V. Latrabe

Percutaneous CT-Guided Biopsy of the Lung: Comparison Between Aspiration and Automated Cutting Needles Using a Coaxial Technique

AbstractPurpose: To compare the accuracy and complication rate of two different CT-guided transthoracic needle biopsy techniques: fine needle aspiration and an automated biopsy device. Methods: Two consecutive series of respectively 125 (group A) and 98 (group B) biopsies performed using 20–22 gauge coaxial fine needle aspiration (group A) and an automated 19.5 gauge coaxial biopsy device (group B) were compared in terms of their accuracy and complication rate. Results: Groups A and B included respectively 100 (80%) and 77 (79%) malignant lesions and 25 (20%) and 18 (21%) benign lesions. No significant difference was found between the two series concerning patients, lesions, and procedural variables. For a diagnosis of malignancy, a statistically significant difference in sensitivity was found (82.7% vs 97.4%) between results obtained with the automated biopsy device and fine needle aspiration respectively. For a diagnosis of malignancy, the false negative rate of the biopsy result was significantly higher (p <0.005) in group A (17%) than in group B (2.6%). For a specific diagnosis of benignity, no statistically significant difference was found between the two groups (44% vs 26%) but the automated biopsy device provided fewer indeterminate cases. There was no difference between the two groups concerning the pneumothorax rate, which was 20% in group A and 15% in group B, or the hemoptysis rate, which was 2.4% in group A and 4% in group B. Conclusion: For a diagnosis of malignancy when a cytopathologist is not available on-site, automated biopsy devices provide a lower rate of false negative results and a similar complication rate to fine needle aspiration.

Reproducibility of multi-detector spiral computed tomography in detection of sub-segmental acute pulmonary embolism

The aim of this study was to evaluate the inter-observer and intra-observer agreement of the diagnosis of sub-segmental acute pulmonary embolism (PE) in an inpatient population explored by 16 slice multi-detector spiral computed tomography (MDCT). Four hundred consecutive inpatients were referred for MDCT for the clinical suspicion of acute PE. One hundred and seventy seven (44.2%) had a known cardio-respiratory disease at the time of examination. Inter-observer and intra-observer agreements for the diagnosis of acute PE and of sub-segmental acute PE were assessed blind and independently by three experienced readers and by kappa statistics. Seventy-five patients were diagnosed as having acute PE findings (19.5%), and clots were located exclusively within sub-segmental arteries in nine patients (12%). When clots were limited to sub-segmental or more distal branches of the pulmonary arteries, kappa values were found to be moderate (0.56) to very good (0.85) for the diagnosis of sub-segmental acute PE, whereas for the diagnosis of acute PE in the whole population, kappa values ranged from 0.84 to 0.97. Intra-observer agreement was found to be perfect (kappa=1). MDCT is a reproducible technique for the diagnosis of sub-segmental acute PE as well as for acute PE. In this inpatient population, sub-segmental acute PE was not a rare event.

Computer tomography in pulmonary invasive aspergillosis in hematological patients with neutropenia: an useful tool for diagnosis and assessment of outcome in clinical trials.

BACKGROUND AND OBJECTIVE The exact timing of the evolution of lesion volumes of invasive pulmonary aspergillosis (IPA) on CT scan images could be helpful in the management of hematological patients but has never been evaluated in a prospective study. We analyzed the CT scan data from the prospective Combistrat trial. DESIGN AND METHODS Volumes of aspergillosis lesions from 30 patients (including 24 acute myeloid leukaemia) with probable (n=26) or proven (n=4) IPA according to the EORTC-MSG modified criteria, were measured prospectively on the thoracic CT scans at the enrolment in the study on day 0 (D0), D7, D14 and end of treatment (EOT). RESULTS For the overall population, the volume of pulmonary aspergillosis lesions increased significantly from D0 to D7 (1.6 fold; p=0.003). Then this volume decreased significantly from D7 to D14 (1.36 fold at D14 with p=0.003 for D14 vs. D7, but with p=0.56 for D14 vs. D0). At EOT (= D17, median value), the volume of lesions was significantly lower than D14 (0.76 fold the initial volume; p<0.001) but it was not significantly different when compared to D0 (p=0.11). CONCLUSIONS The results of this prospective study suggest that the sequential analysis of CT scan in neutropenic patients with IPA depicts more precisely the evolution of lesion volumes than comparison to baseline images. Moreover, the systematic use of chest CT appears to be a useful tool for diagnosis and outcome evaluation of IPA in clinical trials.

