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The aim of this study is to perform a systematic review and meta-analysis of published studies to evaluate the efficacy and safety of computed tomography (CT)-guided percutaneous biopsy for retroperitoneal lesions. PubMed and the Cochrane Library were searched for English-language articles published up to October 2021 and reporting findings about patients with retroperitoneal lesions who underwent CT-guided percutaneous biopsy. The outcome measures assessed in this systematic review and meta-analysis are accuracy, false negative rate, and rate of minor and major complications. Heterogeneity among studies was evaluated by testing Cochran's Q and the inconsistency index statistics. Seven studies published from 1975 to 2021 were selected for the analysis of accuracy, false negative rates, and rate of major and minor complications. The pooled accuracy of CT-guided percutaneous biopsy for retroperitoneal lesions was 93.6% [95% confidence interval (CI), 88.1-96.6%], with high heterogeneity. The pooled false negative rate was 6.3% (95% CI, 3.3-11.7%) with high heterogeneity. Pooled rates of minor and major complications were 3.7% (95% CI, 1.6-8.6%) with moderate heterogeneity and 0.7% (95% CI, 0.4-1.1%) with low heterogeneity, respectively. CT-guided percutaneous biopsy for retroperitoneal lesions has been reported to have high accuracy with a limited rate of major complications.

Aim: This study aimed to retrospectively determine the feasibility and safety of computed tomography (CT)-guided intrathoracic and bone re-biopsy for patients with non-small cell lung cancer (NSCLC)., Materials and Methods: Seventeen patients underwent CT-guided intrathoracic or bone re-biopsy for the determination of epidermal growth factor receptor (EGFR) T790M mutation and/or programmed cell death-ligand 1 (PD-L1) expression. The characteristics of each lesion, success rate of analyses, and complications were investigated., Results: Specimens from 16 out of the 17 patients were adequate for evaluation of EGFR T790M mutation and/or PD-L1 expression. The mean diameter of the lesions was 40 mm, the mean procedural time was 24 minutes, and the median number of punctures was 2. There were no significant differences in lesion characteristics and success rates between CT-guided intrathoracic and bone re-biopsies. No serious complications occurred., Conclusion: Both CT-guided intrathoracic and bone re-biopsies for patients with NSCLC were feasible and safe., (Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Purpose: To evaluate the usefulness of a method we developed to predict the ablation area at the time of CT guided radiofrequency (RF) ablation for liver tumors on a CT workstation., Material and Methods: Ten tumors (mean diameter 15.5 mm, range, 9.0-21.5 mm) in seven patients with hepatocellular carcinoma for which CT guided RF ablation was performed were subjects of this study. After advancing the electrode, plain CT was obtained. Then a simulated ball to predict the ablated area was created on the workstation. After confirming that the tumor was sufficiently within the ball, ablation was performed. The distance of the edge of the actual ablated area from that of the predicted ablated area was measured at six points in three cross-sectional directions on CT images after ablation., Results: The procedures were successfully performed without complications. No local recurrence occurred. Mean absolute value of the distance of the gap between the actual and predicted ablated areas was 3.06 ± 2.18 mm (range: 0 to 9 mm). At 29 (55.8%) points, the actual ablated area was smaller than the predicted ablated area; it was larger in 17 (32.7%), and was the same in 6 (11.5%) points., Conclusion: Our method produces an acceptable simulation during RF ablation under CT guidance.

Objective: To evaluate the one step technique compared with the Seldinger technique in computed tomography (CT) fluoroscopy-guided percutaneous drainage of abdominal and pelvic abscess., Material and Methods: Seventy-six consecutive patients (49 men, 27 women; mean age 63.5 years, range 19-87 years) with abdominal and pelvic abscess were included in this study. Drainages were performed with the one step (n = 46) and with the Seldinger (n = 48) technique between September 2012 and June 2014., Results: The technical success and clinical success rates were 95.8% and 93.5%, respectively, for the one step group, and 97.8% and 95.7%, respectively, for the Seldinger group. The mean procedure time was significantly shorter with the one step than with the Seldinger method (15.0 ± 4.3 min, range 10-29 min vs. 21.0 ± 9.5 min, range 13-54 min, p < .01). The mean abscess size and depth were 73.4 ± 44.0 mm and 42.5 ± 19.3 mm, respectively, in the one step group, and 61.0 ± 22.8 mm and 35.0 ± 20.7 mm in the Seldinger group., Conclusion: The one step technique was easier and faster than the Seldinger technique. The effectiveness of both techniques was similar for the CT fluoroscopy-guided percutaneous drainage of abdominal and pelvic abscess.

Purpose: To evaluate changes in imaging findings on CT during hepatic arteriography (CTHA) and CT during arterial portography (CTAP) by balloon occlusion of the treated artery and their relationship with iodized oil accumulation in the tumor during balloon-occluded transcatheter arterial chemoembolization (B-TACE)., Methods: Both B-TACE and angiography-assisted CT were performed for 27 hepatocellular carcinomas. Tumor enhancement on selective CTHA with/without balloon occlusion and iodized oil accumulation after B-TACE were evaluated. Tumorous portal perfusion defect size on CTAP was compared with/without balloon occlusion. Factors influencing discrepancies between selective CTHA with/without balloon occlusion and the degree of iodized oil accumulation were investigated., Results: Among 27 tumors, tumor enhancement on selective CTHA changed after balloon occlusion in 14 (decreased, 11; increased, 3). In 18 tumors, there was a discrepancy between tumor enhancement on selective CTHA with balloon occlusion and the degree of accumulated iodized oil, which was higher than the tumor enhancement grade in all 18. The tumorous portal perfusion defect on CTAP significantly decreased after balloon occlusion in 18 of 20 tumors (mean decrease from 21.9 to 19.1 mm in diameter; p = 0.0001). No significant factors influenced discrepancies between selective CTHA with/without balloon occlusion. Central area tumor location, poor tumor enhancement on selective CTHA with balloon occlusion, and no decrease in the tumorous portal perfusion defect area on CTAP after balloon occlusion significantly influenced poor iodized oil accumulation in the tumor., Conclusions: Tumor enhancement on selective CTHA frequently changed after balloon occlusion, which did not correspond to accumulated iodized oil in most cases.

