CT-guided Percutaneous Aspiration Research Articles

To investigate the factors influencing the diagnostic accuracy in CT-guided percutaneous transthoracl aspiration biopsy of lung lesions

目的 探讨影响CT引导下肺内病变穿刺活检诊断正确率的因素.方法 回顾肺内病变(有手术病理、临床随访)CT引导下穿刺活检870例,应用单因素统计分析和多元素多逐步Lgistic回归分析方法,分析病灶良恶性、大小、位置及有无坏死空腔,操作者熟练程度,患者的体位、性别、年龄、有无肺气肿对诊断正确率的影响.结果 (1)870例病变最终诊断578例为恶性;298例为良性,CT引导下穿刺活检诊断正确为85.1%(746/870).单因素统计分析显示CT引导下穿刺活检对良、恶性病变诊断正确率分别为79.9%(238/298)和91.2%(527/578),诊断正确组和非正确组病灶大小分别为(3.76±1.74)cm 和(3.08±1.35)cm(F=13.79,P=0.0002).(2)应用多元素逐步Logistic回归分析病灶良、恶性,有无坏死、出血,被列入回归方程.结论 病灶的良、恶性和病灶内有无坏死、出血,是影响(CT引导下肺内病变穿刺活检诊断正确率的主要因素。

The Recurrent Psoas Abscess Caused by Two Different Pathogens - A Case Report -

We report a case of a recurrent psoas abscess caused by two different pathogens. The abdominal CT scans revealed a multiseptated cystic mass along the right psoas-iliacus muscle. The patient was treated with antibiotics treatment in combination with CT-guided percutaneous aspiration and drainage using a catheter. The microbiological examination revealed Klebsiella pneumoniae. Six months later, the patient presented with anorexia, malaise, epigastric pain, lower back pain and fever of 37.8oC for a one-week duration. The abdominal CT scans revealed an abscess cavity on the inferior side of the right psoaos-iliacus muscle. This was accompanied by retrocecal appendicitis and a periappendiceal abscess. Magnetic resonance imaging of the pelvis showed that the psoas abscess was located on the right psoas-iliacus muscle. We performed an appendectomy and laparotomy. Subsequently, the culture yielded Escherichia coli in the psoas abscess. To our knowledge, this is the first case of a recurrent psoas abscess caused by two different pathogens.

Ungewöhnliche Ursache eines Leberabszesses

Right upper quadrant pain with chronic malaise and fever can be the clinical manifestation of a hepatic infection. An uncommon cause for the disease is hepatic actinomycosis. Actinomycosis was common in the preantibiotic era but is less frequent nowadays; consequently its timely recognition has become more difficult. The clinical and radiological findings often resemble other inflammatory and neoplastic lesions. We report a case of a mixed anaerobic liver abscess including fusobacteria and actinomycetes, without apparent predisposing factor. The diagnosis was obtained by CT-guided percutaneous aspiration of the hepatic mass, where microscopy revealed the presence of fusiform gramnegative bacteria and gram-positive branching filamentous rods consistent with Actinomyces species. The latter did not grow in culture, while the gram negatives were identified as fusobacterium nucleatum. The diagnosis of actinomycosis of the liver is confirmed in only a minority of cases by culture. The disease is usually treated with an extended course of antibiotics. Penicillin is the preferred choice.

Diagnostic yield of CT-guided percutaneous aspiration procedures in suspected spontaneous infectious diskitis.

To evaluate the diagnostic yield of computed tomography (CT)-guided percutaneous needle aspiration procedures in the setting of suspected spontaneous infectious diskitis and to assess the usefulness of concurrent cytologic examination as a supplement to microbiologic evaluation. A retrospective study was performed to evaluate 105 consecutive CT-guided percutaneous disk space aspiration procedures in 92 patients suspected of having spontaneous (non-postoperative) infectious diskitis. Our criterion standard for the presence of active infection was the identification of a pathogen either from the CT-guided aspiration specimen or from a surgical specimen. All cases had microbiologic analysis, 78 cases had cytopathologic analysis, and 31 cases had open surgery. Microbiologic analysis of the CT-guided percutaneous aspiration specimens was positive in 39 of 43 cases proved to have active infections, with four false-negative and no false-positive cases (sensitivity, 91%; specificity, 100%). The false-negative cases were all active fungal infections identified from surgical specimens. Adding cytopathologic analysis to microbiologic analysis improved sensitivity but reduced specificity. The most common pathogens were species of Staphylococcus, Streptococcus, Candida, and Mycobacterium. All 30 active bacterial infections were identified with the CT-guided procedures, but only five of nine fungal infections were identified. CT-guided percutaneous needle aspiration is an accurate method for identifying active bacterial disk space infections but is less reliable for identifying fungal infections.