Feasibility of aortic pulse pressure and pressure wave velocity MRI measurement in young adults.

To investigate the feasibility of assessing, noninvasively, aortic pulse pressure (APP) and pulse wave velocity (PWV) in the ascending aorta of young adults by means of velocity‐encoded magnetic resonance (MR) imaging.

Percutaneous biopsy in lung cancer

This paper presents current indications, contraindications, technical aspects, complications and yield of diagnosis of percutaneous lung biopsy in the setting of lung cancer. Percutaneous lung biopsy should be performed each time that the therapeutic strategy can be significantly influenced, when the procedure is technically feasible and to patients for which the benefits outweigh the risks, that are pneumothorax and pulmonary haemorrhage. Factors identified as potentially favouring post-biopsy pneumothorax are numerous whereas the use of a needle size larger than 18 gauge is the major risk factor of bleeding. Although a coaxial system is highly suitable in any case, two categories of needles can be used; those providing aspiration and those for core biopsies. Both offer similar yields for the diagnosis of malignancy, but core biopsies are more efficient for the specific diagnosis of benignity and lymphoma. Technical improvements of guidance, needle design and pathological techniques may contribute to lower the size limit of the nodule to be biopsied, to decrease the complication rate and their severity and to increase the yield of diagnosis.

A validation of a flow quantification by MR phase mapping software

AIM We evaluated a Siemens software of flow quantification (FQ) by MR phase mapping, in the framework of a common practical use. METHODS Experiments with a laminar flow phantom and in vivo pulsatile flow were performed. In particular, FQ in ascending aorta was investigated in healthy volunteers. RESULTS AND CONCLUSION Flow phantom experiments reveal that the FQ slightly underestimates (8% on the average) actual velocities (mean velocities over a vessel area), and also that velocity uncertainties are related to the encoding velocity value, whatever the measured velocity. Furthermore, using well characterized working criteria, we found low intraobserver variability and negligible interobserver variability in ascending aorta FQs. The role played by the choice of reference area in FQ accuracy is emphasized. When recording several cardiac cycles during the same acquisition, it is shown that the FQ software may provide erroneous results. Several comments for FQ software use in the ascending aorta are added.

Ebstein Anomaly Associated With Left Ventricular Noncompaction

A 56-year-old woman with gradually progressing exertional dyspnea was referred to our hospital. She had a known diagnosis of Ebstein anomaly and patent foramen ovale since childhood. One year previously, she had presented with a transient ischemic attack that was thought to be secondary to a paradoxal embolism through the patent foramen ovale, so an Amplatzer occluder had been implanted. Clinical examination revealed a normal sinus rhythm at 56 bpm and a New York Heart Association class II dyspnea without cyanosis. ECG (Figure 1) showed a first- degree atrioventricular block with a pattern of complete right bundle-branch block. Chest radiography (Figure 2) demonstrated mild cardiomegaly and clear lung fields. Two-dimensional echocardiography showed malposition of the anterior and septal tricuspid valve leaflets with grade 2 tricuspid regurgitation. The atrial septal occluder was in correct position without residual shunt. In …

Measurement of cardiac ventricular volumes using multidetector row computed tomography: comparison of two- and three-dimensional methods

