Lung density in the trajectory path — a strong indicator of patients sustaining a pneumothorax during CT-guided lung biopsy

Introduction: The purpose is to evaluate the prognostic significance of lung parenchymal density during percutaneous coaxial cutting needle lung biopsy (PNLB). Materials and methods: Retrospective analysis of 179 consecutive patients (106 males, 73 females; mean age 59.16 ± 16.34 years) undergoing PNLB was included. Mean lobar parenchymal lung density, mean densities anterior to the lesion and posterior to the chest wall in the needle trajectory path were measured in HU. Lesion location and needle trajectory were also measured. Fisher’s exact test and Chi-square test were conducted to analyze the categorical variables. ANOVA test was done to examine continuous and normally distributed variables. Statistical significance was considered when p < 0.05. Results: Mean lobar parenchymal lung density (p < 0.05) and mean parenchymal lung density relative to the needle trajectory path were below -800 HU in patients who sustained a pneumothorax. Increase in the number of pleural passes was significantly associated with the risk of patients having pneumothorax (p < 0.05). The mean distance from the skin to the lesion and needle trajectory angle were not statistically different among patients with and without pneumothorax (p > 0.05). Conclusion: Lobar parenchymal density and lung parenchymal density anterior to the lesion and posterior to the chest wall in the needle trajectory path could be used as predicting parameters in patients undergoing PNLB who sustained a pneumothorax. These findings can help interventional radiologist further assess risk of pneumothorax when preforming such procedure

Contrast media volume is significantly related to patient lung volume during CT pulmonary angiography when employing a patient-specific contrast protocol

Aim: The purpose of this study is to investigate the relationship between contrast media volume and patient lung volume when employing a patient-specific contrast media formula during pulmonary computed tomography angiography (CTA). Materials and methods: IRB approved this retrospective study. CTA of the pulmonary arteries was performed on 200 patients with suspected pulmonary embolism (PE). The contrast media volume (CMV) was calculted by employing a patient-specific contrast formula. Lung volume was quantified employing semi-automated lung software that calculated lung volumes (intellispace -Philips). The mean cross-sectional opacification profile of central and peripheral pulmonary arteries and veins were measured for each patient and arteriovenous contrast ratio (AVCR) calculated for each lung segment.  Mean body mass index (BMI) and lung volume were quantified. Receiver operating (ROC) and visual grading characteristics (VGC) measured reader confidence in emboli detection and image quality respectively. Inter and intra-observer variations were investigated employing Cohen’s kappa methodology. Results: Results showed that the mean pulmonary arterial opacification of the main pulmonary circulation (343.88±73HU), right lung; upper (316.51±23HU), middle (312.5±39HU) and lower (315.23±65HU) lobes and left; upper (318.76±83HU), and lower (321.91±12HU) lobes. The mean venous opacification of all pulmonary veins was below 182±72HU. AVCR was observed at all anatomic locations (p<0.0002) where this ratio was calculated. Moreover, larger volumes of contrast significantly correlated with larger lung volumes (r=0.89, p<0.03) and radiation dose (p<0.03). VGC and ROC analysis demonstrated increased area under the curve: 0.831 and 0.99 respectively (p<0.02). Inter-observer variation was observed as excellent (κ = 0.71). Conclusion: We conclude that increased CMV is significantly correlated to increased patient lung volume and radiation dose when employing a patient-specific contrast formula. The effects patient habitus is highlighted

Contrast medium administration and image acquisition parameters in renal CT angiography: what radiologists need to know

Over the last decade, exponential advances in computed tomography (CT) technology have resulted in improved spatial and temporal resolution. Faster image acquisition enabled renal CT angiography to become a viable and effective noninvasive alternative in diagnosing renal vascular pathologies. However, with these advances, new challenges in contrast media administration have emerged. Poor synchronization between scanner and contrast media administration have reduced the consistency in image quality with poor spatial and contrast resolution. Comprehensive understanding of contrast media dynamics is essential in the design and implementation of contrast administration and image acquisition protocols. This review includes an overview of the parameters affecting renal artery opacification and current protocol strategies to achieve optimal image quality during renal CT angiography with iodinated contrast media, with current safety issues highlighted