Background: In preoperative lipiodol marking for small pulmonary nodules, lipiodol has a potential risk of distribution in the surrounding lung structure. There are no reports about the detailed accumulation and distribution of lipiodol., Purpose: To evaluate computed tomography (CT) findings after lipiodol marking before thoracoscopic surgery for pulmonary nodules., Material and Methods: Sixty-four consecutive CT-guided lipiodol markings for 103 nodules were performed in 55 patients. Lipiodol (0.2-0.4 mL) was injected using a 21-gauge needle near the nodule. The appearance of lipiodol spots was classified into the following three types on CT: type 1, dense; type 2, punctate; and type 3, unclear. The distribution of lipiodol was also investigated. Statistical analyses were performed on the accumulation and distribution related to nodule factors. Incidences of complications were also investigated., Results: A total of 110 markings were performed because of seven additional procedures due to insufficient marking. All nodules were successfully resected on the same day. The appearances of the lipiodol spots were type 1 (82%), type 2 (11%), and type 3 (7.3%). The areas of distribution were lung parenchyma (54%), central bronchus (39%), peripheral bronchovascular bundle (24%), needle tract (20%), pleural space (19%), another segment of ipsilateral lung (5.5%), and contralateral lung (0.9%). Distribution into pleural space and central bronchus was frequently seen in the shallow nodules (P < 0.05). Complications were pneumothorax (61%) and pulmonary hemorrhage (35%). There were no serious symptoms., Conclusion: The appearance of the lipiodol spot was dense in most cases, despite frequent distribution in the surrounding lung structures without serious complications., (© The Foundation Acta Radiologica 2015.)

Rationale and Objectives: The purpose of our study was to compare test bolus techniques using undiluted or diluted contrast material for their ability to predict aortic enhancement on coronary computed tomographic angiography (c-CTA) images., Materials and Methods: We divided 200 consecutive patients who underwent c-CTA on a 64-MDCT scanner into two groups. In group A (n = 100), we used a test bolus of undiluted contrast material and in group B (n = 100), the contrast material was diluted. The injection volume was body weight × 0.2 (contrast material 100%) in group A and body weight × 0.7 (contrast material 30%, saline 70%) in group B. We then compared the CT number in the ascending aorta on c-CTA images obtained with undiluted and diluted contrast media to the CT number on c-CTA images., Results: The mean CT number in the ascending aorta was significantly higher in group B than group A (217.1 vs. 157.4 HU, P < .001). There was a significant difference in the correlation between the CT number of the ascending aorta on c-CTA images and on images acquired with the test bolus using undiluted or diluted test bolus (P < .001). In group B, the correlation had a strong positive linear relationship (r = 0.72, P < .001), whereas in group A the positive linear relationship was weak (r = 0.36)., Conclusions: The test bolus with diluted contrast material was useful for predicting aortic enhancement before c-CTA scanning., (Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.)

Background/aims: The aim of this retrospective study was to evaluate the feasibility and treatment effects of transcatheter arterial chemoembolization (TACE) for recurrent intrahepatic hepatocellular carcinoma (HCC) after liver transplantation., Methodology: Between March 2007 and December 2012, we treated 8 patients (6 men and 2 women; mean age, 54 years) with recurrent HCC after living donor liver transplantation by TACE using an interventional-CT system. We retrospectively investigated treatment outcomes, complications, and the prognosis in these patients., Results: Overall, 17 sessions of TACE were performed. A single TACE session was performed in 4 patients while multiple TACE sessions were performed in 4 patients. Anticancer drugs and embolic agents were selectively infused from the right hepatic artery (n=7), left hepatic artery (n=1), A3 (n=1), A5 (n=1), A6 (n=1), A7 (n=2), anterior branch (n=1), posterior branch (n=3), intercostal artery (n=1), and right inferior phrenic artery (n=5). There were no procedure-related complications. Response rate was 50%. The median overall survival from the initial TACE for recurrence of HCC was 12.9 months (95% confidence interval, 5 to 21). The 1-year survival rate was 42.9%., Conclusion: TACE with an interventional-CT system could play an important role in the treatment of recurrent HCC after liver transplantation.