Labeled granulocyte scanning for the diagnosis of infected necrosis in acute pancreatitis: what kind of labeling should be used?

Clinical and laboratory data or imaging results cannot provide a positive diagnosis of septic complications of pancreatic and peripancreatic necrosis in patients with acute pancreatitis. Confirmation can be obtained only after percutaneous computed tomography (CT)-guided aspiration of the necrotic tissues or fluid collection; although the important role of 99Tc(m)-HMPAO-labeled granulocyte scintigraphy has been recently emphasized. The aim of this study was to determine the sensitivity and specificity of 99m-technetium-hexamethylpropyleneamine oxime (99Tc(m)-HMPAO)- or 111In-oxine-labeled granulocyte scintigraphy for the diagnosis of infection in pancreatic or peripancreatic necrosis to define the ideal label for diagnosis. Thirty-six scintigraphic examinations were performed in 34 consecutive patients (mean age, 58 +/- 2 years) 20 +/- 2 days after the onset of acute pancreatitis (Balthazar classes A-C, n = 7; classes D and E, n = 29). The scintigraphic study included scintigraphic tomography and static acquisition 1 and 3 h, respectively, after reinjection of the autologous 99Tc(m)-labeled granulocytes and static images 3-4 and 24 h after the simultaneous reinjection of 111In-oxine-labeled autologous granulocytes. The diagnosis of infected pancreatic or peripancreatic necrosis was confirmed with percutaneous CT-guided aspiration (14 positive aspirates among 20 performed) and sterile necrosis after negative aspiration (6 negative aspirates) or after a 6 +/- 1-month follow-up free of clinical or biological signs of ongoing sepsis. The sensitivity and specificity were 86 and 73%, respectively, for scintigraphic tomography, 100 and 55% for 3-h 111In images, 93 and 68% for 3-4-h 111In images, and 100 and 64% for 24-h 111In images. The fall in splenic activity between the 3-4 and the 24-h 111In images was 26 +/- 3% in patients with septic pancreatic and peripancreatic necrosis (n = 14) and 16 +/- 3% in those with sterile necrosis (n = 22) (p < 0.01). Labeled granulocyte scintigraphy was thus shown to be an effective tool for the diagnosis of infection in pancreatic and/or peripancreatic necrosis due to acute pancreatitis, especially when the scintiscans are performed early after injection of 99Tc(m) or when the fall in splenic activity over the 24 h following reinjection of 111In is measured in particularly difficult cases. These promising preliminary results should be confirmed by a prospective study.

INFECTIONS COMPLICATING SEVERE PANCREATITIS

Infections accompanying severe pancreatitis are secondary and of three types: infected pancreatic necrosis, infected pseudocyst (including peripancreatic fluid collection), and pancreatic abscess. The first is an earlier, more morbid process, with antibiotics supportive and surgical debridement necessary. The latter two processes occur later in the course of pancreatitis and are less morbid. Antibiotics are supportive and invasive-nonsurgical drainage methods are possible. The decision for intervention is based first on clinical toxicity as determined by an overall assessment by the clinician. The presence of parenchymal necrosis is best determined by the dynamic bolus CT scan. The presence of infection is best determined by percutaneous CT-guided aspiration. Infected necrosis is fatal unless treated with operative intervention. A peripancreatic fluid collection, pseudocyst, or pancreatic abscess needs to be treated if symptomatic. If infected, as determined by CT-guided needle aspiration, then they should be drained. Radiologic or endoscopic invasive-nonsurgical methods are tried initially and then surgery is attempted if they fail. The nonsurgical methods are most successful with pancreatitis of a nonbiliary or a nonalcohol etiology.

