Brönnimann Michael P, Manser Leonie, Maurer Martin H, Gebauer Bernhard, Auer Timo A, Schnapauff Dirk, Collettini Federico, Nguyen Thanh-Long, Komarek Alois, Krokidis Miltiadis E, Heverhagen Johannes T
Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland.
Department of Radiology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Diagnostics (Basel). 2024 Nov 23;14(23):2639. doi: 10.3390/diagnostics14232639.
BACKGROUND/OBJECTIVES: This study aimed to investigate pneumothorax risk, focusing on the gravitational effect of pleural pressure caused by specific patient positioning.
We retrospectively analyzed 144 percutaneous CT-guided lung biopsies performed between January 2019 and December 2023. Patients were grouped into those with or without pneumothorax. Variations in patient positioning (prone, supine, lateral, lesion in decubitus biopsy-side-down [LD BSD] and the dependent area [L DA M], and access route beginning in the dependent area [AR LD M]) were compared using the chi-square, Fisher's exact, and Mann-Whitney U tests. Performance metrics were evaluated. Univariate and binomial logistic regression models assessed the influence of these factors and other patient-related and interventional parameters on pneumothorax occurrence.
Three positional variants (AR DA M, L DA M, and L LD BSD; < 0.001), general emphysema ( = 0.009), emphysema in the access route ( = 0.025), greater needle size (18G vs. 20G; < 0.001), and the use of a side-cut instead of a full-core system ( = 0.002) were significantly linked to lower peri-interventional pneumothorax incidence. Even after adjusting for various factors, AR DA M and general emphysema remained independently associated with a reduced pneumothorax risk (OR 0.168, < 0.001; OR 2.72, = 0.034). Assessing the dependent zones showed superior performance regardless of the patient's position, with the best performance demonstrated for AR DA M (AUC 0.705; sensitivity 60%, specificity 81.8%).
Focusing on the dependent zones of each lung and adjusting the access route accordingly can significantly reduce the risk of pneumothorax compared to conventional positioning techniques.
背景/目的：本研究旨在调查气胸风险，重点关注特定患者体位引起的胸膜压力的重力效应。
我们回顾性分析了2019年1月至2023年12月期间进行的144例经皮CT引导下肺活检。患者被分为发生气胸和未发生气胸两组。使用卡方检验、Fisher精确检验和Mann-Whitney U检验比较患者体位（俯卧位、仰卧位、侧卧位、活检侧在下的病变卧位[LD BSD]和下垂区域[L DA M]）以及从下垂区域开始的进针路径（AR LD M）的差异。评估性能指标。单因素和二项逻辑回归模型评估这些因素以及其他患者相关和介入参数对气胸发生的影响。
三种体位变体（AR DA M、L DA M和L LD BSD；<0.001）、弥漫性肺气肿（=0.009）、进针路径中的肺气肿（=0.025）、更大的针号（18G vs. 20G；<0.001）以及使用侧切而非全芯系统（=0.002）与介入期间较低的气胸发生率显著相关。即使在对各种因素进行调整后，AR DA M和弥漫性肺气肿仍与降低的气胸风险独立相关（OR 0.168，<0.001；OR 2.72，=0.034）。评估下垂区域显示，无论患者体位如何，其性能均更优，AR DA M表现最佳（AUC 0.705；敏感性60%，特异性81.8%）。
与传统定位技术相比，关注每个肺的下垂区域并相应调整进针路径可显著降低气胸风险。