Objectives: This study evaluated the efficacy of the combination of imprint cytology and histology in tissue-core percutaneous biopsy under real-time computed tomography (CT) fluoroscopic guidance., Methods: Between October 2009 and June 2013, 156 percutaneous needle biopsies were performed in our institution. Those obtained by tissue-core biopsy underwent both imprint cytological and histological examinations routinely after touch imprint cytology was performed on site to evaluate the samples' sufficiency for cytological and pathological examination. Final diagnosis was confirmed by independent surgical pathology, independent culture results or clinical follow-up., Results: Rates of adequate specimens and precise diagnosis, by combined cytological and histological examination were 100 % (156/156) and 96.2 % (150/156), by cytology 94.4 % (152/156) and 83.3 % (130/156) and by histology 99.3 % (155/156) and 92.3 % (144/156). Precise diagnosis was achieved by combined examinations in 94.7 % (89/94) of thoracic lesions, 97.6 % (40/41) of musculoskeletal lesions, and 100 % (21/21) of abdominal, pelvic and retroperitoneal lesions. In all 104 lesions diagnosed as malignant by CT-guided biopsy and in 30 of 52 diagnosed as benign, specific cell types could be proved by combined examinations., Conclusions: Combined imprint cytology and histology performed after on-site touch imprint cytological evaluation improved the diagnostic ability of CT fluoroscopically guided biopsy., Key Points: • CT-guided needle biopsy is a well-established diagnostic technique. • Touch imprint cytological evaluation on site is helpful in improving quality of CT-guided biopsy. • The rate of diagnosing malignant lymphoma specifically with cytological examination is relatively low. • The rate of specific diagnosis of benign lesion in musculoskeletal regions is low.

Purpose: To evaluate the correlation between computed tomography (CT) findings after therapeutic lymphangiography for lymphatic leakage and the clinical course of lymphatic leakage., Materials and Methods: Therapeutic lymphangiography for lymphatic leakage was performed in 14 patients. In all patients, CT was performed 0.5-26 h (mean 6.9 h) after lymphangiography and results were retrospectively evaluated., Results: In 8 of the 14 patients (57 %), lymphatic leakage stopped after lymphangiography. Lymphatic leakage was detected on CT in 9 of the 14 patients (64 %) and had either a nodular (n = 4) or beaded appearance (n = 5). The amount of drainage had decreased the day after lymphangiography, and leakage finally stopped in all 4 patients in whom the leakage had a nodular appearance. However, leakage did not stop in 3 of the 5 patients having leakage with a beaded appearance., Conclusion: A nodular appearance of leakage might predict success of therapeutic lymphangiography.

Background: Reports on CT-guided percutaneous drainage within the intervertebral space for pyogenic spondylodiscitis with a secondary psoas abscess are limited., Purpose: To evaluate CT-guided percutaneous drainage within the intervertebral space for pyogenic spondylodiscitis and a secondary psoas abscess in which the two sites appear to communicate., Material and Methods: Eight patients with pyogenic spondylodiscitis and a secondary psoas abscess showing communication with the intradiscal abscess underwent CT-guided percutaneous drainage within the intervertebral space. The clinical outcome was retrospectively assessed., Results: An 8-French pigtail catheter within the intervertebral space was successfully placed in all patients. Seven patients responded well to this treatment. The one remaining patient who had developed septic shock before the procedure died on the following day. The mean duration of drainage was 32 days (13-70 days). Only one patient with persistent back pain underwent surgery for stabilization of the spine after the improvement of inflammation. Among seven patients responding well, long-term follow-up (91-801 days, mean 292 days) was conducted in six patients excluding one patient who died of asphyxiation due to aspiration unrelated to the procedure within 30 days after the procedure. In these six patients, no recurrence of either pyogenic spondylodiscitis or the psoas abscess was noted., Conclusion: CT-guided percutaneous drainage within the intervertebral space can be effective for patients with pyogenic spondylodiscitis and a secondary psoas abscess if the psoas abscess communicates with the intradiscal abscess.

We report the case of a 12-year-old boy with a huge liver tumour 20 cm in diameter with multiple lung metastases. Six months after systemic chemotherapy was initiated, all tumours had disappeared with the exception of the liver tumour and a tiny lung tumour 2.5 mm in diameter. Fluoroscopy-assisted thoracoscopic resection of the pulmonary nodule was performed to evaluate whether viable tumour tissue remained in the lung lesion. Before moving the patient to the operating room, the nodule was marked by Lipiodol under CT fluoroscopic guidance with the patient under local anaesthesia. This procedure allowed correct visualisation of the area that should be resected., (© 2011 The Authors. Journal of Medical Imaging and Radiation Oncology © 2011 The Royal Australian and New Zealand College of Radiologists.)

We describe a 71-year-old woman with a hepatocellular carcinoma who underwent percutaneous radiofrequency ablation (RF) with a single internally cooled electrode under computed tomography (CT) fluoroscopic guidance. Nine months after the procedure, CT images showed herniation of the large intestine into the right pleural cavity. To our knowledge this complication of RF performed with a single internally cooled electrode under CT guidance has not been previously reported.

Background: Various treatments for hepatocellular carcinoma (HCC) beneath the diaphragm have been reported. Transpulmonary radiofrequency (TPRF) ablation for HCC beneath the diaphragm has been developed as a safe treatment, but pneumothorax has been reported as the most common complication of TPRF ablation., Purpose: To evaluate the relationship between the incidence of pneumothorax and various variables after TPRF ablation., Material and Methods: Seventy-six TPRF ablation sessions for unresectable HCC were performed in 66 patients (19 women, 47 men; mean age 69.6 years) under computed tomography (CT)-fluoroscopic guidance between November 2005 and April 2009. All patients had HCC beneath the diaphragm, not visible by ultrasonography. In 62 of the 76 sessions, the number of transpulmonary approaches was one as adequate, while multiple transpulmonary approaches were performed in 14 of the 76 sessions. The rate of pneumothorax and risk factors for pneumothorax were investigated., Results: Among the 76 sessions, pneumothorax was detected in 51 sessions (67.1%). Among the 14 sessions with multiple transpulmonary passages, pneumothorax was detected in 13 (92.9%), while in the 62 sessions with a single transpulmonary passage, pneumothorax occurred in 38 sessions (61.3%). Hence, the number of transpulmonary approaches was a significant factor (P=0.0232). Among 13 variables investigated for the 62 sessions with a single transpulmonary approach, the only significant factor correlated with the occurrence of pneumothorax was the length of the needle trajectory through the aerated lung (P=0.0014). The incidence of chest tube placement was 7.9%., Conclusion: Pneumothorax occurred frequently after TPRF ablation for HCC. The main risk factors for pneumothorax after TPRF ablation for HCC were increased length of needle trajectory through the aerated lung and multiple transpulmonary approaches in one session. Even if pneumothorax occurred, pneumothorax disappeared spontaneously or with simple treatment such as manual aspiration in most cases.

