June 2016 and October 2019, 454 consecutive patients with 501 SPNs who received CTguided microcoil localization before VATS in our institution were enrolled. The diameter of the nodules was 0.93 ± 0.49 cm, and the shortest distance from the nodules to the pleura was 1.41 ± 0.95 cm. The distal end of the microcoil was placed less than 1 cm away from the nodule, and the proximal end was placed outside the visceral pleura. VATS was performed under the guidance of implanted microcoils without the aid of intraoperative fluoroscopy. @*Results@#All 501 nodules were marked with microcoils. The time required for microcoil localization was 12.8 ± 5.2 minutes. Microcoil localization-related complications occurred in 179 cases (39.4%). None of the complications required treatment. A total of 463 nodules were successfully resected under the guidance of implanted microcoils. VATS revealed 38 patients with dislocated microcoils, of which 28 underwent wedge resection (21 cases under the guidance of the bleeding points of pleural puncture, 7 cases through palpation), 5 underwent direct lobectomy, and the remaining 5 underwent a conversion to thoracotomy. In 4 cases, a portion of the microcoil remained in the lung parenchyma. @*Conclusion@#CT-guided microcoil localization of SPNs is safe and reliable. Marking the nodule and pleura simultaneously with microcoils can effectively guide the resection of SPNs using VATS without the aid of intraoperative fluoroscopy.
ABSTRACT
OBJECTIVE: (1) To evaluate the value of CT-guided microcoil implantation for localizing pulmonary ground-glass nodules (GGNs) before video-assisted thoracoscopic surgery (VATS). (2) To evaluate the feasibility, safety and accuracy of cephalic-caudal oblique approach for lesions difficult to access on axial images owing to overlying bony structures, large vessels or interlober fissures. METHODS: From June 2016 to March 2019, all patients with GGNs resected by VATS after marking using CT-guided microcoil implantation in China-Japan friendship hospital were enrolled and clinical and imaging data were retrospectively analyzed. According to the microcoil marked path, the GGNs were divided into cephalic-caudal oblique group (oblique group) and non-oblique group. The success rate of marking, the time required for marking and the incidence of complications between the two groups were compared. RESULTS: 258 GGNs from 215 consecutive patients were included in this study. The diameter of GGNs was 1.22 ± 0.50 cm, and the shortest distance from GGNs to the pleura was 1.56 ± 1.09 cm. All 258 GGNs were successfully resected by VATS under the guidance of implanted microcoils, and no case was converted to thoracotomy. During CT-guided microcoil implantation, cephalic- caudal oblique approach was taken in 56 GGNs (oblique group) to avoid bone, interlobar fissure and blood vessels. The time required for marking was significantly longer for oblique group compared with non-oblique group (16.6 ± 2.4 vs. 13.1 ± 1.9 min, p<0.01). No significant differences in the success rate of marking (94.6% vs 91.6%), the incidence of pneumothorax (19.6% vs 17.8%), the bleeding rate (10.7% vs 8.9%), and the hemoptysis rate (1.8% vs 1.5%) were observed between the two groups. CONCLUSION: CT-guided microcoil implantation can effectively guide VATS to resect GGNs. For GGNs difficult to access on axial images, CT-guided cephalic-caudal oblique approach is feasible, safe, and accurate. ADVANCES IN KNOWLEDGE: CT-guided microcoil implantation can effectively guide VATS to resect GGNs. The marked path with cephalic-caudal obliquity can effectively avoid bone, interlobar fissure and blood vessels, successfully mark GGNs difficult to access on axial images, while keeping the distance from the pleura to the lesion on the marked path as short as possible at the same time.
Subject(s)
Lung Neoplasms/surgery , Multiple Pulmonary Nodules/surgery , Thoracic Surgery, Video-Assisted/methods , Feasibility Studies , Female , Fiducial Markers , Humans , Male , Middle Aged , Prosthesis Implantation , Radiography, Interventional , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: To assess the value of coronal short-tau inversion recovery whole-body MRI (STIR-WBMRI) for screening osteonecrosis in patients with polymyositis (PM)/dermatomyositis (DM). METHODS: The imaging and medical records of 129 patients with PM/DM who met the Bohan and Peter diagnostic criteria were retrospectively analyzed. STIR-WBMRI was performed in all patients. 18 patients had follow-up STIR-WBMRI. 12 patients underwent regional knee and/or hip MRI while 25 patients underwent radiography of the lower extremities. RESULTS: STIR-WBMRI detected osteonecrosis in 15 (11.6%) patients. 38 joints were affected (mean, 2.5 per patient; range, 1-5 joints). Of the 38 joints affected by osteonecrosis, 33 had no clinical symptoms. Among the 12 patients who underwent regional MRI, STIR-WBMRI detected all 10 osteonecrotic sites seen on the regional MRI. The location, shape and size of the osteonecrotic lesions revealed on regional MRI were in accordance with those displayed on STIR-WBMRI. Of the 15 patients with osteonecrosis, 6 performed routine radiography of the affected joints and revealed no osteonecrotic lesions. Follow-up WBMRI detected new osteonecrosis in two patients whose first WBMRI revealed that there was no osteonecrosis in any skeleton. CONCLUSION: In addition to displaying muscle inflammation, STIR-WBMRI can efficiently detect early multifocal osteonecrosis in the whole bodies of patients with PM/DM. Advances in knowledge: In patients with PM/DM, WBMRI which takes 12-15 min can display muscular involvement and detect early multisite osteonecrosis in the whole body at the same time. Osteonecrotic lesions revealed by WBMRI are in accordance with those displayed on regional WBMRI.
