Computer tomography guided lung biopsy using interactive breath-hold control: a randomized study

BACKGROUND

Interactive breath-hold control (IBC) may improve the accuracy and decrease the complication rate of computed tomography (CT)-guided lung biopsy, but this presumption has not been proven in a randomized study.

METHODS

Patients admitted for CT-guided lung biopsy were randomized to biopsy either with (N=201) or without (N=206) IBC. Biopsy accuracy, procedure time, radiation, and complications were compared in the two groups. Predictors for pneumothorax were analyzed.

RESULTS

Procedures performed with the use of IBC (N=130) did not show higher biopsy accuracy (P=0.979) but were associated with a higher risk of pneumothorax (P=0.022) compared to procedures without the use of IBC (N=171). Overall, 50% of the biopsies were malignant, 13% were benign, and 33% were inconclusive (4% missing). Long needle time (P=0.037) and small nodule size (P=0.001) were predictors of pneumothorax.

CONCLUSIONS

The use of IBC for CT-guided lung biopsy was not an advantage for unselected patients in our care, since it did not improve the biopsy accuracy and the risk of pneumothorax was increased.

[Diagnostic imaging modalities for gallstones--where are we heading?]

External ultrasonography is the cornerstone imaging modality for the diagnosis of gallbladder stones, and it is unlikely that it will be replaced by other examination methods. Due to the complications associated with endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography and magnetic resonance cholangiopancreatography should replace this examination method in patients with a low probability of common bile duct stones. However, ERCP may be used as the first examination method in selected patients with a high probability of bile duct stones.

Fistula in ano: evaluation with low-field magnetic resonance imaging (0.1 T)

BACKGROUND

Patients suspected of having perianal suppurative disease often undergo a combination of several potentially painful, invasive procedures to establish or rule out the diagnosis. To evaluate the accuracy of low-field magnetic resonance imaging (MRI) in distinguishing patients with active anal fistulae and patients with no active fistulation we performed a retrospective study.

METHODS

Fifty-six patients suspected of having anal fistulation were evaluated in the surgical outpatient clinic. Patients were examined with low-field MRI (0.1 T; gradient echo technique, TR/TE 1,500/40 and TR/TE 115/25, +/- gadodiamide (0.1 mM/kg intravenously)) in both coronal and axial planes, using a body quadrature coil. Altogether 71 MRIs were performed. In selected patients evaluation included endoanal ultrasonography, fistulography, and/or surgery. On the basis of the combined results of all available follow-up data for 6 months after the MRI, patients were placed in groups either having active fistulation or not.

RESULTS

MRI findings agreed with the combined findings of other examinations in 54 patients. Active or possibly active fistulae were found in 36 cases, whereas 33 patients showed no active fistulae. The kappa value is 0.944 (95% confidence limits, 0.866-1.021). In two patients the MRI findings disagreed with the combined findings of the other modalities.

CONCLUSION

The use of low-field MRI of the pelvic region in the investigation of suspected perianal fistulae is a feasible, reliable, and painless examination. MRI should be considered in patients with suspected complex anal fistulae. Future prospective studies are warranted.

Frequency of unexpected multifocal metastasis in patients with acute spinal cord compression. Evaluation by low-field MR imaging in cancer patients

PURPOSE

The aim of the study was to estimate, in an acute care service, the frequency of multiple-level lesion involvement in patients with clinically suspected spinal cord compression or spinal blockage.

MATERIAL AND METHODS

Over a period of 17 months, 240 patients with symptoms of acute spinal cord compression underwent acute MR examination of the spine in a 0.1 T MR unit. The cervical spine was only added to the examination if there was clinical suspicion of cord compression above Th1.

RESULTS

In 65 (27%) of the 240 patients, involvement of at least one level was found. Of these patients, 32 (49%) showed involvement of more than one level. This high rate was surprising, since only 14 (44%) of the 32 multiple lesions had been clinically suspected. There was no correlation to age or original type of cancer.

CONCLUSION

MR accurately demonstrates the anatomy of the spine and spinal cord, showing the level and complexity of spinal lesions. Multiple lesions may be underestimated when the combination of myelography/radiculography and CT is used.

[Preoperative ultrasonic diagnosis of maldescended testis]

In 30 boys with a total of 35 maldescended testicles, the present authors found that ultrasonic examination was a useful aid in the diagnosis of maldescended testicles, including intraabdominal testicles. Ultrasonic examination is recommended preoperatively in boys with non-palpable testicles in order to provide optimal surgical intervention.