Background: Pneumothorax is the most common complication after computed tomography (CT)-guided lung biopsy. The presence of a pneumothorax per se does not complicate patient management, but an increasing pneumothorax, making chest tube placement necessary, is highly problematic., Purpose: To evaluate the efficacy and limitations of simple aspiration of air from the pleural space to prevent increased pneumothorax and avoid chest tube placement in cases of pneumothorax following CT-guided lung biopsy., Material and Methods: The subjects of our study were 642 consecutive lung lesions in 594 patients for which percutaneous needle lung biopsies were performed using CT guidance. While patients were on the CT scanner table, percutaneous manual aspiration was performed in all patients with a non-small pneumothorax demonstrated on post-biopsy chest CT images. The frequency of pneumothorax, management of each such case, and factors influencing the incidence of worsening pneumothorax that finally required chest tube placement were evaluated., Results: Post-biopsy pneumothorax occurred in 243 of 642 (38%) procedures. Of the 243 cases, 112 were treated with manual aspiration immediately after biopsy. In 210 (86.4%), the pneumothorax had resolved completely on follow-up chest radiographs without chest tube placement. Only 33 patients required chest tube placement. Requirement of chest tube insertion significantly increased in parallel with the degree of pneumothorax as shown on post-biopsy CT images. The rate of chest tube insertion was statistically higher in subjects with values for aspirated air above 543 ml., Conclusion: Percutaneous manual aspiration of biopsy-induced pneumothorax performed immediately after biopsy may prevent worsening of pneumothorax and avoid chest tube placement. The amount of aspirated air can be predictive of the requirement for chest tube placement.

Objectives: The goal of our study was to determine the usefulness of percutaneous abscess drainage under guidance of computed tomography (CT) fluoroscopy., Materials and Methods: Our subjects were 21 patients (seven women, 14 men; mean age 64 years; age range 30-87 years) who had undergone percutaneous drainage of 26 psoas abscess lesions under CT fluoroscopic guidance between May 2001 and January 2008. Drainage methods involved a needle puncture, insertion of a guidewire, serial dilations, and the exchange of the needle with a drainage tube. The procedures were guided by use of a helical CT scanner that provided real-time fluoroscopic reconstruction., Results: Percutaneous drainage under real-time CT fluoroscopic guidance was successfully performed in every procedure. Use of real-time CT fluoroscopy allowed rapid assessment of needle, guidewire, and catheter placement. No patient had serious complications related to the drainage procedure. The mean procedure time required to drain one lesion was 35.6 +/- 13.6 min. Mean period after the drainage procedure until complete disappearance of the abscess as confirmed by CT was 12.4 +/- 10.0 days (range 3-46 days)., Conclusion: CT fluoroscopy is useful in achieving accurate and safe drainage of abnormal psoas fluid collections.

Background/aims: Radiofrequency ablation has been accepted as a safe treatment for unresectable malignant hepatic tumors. Tumors beneath the diaphragmatic dome may be difficult to visualize with ultrasonography. The aim of this study was to assess the use of transpulmonary radiofrequency ablation under real-time computed tomography-fluoroscopic guidance for hepatocellular carcinoma., Methodology: Twenty-four radiofrequency ablation treatments by means of a transpulmonary approach were performed in 22 patients under computed tomography-fluoroscopic guidance between December 2002 and April 2006. Every patient had a hepatocellular carcinoma less than 3cm in size beneath the diaphragmatic dome., Results: Transpulmonary radiofrequency ablation under real-time computed tomography-fluoroscopic guidance was successfully performed in every procedure. There was no local tumor recurrence in 22 cases (92%) on follow-up dynamic computed tomography performed an average of 8 months after radiofrequency ablation. The major complication was pneumothorax after 9 procedures (38%): pneumothorax in 6 patients had completely resolved on follow-up chest radiographs, and was treated with manual aspiration immediately after radiofrequency ablation in 3 patients, and no patients required chest-tube placement., Conclusion: Transpulmonary radiofrequency ablation under computed tomography-fluoroscopic guidance is a useful method for the accurate and safe ablation of hepatocellular carcinoma that is not detectable with ultrasonography.

Background: Changes in the relative arterial flow to hepatocellular carcinomas and adjacent normal liver with hepatic arterial epinephrine infusion were studied with CT hepatic arteriography (CTHA)., Methods: Data from 31 pathologically confirmed hepatocellular carcinomas were retrospectively analyzed in 16 patients who simultaneously underwent CT during arterial portography (CTAP) and CTHA for examination of liver tumors and then CTHA with hepatic arterial epinephrine infusion., Results: Regarding visual analysis, tumor enhancement of hepatocellular carcinomas on CTHA after hepatic arterial epinephrine injection changed as follows: more clear in 83.9% (26/31), equal in 16.1% (5/31), and less clear in 0% (0/31). As for the quantitative analysis, CT attenuation value of hepatocellular carcinomas significantly increased after injection of epinephrine (mean increase from 225.8 to 333.9 HU; P < 0.0001, paired t test). The CT attenuation value of normal liver parenchyma around a tumor significantly decreased after injection of epinephrine (mean decrease from 101.1 to 84.6 HU; P < 0.0001, paired t test). The tumor-to-liver conspicuity significantly increased after injection of epinephrine (mean increase from 124.6 to 249.2 HU; P < 0.0001, paired t test)., Conclusions: Hepatic arterial epinephrine infusion changes the relative arterial flow of hepatocellular carcinomas.

