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

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

Sexual Changes During Pregnancy in a Middle-Eastern Population

Several studies reported a progressive decrease in sexual activity, interest and enjoyment throughout pregnancy. These changes in sexual life are influenced by changes in body image, alterations in the neurological, vascular, endocrine and other systems, as well as psychological and emotional disturbances that may affect the couple's sexual relationship. The aim of our study is to understand the effect of pregnancy on sexual activity in a Middle-Eastern population, and to understand, as healthcare providers, the patient's perception of sexual activity during pregnancy. A modified Pregnancy Sexual Response Inventory questionnaire was filled by 60 pregnant women who attended the antenatal clinic or the pre-admission unit in one public and two private Lebanese hospitals. The results showed decreased levels of sexual activity, sexual desire, frequency of orgasm in women and decreased level of partnered sexual activity of the spouse during pregnancy as compared to prior to pregnancy. Pain during sexual intercourse was unchanged prior to and during pregnancy. Our study highlighted the many concerns pregnant women had about their sexual life during pregnancy. Those concerns should not be ignored by the obstetricians who should discuss sexual health matters during the antenatal visits

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