Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Eur Radiol. 2022 Oct;32(10):6800-6811. doi: 10.1007/s00330-022-09079-6. Epub 2022 Aug 25.
To assess whether pulmonary vein injury is detectable on CT and associated with air embolism after percutaneous transthoracic needle biopsy (PTNB) in a tertiary referral hospital.
Between January 2012 and November 2021, 11,691 consecutive CT-guided PTNBs in 10,685 patients were retrospectively evaluated. Air embolism was identified by reviewing radiologic reports. Pulmonary vein injury was defined as the presence of the pulmonary vein in the needle pathway or shooting range of the cutting needle with the presence of parenchymal hemorrhage. The association between pulmonary vein injury and air embolism was assessed using logistic regression analysis in matched patients with and without air embolism with a ratio of 1:4.
A total of 27 cases of air embolism (median age, 67 years; range, 48-80 years; 24 men) were found with an incidence of 0.23% (27/11,691). Pulmonary vein injury during the procedures was identifiable on CT in 24 of 27 patients (88.9%), whereas it was 1.9% (2/108) for matched patients without air embolism The veins beyond the target lesion (70.8% [17/24]) were injured more frequently than the veins in the needle pathway before the target lesion (29.2% [7/24]). In univariable and multivariable analyses, pulmonary vein injury was associated with air embolism (odds ratio, 485.19; 95% confidence interval, 68.67-3428.19, p <.001).
Pulmonary vein injury was detected on CT and was associated with air embolism. Avoiding pulmonary vein injury with careful planning of the needle pathway on CT may reduce air embolism risk.
• Pulmonary vein injury during CT-guided biopsy was identifiable on CT in most of the patients (88.9% [24/27]). • The veins beyond the target lesion (70.8% [17/24]) were injured more frequently than the veins in the needle pathway before the target lesion (29.2% [7/24]). • Avoiding the distinguishable pulmonary vein along the pathway or shooting range of the needle on CT may reduce the air embolism risk.
评估在一家三级转诊医院中，经皮经胸穿刺活检（PTNB）后 CT 是否可检测到肺静脉损伤，并与空气栓塞相关。
回顾性分析 2012 年 1 月至 2021 年 11 月期间 10685 例患者的 11691 例连续 CT 引导下 PTNB。通过查看放射学报告确定空气栓塞。肺静脉损伤定义为在存在实质出血的情况下，穿刺针路径或切割针的射流范围内存在肺静脉。使用具有 1:4 比例的匹配有和无空气栓塞的患者的逻辑回归分析评估肺静脉损伤与空气栓塞之间的关联。
共发现 27 例空气栓塞（中位年龄 67 岁；范围 48-80 岁；24 例男性），发生率为 0.23%（27/11691）。在 27 例患者中的 24 例（88.9%）的 CT 上可识别到术中肺静脉损伤，而在无空气栓塞的匹配患者中发生率为 1.9%（2/108）。超过靶病变的静脉（70.8%[17/24]）比靶病变前的针道中的静脉更常受伤（29.2%[7/24]）。在单变量和多变量分析中，肺静脉损伤与空气栓塞相关（优势比，485.19；95%置信区间，68.67-3428.19，p<.001）。
CT 可检测到肺静脉损伤，并与空气栓塞相关。通过在 CT 上仔细规划针道，避免肺静脉损伤可能会降低空气栓塞的风险。
CT 引导下活检过程中肺静脉损伤在大多数患者（88.9%[24/27]）中可在 CT 上识别。
超过靶病变的静脉（70.8%[17/24]）比靶病变前的针道中的静脉更常受伤（29.2%[7/24]）。
在 CT 上避开可识别的沿针道或针的射流范围内的肺静脉可能会降低空气栓塞的风险。