Purpose: To examine the characteristics of lung tumors for which radiofrequency (RF) ablation therapy is effective, and to determine what RF ablation parameters are effective for obtaining complete coagulation of the entire ablation zone with a single RF ablation session., Materials and Methods: Computed tomography (CT)-guided RF ablation of lung tumors was performed on 82 lesions in 34 patients between April 2003 and May 2005. Tumor characteristics and ablation parameters, including tumor size, location, and depth, and ablation duration, power deployed during ablation, and temperatures achieved were analyzed with regard to local tumor progression., Results: In all, 103 RF ablation sessions were performed on 82 tumors. As a procedure-related complication, pneumothorax occurred in 27 procedures. During the mean follow-up period of 10 months (range, 6-28 months), local tumor progression occurred in 18 (22.0%) of the 82 ablated tumors (3 months after RF ablation in 10, 6 months after RF ablation in 5, 9 months after RF ablation in 1, and 12 months after RF ablation in 2). Mean local progression-free duration was 8.7 +/- 4.5 months (range, 3-28 months). The frequency of local tumor progression was significantly correlated with size, whereas other variables had no statistical association. In tumors with a diameter > or =2.5 cm, only the period of ablation during the initial session was significantly correlated with subsequent local tumor progression (P = 0.000002, chi-square test)., Conclusion: A long duration of RF ablation is desirable for large lung tumors. The success of RF ablation is dependent upon tumor size. RF ablation treatment is most effective for lesions < 2.5 cm.

Purpose: To evaluate the usefulness of selective computed tomography (CT) angiography in preventing severe complications, such as spinal cord injury and broncho- esophageal fistula, during the transcatheter arterial embolization or infusion chemotherapy for thoracic diseases., Materials and Methods: Data from 28 patients with thoracic diseases were retrospectively analyzed in terms of selective CT angiography procedures carried out before transcatheter arterial embolization or transcatheter arterial infusion chemotherapy., Results: There were no spinal cord injuries (0/13 and 0/15) or broncho-esophageal fistula developments (0/13 and 0/15) during transcatheter arterial embolization and transcatheter arterial infusion chemotherapy, respectively., Conclusion: We conclude that selective CT angiography is potentially useful for reducing the incidence of severe complications during transcatheter arterial embolization or infusion chemotherapy for thoracic diseases.

The purpose of this study was to determine management guidelines for biopsy-induced pneumothorax with the assistance of manual aspiration, mainly based on the duration of complicated pneumothorax. Data from 388 consecutive percutaneous needle lung biopsies were examined. Patients with pneumothorax on postbiopsy chest CT images underwent percutaneous manual aspiration with an 18-G i.v. catheter. Frequency and management of biopsy-induced pneumothorax and period to its disappearance were reviewed. Postbiopsy pneumothorax occurred in 133 of 388 (34.3%) procedures. Manual aspiration in 72 of these 133 patients was carried out immediately after biopsy. The pneumothorax had resolved completely on follow-up chest radiographs without chest tube placement in 121 of the 133 pneumothoraces (91.0%). In cases requiring chest tube, the mean period from biopsy until resolution of the pneumothorax was 6.0 +/- 5.3 days, but was only 2.4 +/- 2.9 days when chest tube placement was not needed. Specifically, time until recovery was short both in those not requiring manual aspiration (2.1 +/- 3.4 days) and in those with a pneumothorax that disappeared completely or almost completely after manual aspiration (1.9 +/- 2.0 days). The almost equally short recovery periods in patients not requiring manual aspiration and those requiring immediate manual aspiration indicates the value of rapid management.

Background/aims: The goal of our study was to assess the use of real-time computed tomography-fluoroscopy guidance for percutaneous drainage of abnormal thoracic, abdominal, and pelvic fluid collections., Methodology: The subjects were 32 patients who underwent 36 percutaneous computed tomography-fluoroscopy guided thoracic, abdominal, and pelvic drainage procedures to drain abscess (n=29), fluid collection after pancreatitis (n=3), lymphocyst after gynecological surgery (n=3), and the gallbladder transhepatically (n=1) between September 1997 and August 2003. The patient population was 28-86 years old and consisted of 19 men and 13 women. The drainage methods included a Seldinger's technique with a guidewire and serial dilators in every case. The procedures were guided by using a helical computed tomography scanner that provided real-time fluoroscopy reconstruction., Results: Percutaneous drainage under real-time computed tomography-fluoroscopy guidance was successfully performed in every procedure. Real-time computed tomography-fluoroscopy allowed rapid assessment of needle, guidewire, dilator, and catheter placement. The only drainage-induced complication encountered was a subcutaneous hematoma after one procedure (2.8%). No patients had serious complications. The average procedure time was 32 minutes., Conclusions: Computed tomography-fluoroscopy is a useful method for guiding the accurate and safe drainage of abnormal thoracic, abdominal, and pelvic fluid collections.

