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Aim: To evaluate the accuracy and complications of computed tomography (CT)-guided core needle biopsy (CNB) of small (≤20 mm) subpleural pulmonary lesions with the use of the long transpulmonary needle path., Materials and Methods: A retrospective study was undertaken comprising 235 patients who underwent CT-guided CNB of small (≤20 mm) subpleural pulmonary lesions. One of two needle paths was used: a long (≥10 mm) transpulmonary needle path (n=164, group A) or a short (<10 mm) transpulmonary needle path (n=71, group B). Diagnostic accuracy, pneumothorax, and bleeding rates were compared between the two groups., Results: The diagnostic accuracy in group A was significantly higher than that in group B (93.9% versus 81.7%, p=0.004), particularly in patients with 5-10 mm lesions (89.2% versus 53.3%, p=0.013). The mean length of the transpulmonary needle path was 23.9 mm in group A and 5.9 mm in group B (p<0.001). The mean number of pleural punctures in group A was 1.01 and 1.11 in group B (p=0.016), but for patients with more than one puncture, the short transpulmonary path was not associated with a higher accuracy rate. The incidence of bleeding was 22% in group A and 9.9% in group B (p=0.028)., Conclusion: Diagnostic accuracy for small subpleural pulmonary lesions with the use of the long transpulmonary needle path was higher than that with the use of the short transpulmonary needle path, especially for 5-10 mm lesions; however, the long transpulmonary needle path was associated with a higher rate of bleeding., (Copyright © 2019. Published by Elsevier Ltd.)

Aim: To assess the diagnostic value of the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) of diffusion tensor imaging (DTI) at several anatomical locations in patients with carpal tunnel syndrome (CTS) to explore the optimal parameters and measurement location., Materials and Methods: A search was conducted using the PubMed, EBSCO, Ovid, Web of Science, and Cochrane databases to identify articles relevant to this study published before September 2017. Studies were selected and included according to strict eligibility criteria. Mean differences (MD) and 95% confidence intervals (CIs) were used to compare FA and ADC values between CTS patients and healthy subjects. Potential publication bias was investigated., Results: Eleven studies involving 349 CTS wrists and 278 controls were selected for the meta-analysis. A notable MD: was found for lowered FA at the level of the pisiform bone for CTS versus controls (MD: -0.11, 95% confidence interval [CI]: -1.14 to -0.07, z=5.83, p<0.001). A higher ADC was found at the pisiform bone and hamate bone levels for CTS versus controls (P: MD: 0.15, 95% CI: 0.10 to 0.20, z=5.98, p<0.001, H: MD: 0.15; 95% CI: 0.09 to 0.21, z=4.67, p<0.001)., Conclusions: The meta-analysis demonstrated a significant FA reduction and ADC increase in CTS patients. This result supports the use of DTI parameters in differentiating CTS patients from health subjects. The anatomical site for FA at the pisiform and ADC at the pisiform and hamate levels were more accessible than other sites for the diagnosis of CTS patients., (Copyright © 2018 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Aim: To determine whether the use of normal saline for sealing the needle track can reduce the incidence of pneumothorax and chest tube placement after computed tomography (CT)-guided lung biopsy., Materials and Methods: A prospective, randomised, controlled trial enrolling 322 patients was conducted. All patients were randomly assigned to one of two groups: those in whom the needle track was not sealed with normal saline (n=161, Group A) and those who did receive normal saline (n=161, Group B). CT-guided biopsy was performed with coaxial technique. Normal saline, which ranged from 1-3 ml, was injected while the trocar needle was being withdrawn. Patient characteristics, lesion, and procedure variables were analysed as potential risk variables for occurrence of pneumothorax and chest tube placement., Results: The incidence of pneumothorax was 26.1% in Group A and 6.2% in Group B (p<0.001). Nine patients in Group A and one patient in Group B required chest tube placement (p=0.010). Using multiple logistic regression analysis, smaller lesion size, greater needle-pleural angle, longer lesion-pleural distance, presence of emphysema, and no sealing the needle track with normal saline were significantly associated with an increased risk of pneumothorax, and that the latter three factors were also associated with an increased risk of pneumothorax requiring chest tube placement., Conlusion: Normal saline for sealing the needle track significantly reduces the incidence of pneumothorax and prevents subsequent chest tube placement after CT-guided lung biopsy., (Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Aim: To evaluate the factors influencing diagnostic yield of computed tomography (CT)-guided percutaneous core needle biopsy (CNB) for bone lesions., Materials and Methods: Between September 2005 and July 2011, 162 consecutive CT-guided CNB procedures were performed in 155 patients. The variables analysed were age, sex, lesion location, lesion type, lesion size, specimen size, biopsy needle gauge, and individual radiologist. The factors influencing diagnostic yield of CT-guided percutaneous CNB for bone lesions were determined by multivariate analysis of variables., Results: The diagnostic yield was 81.5%. Diagnostic yield was 89.9% for lytic bone lesions and 48.5% for sclerotic bone lesions (p < 0.001), and 89.2% for lesions ≥3 cm and 73.4% for lesions <3 cm (p = 0.010). The significant factors influencing diagnostic yield of CT-guided percutaneous CNB for bone lesions were lesion type [p < 0.001; odds ratio (OR) for a lytic lesion was approximately 12 times higher than that for a sclerotic lesion; 95% confidence interval (CI): 4.22-34.01], and lesion size (p = 0.012; OR for a lesion size ≥3 cm was about five-times higher than that for a lesion size <3 cm; 95% CI: 1.42-16.71)., Conclusion: Lesion type and lesion size are determining factors in diagnostic yield. The higher diagnostic yield is correlated with lytic lesion and lesion size ≥3 cm., (Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Aim: To assess the accuracy and risk factors for complications of computed tomography (CT)-guided percutaneous core needle biopsy (CNB) for small (≤20 mm) pulmonary lesions., Materials and Methods: A retrospective study was undertaken comprising 169 patients who underwent CT-guided CNB for small (≤20 mm) pulmonary lesions. To assess the accuracy of the procedure, the diagnosis at biopsy was compared with the diagnosis after definitive surgery or clinical follow-up. The risk factors for pneumothorax and bleeding were determined by multivariate analysis of variables., Results: The overall diagnostic accuracy was 93.5%. The sensitivity for malignancy and specificity for benign lesions were 90.4% and 100%, respectively. Positive and negative predictive values were 100% and 83.3%, respectively. Twenty-five patients (14.8%) had pneumothorax after CT percutaneous CNB of the lung. The significant risk factors affecting the incidence of pneumothorax were lesion-pleural distance (p = 0.008) and needle-pleural angle (p = 0.012). The highest rate of pneumothorax correlated with a lesion-pleural distance ≥21 mm (OR = 18.46; 95%CI: 2.27-149.95) and a needle-pleural angle ≥51° (OR = 8.22; 95%CI: 2.14-31.49). Bleeding occurred in 30 patients (17.8%). The only significant risk factor affecting the incidence of bleeding was lesion-pleural distance (p = 0.011). The highest bleeding rate correlated with a lesion-pleural distance ≥21 mm (OR = 7.93; 95%CI: 1.73-36.43)., Conclusion: CT-guided percutaneous CNB of small (≤20 mm) pulmonary lesions provides high diagnostic accuracy with acceptable complications. A lesion-pleural distance of ≥21 mm and needle-pleural angle of ≥51° are identified as the risk factors for highest pneumothorax rate. In addition, the needle-pleural angle is a novel predictor of pneumothorax. A lesion-pleural distance of ≥21 mm is also identified as a risk factor for the highest bleeding rate., (Copyright © 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)