Maehara Yosuke, Miura Hiroshi, Hirota Tatsuya, Asai Shunsuke, Okamoto Toshiyuki, Ohara Yu, Yamada Kei
From the Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
J Comput Assist Tomogr. 2023;47(1):71-77. doi: 10.1097/RCT.0000000000001376. Epub 2022 Sep 22.
The aim of the study is to analyze incidence and risk factors for air embolism during computed tomography (CT) fluoroscopy-guided lung biopsies using noncoaxial automatic needle.
Between February 2014 and December 2019, 204 CT fluoroscopy-guided lung biopsies (127 men; mean age, 70.6 years) using noncoaxial automatic needle under inspiratory breath holding were performed. We retrospectively evaluated the incidence of air embolism as presence of air in the systemic circulation on whole-chest CT images obtained immediately after biopsy. Risk factors of the patient, tumor and procedural factors (size, location and type of nodule, distance from the pleura, the level of the lesion relative to the left atrium, emphysema, patient position, penetration of a pulmonary vein, etc) were analyzed.
The technical success rate was 97.1%. Air embolism was radiologically identified in 8 cases (3.92%, 7 males; size, 21.6 ± 18.2 mm; distance to pleura, 11.9 ± 14.5 mm). Two patients showed overt symptoms and the others were asymptomatic. Independent risk factors were needle penetration of the pulmonary vein ( P = 0.0478) and higher location relative to left atrium ( P = 0.0353). Size, location and type of nodule, distance from the pleura, emphysema, patient position, and other variables were not significant risk factors. As other complications, pneumothorax and alveolar hemorrhage were observed in 57.4% and 77.5%, respectively.
In CT fluoroscopy-guided lung biopsy using the noncoaxial automatic needles, radiological incidence of air embolism was 3.92%. Given the frequency of air embolism, it is necessary to incorporate this into postprocedure imaging and clinical evaluation.
本研究旨在分析在计算机断层扫描（CT）透视引导下使用非同轴自动活检针进行肺活检时空气栓塞的发生率及危险因素。
2014年2月至2019年12月期间，在吸气屏气状态下使用非同轴自动活检针对204例患者进行了CT透视引导下的肺活检（男性127例；平均年龄70.6岁）。我们通过活检后立即获取的全胸CT图像上体循环中是否存在空气，回顾性评估空气栓塞的发生率。分析了患者、肿瘤及操作相关因素（结节大小、位置、类型、距胸膜距离、病变相对于左心房的水平、肺气肿、患者体位、肺静脉穿刺等）的危险因素。
技术成功率为97.1%。8例（3.92%，男性7例；大小为21.6±18.2mm；距胸膜距离为11.9±14.5mm）经影像学检查发现空气栓塞。2例患者出现明显症状，其他患者无症状。独立危险因素为肺静脉穿刺（P=0.0478）及相对于左心房位置较高（P=0.0353）。结节大小、位置、类型、距胸膜距离、肺气肿、患者体位及其他变量均不是显著危险因素。作为其他并发症，气胸和肺泡出血的发生率分别为57.4%和77.5%。
在CT透视引导下使用非同轴自动活检针进行肺活检时，空气栓塞的影像学发生率为3.92%。鉴于空气栓塞的发生频率，有必要将其纳入术后影像学检查和临床评估。