Purpose: The goal of this study was to evaluate the efficacy of simple aspiration of air from the pleural space to prevent increased pneumothorax and avoid chest tube placement in cases of pneumothorax after computed tomography (CT)-guided lung biopsy., Materials and Methods: This retrospective study was based on experience with 283 consecutive percutaneous needle lung biopsies with real-time CT fluoroscopic guidance. While patients were on the CT scanner table, percutaneous manual aspiration was performed in all those with moderate or large pneumothorax demonstrated on postbiopsy chest CT images regardless of symptoms. The authors evaluated the frequency of biopsy-induced pneumothorax, management of each such case, and factors that influenced the incidence of worsening pneumothorax that required chest tube placement despite manual aspiration., Results: Of the 104 (36.7%) pneumothoraces occurring after 283 biopsy procedures, 52 were treated with manual aspiration immediately after biopsy. In 95 of the 104 pneumothoraces (91.3%), the pneumothorax had resolved completely on follow-up chest radiographs without chest tube placement. Only nine patients (3.2% of the entire series; 8.7% of those who developed pneumothorax) required chest tube placement. Requirement of chest tube insertion significantly increased parallel to the increased volume of aspirated air. The optimal cutoff level of aspirated air on which to base a decision to abandon manual aspiration alone and resort to chest tube placement was 543 mL., Conclusion: Percutaneous manual aspiration of biopsy-induced pneumothorax performed immediately after biopsy may prevent progressive pneumothorax and eliminate the need for chest tube placement. However, in cases in which the amount of aspirated air is large (such as more than 543 mL in this study), the possibility of required chest tube placement increases.

Objectives: The present study was performed to evaluate the efficacy and safety of gantry tilting for the performance of lung biopsy of peripheral small lesions located beneath the rib., Design: Interventional., Materials and Methods: Our study was based on 22 of 237 lesions for which percutaneous needle biopsies of the lung were performed under CT scan-fluoroscopic guidance at our institution between January 2000 and August 2002. For these 22 lesions, a biopsy was performed with gantry tilt because a rib blocked the biopsy route even after trials to change the relationship between the target and the rib. The characteristics of each lesion, the success rate for obtaining an adequate specimen, and the ability to determine whether the lesion was malignant or benign were investigated, specific cell types were characterized, and the complications that were encountered were identified., Results: In all 22 lesions, adequate specimens for cytopathologic evaluation were obtained using fine-needle aspiration biopsy, tissue core biopsies, or both. In 21 lesions, whether the lesion was malignant or benign was precisely diagnosed, and in 19 lesions the specific cell type was determined. No serious complications occurred., Conclusion: Percutaneous needle biopsy under CT scan-fluoroscopic guidance with gantry tilt is a useful and safe technique for the biopsy of small lung nodules located beneath the rib.

Very few functional neuroimaging studies have been performed on patients with obsessive-compulsive disorder (OCD) undergoing behavior therapy, even though it is recognized to be an effective treatment for this disorder. We measured the regional cerebral blood flow (rCBF) using the Xenon inhalation method in 31 treatment-refractory patients with OCD and the same number of age-matched normal controls. We also studied changes in rCBF in 22 OCD patients who had demonstrated a significant improvement after the behavior therapy. The OCD patients showed a significant bilateral elevation in the rCBF in the basal ganglia compared with the normal controls. After successful treatment, a significant decrease was found in the rCBF in the right head of the caudate nucleus that tended to correlate with clinical improvement.

Objectives: The goal of our study was to evaluate the efficacy and safety of a new type of automated cutting needle for tissue-core lung biopsy under real-time CT fluoroscopic guidance., Design: Observational, Materials and Methods: One hundred ten percutaneous needle tissue-core lung biopsies were performed with the Auto Surecut needle (Create Medic; Yokohama, Japan) under CT fluoroscopic guidance, and the specimens obtained underwent histopathologic evaluation. A final diagnosis was confirmed by independent surgical pathology., Results: The rate of success for the diagnosis for specimens that were adequate for histopathologic analysis was 94.5% (104 of 110 specimens). The sensitivity, specificity, and accuracy in diagnosing malignancy were 95.1%, 100%, and 96.2%, respectively. A specific cell type could be characterized in 95.2% of those 104 lesions (99 lesions; malignant, 76 lesions; benign, 23 lesions). The specific cell type was precisely diagnosed, and was confirmed after surgery in 65 malignant lesions and 23 benign lesions. The biopsy-induced complications encountered were pneumothorax in 34.5% (38 of 110 patients) and hemoptysis in 6.4% (7 of 110 patients). No patient had a serious complication., Conclusion: CT fluoroscopy-guided lung biopsy using the Auto Surecut needle provides a high degree of diagnostic accuracy, allows for the specific characterization of lung nodules, and can be performed safely.

Objective: The goal of our study was to evaluate the efficacy of the combined use of fine-needle aspiration and tissue core biopsy under real-time CT fluoroscopy guidance., Subjects and Methods: One hundred thirty-eight percutaneous needle lung biopsy samples were obtained by two methods. The samples obtained by tissue fine-needle aspiration underwent cytologic evaluation, and those obtained by core biopsy using an automated cutting needle underwent histologic evaluation. The final diagnosis was confirmed by independent surgical pathologic findings, independent culture results, or clinical follow-up., Results: Rates of adequate specimens obtained and of precise diagnosis by combined use of fine-needle aspiration and core biopsy were 97.1% (134/138) and 94.2% (130/138) evaluated lung lesions, respectively, whereas those rates were 84.8% (117/138) and 79.7% (110/138) by fine-needle aspiration alone and 91.3% (126/138) and 89.1% (123/138) by core biopsy alone, respectively. Precise diagnosis was achieved by the combined use of the techniques in 30 (93.8%) of 32 lesions ranging from 3 to 10 mm in diameter, 42 (93.3%) of 45 lesions ranging from 11 to 20 mm, 43 (93.5%) of 46 lesions ranging from 21 to 30 mm, and 100% of 15 lesions ranging from 31 to 100 mm. In 89 of 90 lesions shown to be malignant by CT-guided lung biopsy and 30 of 44 shown to be benign, specific cell types could be proven from specimens obtained by the combined use of the two different types of needle biopsy., Conclusion: The combined use of fine-needle aspiration and core biopsy improves the diagnostic ability of CT fluoroscopy-guided lung biopsy, even in small lesions.

