Hsu Li-Sheng, Chen Chien-Wei, Chang Chia-Hao, Liao Chien-Han, Hsu Sheng-Lung, Lin Wei-Ming
aDepartment of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi bDepartment of Physical Education, Health and Recreation, National Chiayi University, Chiayi cChang Gung University College of Medicine, Taoyuan dInstitute of Medicine, Chung Shan Medical University, Taichung eCollege of Nursing and the Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan.
Medicine (Baltimore). 2017 Nov;96(46):e8558. doi: 10.1097/MD.0000000000008558.
Computed tomography (CT)-guided lung biopsy of nodules located near the heart may be associated with potential complications. To understand the influences of cardiac motion on lung parenchyma during biopsy, we processed the cardiac phase images of coronary CT angiography (CCTA) and noticed shifts in mediastinum lung margin (MLM) at different zones.Thirty eight CCTA (27 men and 11 women) were retrospectively evaluated. Image processing was done with Fiji (an open source Java image processing program by Fiji contributors) using 10% to 90% phase images of CCTA; and tissue displacement (MLM shift) was shown on the resulting images.The participants were 58.29 ± 9.87 years old; their height was 166.32 ± 7.57 cm while their weight was 74.18 ± 13.59 kg. The mean values of MLM shifts in Zones 1 to 9 ranged from 1.98 to 7.76 mm. Large MLM shifts were observed in the free wall of the left ventricle (LV). MLM shift of the upper free wall of the LV was 6.98 ± 1.99 mm and that of the lower free wall of the LV was 7.76 ± 3.26 mm. The largest MLM shift among all patients was 16.05 mm, found in the lower free wall of the LV. The age factor had a weak positive correlation with the wall of the pulmonary artery (r = 0.350, P = .031) and that of the right atrial appendage (r = 0.418, P = .009). In contrast, a weak negative correlation of age factor was observed with the lower free wall of the LV (r = -0.336, P = .039).In conclusion, we suggest that physicians observe caution when performing lung biopsy if the distance between the lung lesion and the MLM is 1 to 2 cm. CT-guided lung biopsy should be avoided if the distance is <1 cm. Physicians should pay special attention to lung lesions near the LV.
计算机断层扫描（CT）引导下对位于心脏附近的肺结节进行活检可能会引发潜在并发症。为了解活检过程中心脏运动对肺实质的影响，我们对冠状动脉CT血管造影（CCTA）的心动周期图像进行了处理，并注意到不同区域纵隔肺边缘（MLM）的移位情况。对38例CCTA（27例男性和11例女性）进行了回顾性评估。使用Fiji（Fiji贡献者开发的开源Java图像处理程序）对CCTA的10%至90%相位图像进行图像处理；并在所得图像上显示组织移位（MLM移位）。参与者年龄为58.29±9.87岁；身高为166.32±7.57厘米，体重为74.18±13.59千克。1至9区MLM移位的平均值在1.98至7.76毫米之间。在左心室（LV）游离壁观察到较大的MLM移位。LV上游离壁的MLM移位为6.98±1.99毫米，LV下游离壁的MLM移位为7.76±3.26毫米。所有患者中最大的MLM移位为16.05毫米，出现在LV下游离壁。年龄因素与肺动脉壁（r = 0.350，P = 0.031）和右心耳壁（r = 0.418，P = 0.009）呈弱正相关。相比之下，年龄因素与LV下游离壁呈弱负相关（r = -0.336，P = 0.039）。总之，我们建议，如果肺病变与MLM之间的距离为1至2厘米，医生在进行肺活检时应谨慎操作。如果距离小于1厘米，应避免CT引导下的肺活检。医生应特别关注LV附近的肺病变。