This study compared a three-dimensional volumetric threshold-based method to a two-dimensional Simpson’s rule based short-axis multiplanar method for measuring right (RV) and left ventricular (LV) volumes, stroke volumes, and ejection fraction using electrocardiography-gated multidetector computed tomography (MDCT) data sets. End-diastolic volume (EDV) and end-systolic volume (ESV) of RV and LV were measured independently and blindly by two observers from contrast-enhanced MDCT images using commercial software in 18 patients. For RV and LV the three-dimensionally calculated EDV and ESV values were smaller than those provided by two-dimensional short axis (10%, 5%, 15% and 26% differences respectively). Agreement between the two methods was found for LV (EDV/ESV: r=0.974/0.910, ICC=0.905/0.890) but not for RV (r=0.882/0.930, ICC=0.663/0.544). Measurement errors were significant only for EDV of LV using the two-dimensional method. Similar reproducibility was found for LV measurements, but the three-dimensional method provided greater reproducibility for RV measurements than the two-dimensional. The threshold value supported three-dimensional method provides reproducible cardiac ventricular volume measurements, comparable to those obtained using the short-axis Simpson based method.

Two-dimensional strain as a marker of subclinical anterior ischaemia in anomaly of left coronary artery arising from pulmonary artery

A 13-year-old boy was admitted to our department after an out-of-hospital cardiac arrest during physical exertion. Transitory ST-segment elevation in the anterior chest leads was noted after defibrillation. At 48 h, initial evaluation was performed. Twelve-lead EKG and telemetry were normal. Transthoracic echocardiography showed normal left ventricle (LV) size and global function. Segmental two-dimensional (2D) longitudinal strain of the anterior wall was significantly decreased when compared with the other segments, and was associated with post-systolic shortening. Coronary angiography and 64-slice computed tomography revealed an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). ALCAPA is a rare congenital malformation. The usual clinical course is a severe left-sided heart failure and mitral valve insufficiency presenting during the first months of life. In some cases, collateral blood supply from the right coronary artery is sufficient and symptoms may be subtle or even absent. However, ventricular arrhythmias or sudden cardiac death during exercise may be the first clinical presentation in patients with ALCAPA. Indirect evidence suggests that myocardial ischaemia is the underlying aetiology of cardiac ventricular ischaemia in patients with ALCAPA. Post-systolic shortening and altered longitudinal strain have recently been described as potential useful markers of ischaemic dysfunction in patients with ischaemic heart disease. In this case report, we demonstrate the usefulness of 2D strain as a non-invasive tool to assess subclinical myocardial ischaemia in patients with an ALCAPA. This provides further supportive evidence for the role of cardiac ischaemia in aetiology of ventricular arrhythmia in this rare condition.

Inter-reader agreement in HRCT detection of pleural plaques and asbestosis in participants with previous occupational exposure to asbestos

Objectives To investigate inter-reader agreement for the detection of pleural and parenchymal abnormalities using CT in a large cross-sectional study comprising information on individual cumulative exposure to asbestos. Methods The project was approved by the hospital ethics committee, and all patients received information on the study and gave their written informed consent. In 5511 CT scans performed in a cohort of retired workers previously exposed to asbestos and volunteering to participate in a multiregional survey programme (Asbestos Related Diseases Cohort, ARDCO), double randomised standardised readings, triple in case of disagreement, were performed by seven trained expert radiologists specialised in thoracic imaging and blind to the initial interpretation. Inter-reader agreement was evaluated by calculating the κ-weighted coefficient between pairs of expert readers and results of routine practice and final diagnosis after expert reading. Results κ-Weighted coefficients between trained experts ranged from 0.28 to 0.52 (fair to good), 0.59 to 0.86 (good to excellent) and 0.11 to 0.66 (poor to good) for the diagnosis of asbestosis, pleural plaques and fibrosis of the visceral pleura, respectively. κ-Weighted coefficients between results of routine practice and final diagnosis after expert reading were 0.13 (poor), 0.53 (moderate) and 0.11 (poor) for the diagnosis of asbestosis, pleural plaques and fibrosis of the visceral pleura, respectively. Conclusions Interpretation of benign asbestos-related thoracic abnormalities requires standardisation of the reading and trained readers, particularly for participants asking for compensation, and with a view to the longitudinal survey of asbestos-exposed workers.