Purpose: To determine whether the location and size of sentinel lymph nodes (SLN) on CT are predictive of the axillary lymph node status in patients with breast cancer., Material and Methods: Forty patients with confirmed breast cancer underwent 5-mm CT of both breasts and axillae and the most inferior lymph node in the affected axilla was designated the SLN. Based on CT assessment of the axillary lymph node status, 22 (55%) patients then underwent dye- and gamma probe (DGP)-guided SLN biopsy followed by axillary dissection; 18 (45%) underwent dissection without prior SLN biopsy. The localization and status of the SLN determined on CT and by DGP-guided biopsy were compared. Biopsied and excised nodes were subjected to histopathologic examinations., Results: All SLN identified on CT were close to the lateral thoracic artery and their localization corresponded well with SLN identified by the DGP-guided method. The positive predictive value of CT diagnosis was 100%. Histopathologic examination of excised nodes confirmed that none of the SLN biopsies was false-negative., Conclusion: Our CT criteria were highly accurate for identification and diagnostic assessment of SLN and useful for evaluating the axillary status in patients with breast cancer.

Objectives: To evaluate the efficacy of simple aspiration of air from the pleural space to prevent increased pneumothorax and to avoid chest tube placement in cases of pneumothorax following CT-guided lung biopsy., Design: Observational., Materials and Methods: One hundred thirty-four consecutive percutaneous needle lung biopsies using real-time CT fluoroscopy guidance formed the basis of our study. All patients that demonstrated moderate or severe pneumothorax on postbiopsy chest CT images underwent percutaneous manual aspiration regardless of symptoms while on the CT scanner table. Correlation between the incidence of pneumothorax after biopsy and many factors (i.e., gender, age, number of pleural passes, presence of emphysema, lesion size, and lesion depth) were determined, and management of each case of biopsy-induced pneumothorax was reviewed., Results: Postbiopsy pneumothorax occurred in 46 of 134 procedures (34.3%). Twenty of the 46 patients were treated by manual aspiration, while 26 patients were simply observed. In 43 of the 46 pneumothoraces (93.5%), the pneumothorax resolved completely on follow-up chest radiographs without requiring tube placement. Only three patients (2.2% of the entire series; 6.5% of those who had pneumothorax develop) required chest tube placement. The risk of pneumothorax significantly increased with lesion size and depth., Conclusion: Results of our nonprospective, nonrandomized study suggest that percutaneous manual aspiration of biopsy-induced pneumothorax performed immediately after biopsy may prevent progressive pneumothorax and subsequent chest tube placement.

Purpose: To investigate nontumorous abnormalities in the liver around the falciform ligament as revealed by arteriography and helical CT arterial portography (CTAP) and helical CT during hepatic arteriography (CTHA)., Material and Methods: One hundred and seventeen patients simultaneously underwent hepatic arteriography and CTAP and CTHA of the common hepatic artery. The number, size, and shape of nontumorous defects of portal perfusion in the liver adjacent to the falciform ligament on CTAP as well as the nontumorous contrast enhancement in the same area on CTHA were determined. In 1 case, in which nontumorous enhancement was observed on CTHA, selective arteriography from the gastric arteries was performed., Results: On CTAP a nontumorous area of decreased portal perfusion of the liver around the falciform ligament was detected in 18 (15.4%) of the 117 patients, while nontumorous enhancement on CTHA was seen in 7 (6.0%). In 4 patients, both of these nontumorous abnormalities were observed. In the patient undergoing selective gastric arteriography, nonportal venous inflow to the liver in the direction to the liver adjacent to the falciform ligament was seen., Conclusion: One cause of nontumorous vascular abnormalities adjacent to the falciform ligament as shown on angiographic helical CT is aberrant gastric venous inflow to this region.

Objective: The purpose of our investigation was to determine if injection of prostaglandin E(1) during CT hepatic arteriography could help physicians to distinguish tumors from nonportal venous flow-related pseudolesions in the region of the gallbladder fossa., Subjects and Methods: In 34 patients who underwent CT during arterial portography to detect liver tumors, CT hepatic arteriography was performed before and after prostaglandin E(1) injection via the superior mesenteric artery. Between each study, an interval of 10 minutes was set. On CT hepatic arteriogram obtained 15 to 20 sec after prostaglandin E(1) injection, we distinguished changes in the size and shape of pseudolesions in the liver around the gallbladder as well as those of 42 tumorous lesions. In addition, we measured the change in CT attenuation of pseudolesions., Results: The size of the enhanced area of pseudolesions visible on CT hepatic arteriography decreased in 69% (25/36) of the pseudolesions after intraarterial prostaglandin E(1) injection, with the mean diameter diminishing from 14.1 mm to 8.8 mm. Notably, in 11 pseudolesions, the enhanced area disappeared. In 86% (31/36), the CT attenuation decreased with the mean attenuation, diminishing from 211.3 H to 163.8 H. However, the size and shape of the enhanced area of tumorous lesions did not change., Conclusion: The hemodynamic features of pseudolesions on angiographically assisted helical CT scans caused by cholecystic venous inflow are easily influenced by increased portal venous flow. Consequently, pseudolesions around the gallbladder usually can be distinguished from tumorous lesions by adding prostaglandin E(1) injection via the superior mesenteric artery during CT hepatic arteriography.