CT-Guided Percutaneous Drainage and Fluid Aspiration in Intensive Care Patients

CT-Guided Percutaneous Drainage and Fluid Aspiration in Intensive Care Patients

CT-Guided Percutaneous Drainage and Fluid Aspiration in Intensive Care Patients

CT-Guided Percutaneous Drainage and Fluid Aspiration in Intensive Care Patients

Percutaneous aspiration and drainage of abdominal fluid collections after pancreatic transplantation

Pancreatic transplantation, performed to avert or delay the long-term complications of insulin-dependent diabetes mellitus, is sometimes complicated by the development of intraabdominal fluid collections. We performed 33 sonographically guided and CT-guided percutaneous abdominal aspiration and drainage procedures in 22 transplant patients; 25 procedures were done with the pancreatic graft-in-situ, and eight were done after removal of the transplant. All 11 percutaneous aspirations performed in 10 patients were successful in obtaining microbiologic culture material, and there were no complications. Sixteen percutaneous catheter drainages were performed in 13 patients with the graft-in-situ. Subsequent surgical intervention was avoided after only five (31%) of these drainage procedures. However, further intervention was unnecessary after five (83%) of six percutaneous catheter drainages in five patients who had previously undergone transplant pancreatectomy. No significant short-term or long-term complications were identified. Guided percutaneous aspiration of abdominal fluid collections after pancreatic transplantation is a safe and effective means of obtaining diagnostic material, and guided catheter drainage is definitive treatment in approximately one-third of procedures with the graft-in-situ and in most procedures done after removal of the graft.

CT-guided percutaneous aspiration and catheter drainage of pyogenic liver abscesses: B. Attar, H. Levendoglu, and N.S. Cuasay. Am J Gastroenterol 81:550–555, (July), 1986

CT-guided percutaneous aspiration and catheter drainage of pyogenic liver abscesses: B. Attar, H. Levendoglu, and N.S. Cuasay. Am J Gastroenterol 81:550–555, (July), 1986

The computed tomography-guided adrenal biopsy. An alternative to surgery in adrenal mass diagnosis.

A series of 16 patients with adrenal masses were biopsied percutaneously under computed tomography (CT) guidance with 18- to 22-gauge modified Chiba needles. Adrenal adenomas, cysts, metastases, melanoma, and adrenal hemorrhage were identified. Of nine oncologic patients, four had adrenal metastases, while five had other nonmalignant adrenal masses. Thus, an adrenal mass in an oncologic patient is not always metastases. No complications occurred. The diagnostic evaluation of an adrenal mass in selected cases should include CT-guided percutaneous aspiration as a safe and reliable alternative to open surgical biopsy. CT-guided biopsy can be performed as an outpatient procedure, avoiding the cost of hospitalization and the morbidity of surgery.

Thoracic biopsy: CT guidance of thin-needle aspiration.

CT-guided percutaneous thin-needle aspiration biopsy of 23 mediastinal and 27 other thoracic masses was performed in 40 patients over a 2-year period. Although biplane fluoroscopy is considered the optimal guidance mechanism for thoracic biopsy, CT was required in this group of patients to ensure accurate needle placement within the lesions or within the most appropriate subsegment of necrotic lesions. A specific diagnosis was obtained in 34 cases, an overall diagnostic accuracy of 85%. Although CT guidance allowed an extrapleural needle trajectory in 23 patients, five of the remaining 17 patients sustained a pneumothorax for which two required tube thoracotomy.

Percutaneous catheter aspiration and drainage of suspected mediastinal abscesses.

The authors describe CT-guided percutaneous aspiration of 13 apparent mediastinal abscesses in 12 extremely ill patients, excluding the diagnosis in 3 and establishing it in 9. Six patients subsequently underwent percutaneous catheter drainage, facilitating elective surgery in 1 and proving curative in 5.

CT-guided percutaneous aspiration and drainage of abscesses.

CT-guided procedures were attempted in 103 patients suspected of having abscesses. CT-guided procedures were performed for diagnostic specimens in 70 patients; they were successful in 30 of 34 sterile collections and 33 of 36 abscesses. In another 33 patients, diagnostic aspiration was performed and percutaneous drainage was attempted; aspirations were successful in 33 of 33 and drainage in 28 of 33 cases. Of the five not drained, four were undrainable because of anatomic extent or high viscosity of the purulent material. The fifth was a necrotic, squamous cell tumor erroneously thought to be an abscess. No complications were encountered. CT-guided procedures are an effective method for obtaining diagnostic specimens in selected patients.