Crossed Unfused Ectopic Pelvic Kidneys: A Case Illustration

Crossed unfused ectopia constitutes a very rare variant of ectopic kidneys, with an approximate incidence of 1 : 75000. We hereby describe a rare case of an incidental finding of crossed unfused ectopic kidneys, in a 45-year-old gentleman incidentally found to have a bladder lesion. The unique blood supply of his kidneys has also been described. The present case also highlights the different subtypes of renal ectopia, the different embryological hypotheses behind their presentation, and the various systematic anomalies, associated with them. Variations in vasculature of ectopic kidneys have been only described in case reports and are crucial to recognize in case any further intervention is needed

Crossed Unfused Ectopic Pelvic Kidneys: A Case Illustration

Crossed unfused ectopia constitutes a very rare variant of ectopic kidneys, with an approximate incidence of 1 : 75000. We hereby describe a rare case of an incidental finding of crossed unfused ectopic kidneys, in a 45-year-old gentleman incidentally found to have a bladder lesion. The unique blood supply of his kidneys has also been described. The present case also highlights the different subtypes of renal ectopia, the different embryological hypotheses behind their presentation, and the various systematic anomalies, associated with them. Variations in vasculature of ectopic kidneys have been only described in case reports and are crucial to recognize in case any further intervention is needed

Incidence of sepsis following transrectal ultrasound guided prostate biopsy at a tertiary-care medical center in Lebanon

ABSTRACT Background Urosepsis is a rare but life-threatening complication following transrectal ultrasound (TRUS) guided needle prostate biopsy. Despite the technological and pharmacological improvements, the problem of bacterial urosepsis after prostate biopsy remains. A strategy for preventing urosepsis following TRUS prostate biopsy in areas with high prevalence of resistant strains or patients presenting risk factors is lacking. Objectives The aim of this study was to assess the prevalence of urosepsis, as well its predictors, following TRUS guided needle biopsy of the prostate in a tertiary care medical center in Lebanon. Materials and Methods We carried out a retrospective study on all patients who underwent TRUS prostate biopsy at the American University of Beirut Medical Center between January 1, 2011 and June 31, 2013. Patients’ hospital charts were reviewed. Data collected included demographic information, pre-procedure disease specific information, as well as post-procedure information. Predictors of urosepsis following TRUS were assessed. Results In total, 265 patients were included in this study, where the prevalence of urosepsis following TRUS prostate biopsy was found to be 9.4%. The significant independent predictors of urosepsis were found to be: age with an OR=0.93 (95% CI: 0.88–1.00, p-value=0.03), and hypertension comorbidity with an OR=3.25 (95% CI: 1.19–8.85, p-value=0.02). Conclusion We found a high prevalence of urosepsis among patients who have undergone TRUS prostate biopsy, and identified two significant risk factors. The results of this study highlight the importance of implementing strategies for prevention of urosepsis following TRUS prostate biopsy

Lung Density in the Trajectory Path—A Strong Indicator of Patients Sustaining a Pneumothorax during CT-Guided Lung Biopsy

Introduction: The purpose is to evaluate the prognostic significance of lung parenchymal density during percutaneous coaxial cutting needle lung biopsy (PNLB). Materials and methods: Retrospective analysis of 179 consecutive patients (106 males, 73 females; mean age 59.16 ± 16.34 years) undergoing PNLB was included. Mean lobar parenchymal lung density, mean densities anterior to the lesion and posterior to the chest wall in the needle trajectory path were measured in HU. Lesion location and needle trajectory were also measured. Fisher’s exact test and Chi-square test were conducted to analyze the categorical variables. ANOVA test was done to examine continuous and normally distributed variables. Statistical significance was considered when p < 0.05. Results: Mean lobar parenchymal lung density (p < 0.05) and mean parenchymal lung density relative to the needle trajectory path were below -800 HU in patients who sustained a pneumothorax. Increase in the number of pleural passes was significantly associated with the risk of patients having pneumothorax (p < 0.05). The mean distance from the skin to the lesion and needle trajectory angle were not statistically different among patients with and without pneumothorax (p > 0.05). Conclusion: Lobar parenchymal density and lung parenchymal density anterior to the lesion and posterior to the chest wall in the needle trajectory path could be used as predicting parameters in patients undergoing PNLB who sustained a pneumothorax. These findings can help interventional radiologist further assess risk of pneumothorax when preforming such procedure