Aims: The purpose of our study was to evaluate the observer performance with combined helical CT during arterial portography (CTAP) and biphasic CT hepatic arteriography (CTHA) in the pre-operative detection of malignant hepatic tumours., Methods: Computed tomography images obtained in 41 patients with suspected hepatic tumours were retrospectively reviewed. In a blind fashion, three off-site, independent radiologists reviewed CTAP and early-phase CTHA combined for the first review, then late-phase CTHA was added for the second review. Statistical analysis was conducted on lesion-by-lesion and segment-by-segment bases; a total of 328 liver segments including 65 segments with 74 malignant hepatic tumours ranging in size from 5 to 100 mm (mean, 21.4 mm) were analysed., Results: Sensitivity for detection of liver segments harbouring tumours of CTAP and biphasic CTHA combined (82%) was identical to that of CTAP and early-phase CTHA combined (82%). Specificity of CTAP and biphasic CTHA combined (93%) was greater than that of CTAP and early-phase CTHA combined (90%, P < 0.005). The mean confidence level for the 74 tumours significantly increased by adding late-phase CTHA (P < 0.0005). The mean confidence level for 100-142 benign perfusion abnormalities detected with CTAP and early-phase CTHA combined significantly decreased by adding late-phase CTHA (P < 0.0005)., Conclusion: By combining late-phase CTHA with CTAP and early-phase CTHA information, the specificity for the detection of malignant hepatic tumours rises significantly, allowing more accurate preoperative tumour detection., (Copyright 2001 The Royal College of Radiologists.)

Background: To investigate nontumorous focal enhancement (FE) with computed tomographic hepatic arteriography (CTHA) and perfusion defect (PD) with computed tomographic arterial portography (CTAP) in pericystic liver tissue., Methods: Incidence, shape, and size of nontumorous FE on CTHA and PD on CTAP were examined in 100 consecutive noncirrhotic and 100 consecutive cirrhotic patients., Results: FE was observed on CTHA in 77 noncirrhotic and 61 cirrhotic patients, whereas PD was observed on CTAP in 50 noncirrhotic and 51 cirrhotic patients. When both findings were visualized in both CT studies, the shape of the FE on CTHA was similar to the overlapping PD on CTAP in 81% of patients but was larger in 92% of patients., Conclusions: FE on CTHA and PD on CTAP are frequently noted in pericystic liver tissue. The size of FE on CTHA is often larger than PD on CTAP, although the shapes are generally the same. Size discrepancy suggests the presence of both portal supply and splanchnic venous drainage.

The correlation between an aberrant pancreaticoduodenal vein and a portal perfusion defect in the dorsal part of segment IV as demonstrated on CT arterial portography (CTAP) was investigated. 14 patients with non-tumorous defects of portal perfusion in the dorsal part of segment IV of the liver parenchyma, shown on CTAP underwent CT during pancreaticoduodenal arteriography. The defect on CTAP was shown as an enhanced area resulting from non-portal venous inflow in eight (57%) of 14 patients on CT during pancreaticoduodenal arteriography. In conclusion, the non-portal venous supply via an aberrant pancreaticoduodenal vein occasionally causes a defect of portal perfusion in the dorsal part of segment IV on CT arterial portography.

Objective: We investigated the cause of nontumorous defects of portal perfusion in the hepatic hilum revealed by CT during arterial portography (CTAP)., Materials and Methods: One hundred sixty patients who simultaneously underwent CTAP and CT during hepatic arteriography of the common hepatic artery formed the basis of our study. The frequency, site, and shape of nontumorous defects of portal perfusion in the hepatic hilum on CTAP and the findings on CT during hepatic arteriography were determined. In 13 patients in whom nontumorous portal perfusion defects were observed on CTAP, CT was performed during selective angiography via the gastric artery, pancreaticoduodenal artery, or both., Results: Nontumorous defects of portal perfusion were detected in 49 regions in 33 of the 160 patients (dorsum of segment IV, n = 30; dorsum of the lateral segment, n = 11; segment I, n = 8). Of the 33 patients, 16 had two defects each. Of the 49 nontumorous defects of portal perfusion, 38 showed enhancement on CT during hepatic arteriography. In the 13 patients who underwent CT during selective arteriography, enhancement due to nonportal venous inflow was seen in 16 of the 19 areas of decreased nontumorous portal perfusion (dorsum of segment IV, nine of 11; dorsum of the lateral segment, four of five; segment I, three of three)., Conclusion: The main cause of nontumorous defects of portal perfusion in the hepatic hilum revealed by CTAP is decreased portal inflow due to nonportal supply via the parabiliary venous system. Thus, such lesions were also enhanced at a high frequency on CT during hepatic arteriography.

The enhancement pattern of hepatic metastases from colorectal cancer on CT arteriography (CTA) was evaluated in 79 cases with 405 lesions. Sixty-two percent of overall lesions irrespective of size showed ring-like enhancement, and 33% of lesions less than 1 cm in diameter showed homogeneous enhancement. In pathological examination of 59 resected lesions, the enhancement pattern on CTA had a good correlation with the extent of tumor cellularity, necrosis or fibrosis in the lesions. And in 8.5% of resected lesions, the extent of enhancement on CTA was larger than that of perfusion defect on CT arterial portography, which was almost equal to the size in the resected specimen. In such lesions, the enhancement on CTA might include enhancement of normal hepatic parenchyma around the lesion.