Scientific Session 22Vascular Imaging: Contrast Agents

*The needle driver would not drive the needle and the casewas finished using the standard manual technique. No adverseevent occurred.

CONCLUSION: The use of a joystick controlled robotic needledriver to place the needle during nerve and facet blocks isfeasible. Additional clinical triais are required to furtherinvestigate the role of this technology.

S59

Abstract No. 1725:11PM

A Comparison of Three Fenoldopam Dosing Regimensfor Prevention of Contrast Nephropathy.G.I. Gordon, Saint-Lukes Hospital, Kansas City, MO, USA• M. Liemkeuhler • E. Yetter • A. Awad • C. Rubble • G.D.Dixon, et al.

the angio suite and contin.ued for 4 hours following theprocedure. 26 patients were pretreated with Mucomist(acetylcysteine) . All patients received pre-procedurehydration with intravenous infusion of 0.45 NS (l cc/kg/hr)for 4 hours priar to the procedure. Attempts were made tolimit the volume of iodinated contrast media by utilizing carbondioxide until images were not of diagnostic quality.

RESULTS: The average pre-procedure serum creatinine was1.85 mg/dl (range 1.4 -3.8 mg/dl) The mean post procedureserum creatinine was 1.7 mg/dl range (0.7 - 3.9 mg/dl) 12patients had a transient rise in their serum creatinine and 5patients had no change in the serum creatinine. Patients witha rise were re-evaluated at from 1 to 2 wks following theprocedure and all had retumed to with 0.2 mg/dl of baseline.The mean change in the creatinine was a decrease of .15 mg/dl(range -1.2 to +0.4 mg/dl). No patient required hemodialysiswithin a 6 months follow-up period. 4 patients experiencedhypotension during the procedure. 1 patient required volumeand doparnine support of blood pressure.

CONCLUSION: A combined strategy of preproceduretreatment with mucornist and intravenous hydration combinedwith intraprocedure fenoldopam and efforts to limit the volumeof contrast prevented dialysis dependent nephropathy in allpatients. Complications were infrequent resulting in a safeand effective strategy.

PURPOSE: The DA-1 agonist, fenoldopam (FEN), has beenshown to reduce risk of contrast nephropathy; however,dosing protocols differ between studies. aur goal was tocompare 3 different dosing strategies for fenoldopam for safetyand efficacy.

MATERIALS AND METHODS: From 101 patientsconsecutively treated with FEN, we retrospectively reviewedincidences of contrast nephropathy (25% increase in serumcreatinine I - 3 days post procedure) and hypotension requiringreduction or interruption of FEN. Patients were generallyselected for FEN if they had a serum Cr (SCr) > 1.5 mg/dL.The high dose and low dose groups were uptitrated every 20minutes from 0.1 mcglkg/rnin to 0.5 mcglkg/min (high dose) orto 0.2 mcg/kg/rnin (medium dose) while keeping SBP > 100mmHg. The 10w dose group received a fixed dose ofO.1 mcg/kg/min. FEN was begun 30 c 60 minutes pre-procedure andcontinued 1-4 hours post-procedure. Use ofN-Acetylcysteineand type of contrast were based on physician discretion.

RESULTS: The mean age ofthe population was 70 (17) yearsand 65% were male. The baseline characteristics ofthe 3 dosegroups were generally sirnilar (Table). Additionally, in thehigh, medium, and low dose groups, baseline calculatedcreatinine clearance was 46.4 (21.3),39.3 (20), 49.9 (25) mL!min. In the dose groups above, 0%, 6.3%, and 11 % ,respectively, had cirrhosis and 21 %, 15%, and 11 %,respectively, had CHE Two patients in the low dose and 1patient in the high dose group required dialysis. Risk ofhypotension was lowest amongst patients receiving the lowestdose group. Efficacy was greater in the medium and high dosegroups than in the low dose group (Table); however, therewas no improvement in efficacy in titrating to a dose beyond0.2 mcglkg/rnin (medium dose group).

Abstract No. 171

Resulls From Ihe Firsl11 PalienlsPatienl Technique BlockType Level Pain Before Pain After Accuracy (mm)

APlLaleral1 Manual Facel L-4I5 1 O 0.6&'0.942 Manual Nerve L-5 1 O 0.41/0.233 Manual Nerve L-4 8 O 0.9610.574 Manual Nerve L-4 9 1 0.69/0.815 Robol Nerve L-4 8 4 1.9211.456 Robol Nerve &-1 4 3 0.23/0.187 Robot Nerve L-5 3 O 0.3410.178 Robot Narve L-4 4 1 2.00'1.449 Manual Nerve L-5 8 1 0.41/1.2210 Robol Nerve L-4 8 O 0.6&'0.1011' Robol Facet L-5 9 4 0.2a/0.68

5:00PM

Sunday, March, 30, 20035:00 PM • 6:30 PMModerator(s): James Caridi, MD

Imaging and Pharmacotherapeutic Strategy To PreventDialysis Dependent Contrast Nephropathy in DiabeticPatients.J.E. Aruny, Yale University School ojMedicine, New Haven,eT, USA • J. Pollak • N. Denbow • M. l-\1ysoki • H.Lustberg

PURPOSE: To present the results of our strategy to preventcontrast nephropathy in diabetic patients with preexistingrenal insufficiency and/or a history of prior transient rise inserum creatinine following intravascular contrast media.

MATERIALS AND METHODS: The robotic needle driver canorient the needle to any angle and is controlled usiog a joystickand touch screen. The interventionalist can thus manipulatethe needle under x-ray f1uoroscopy without direct exposureto the radiation beam. After cadaver studies were completed,a randomized clinical trial of 20 patients undergoing nerve andfacet blocks was approved by the FDA and the localinstitutional review board. The procedure is done in thestandard manner except the robot is used to position, orient,and drive the needle under physician contro\.

RESULTS: As ofOctober 2002, 11 patients have been enrolledin the trial - 5 without the robot and 6 with. The pain scoresare based on a visual analog score where Ois no pain and 10 isthe worst pain the patient has ever experienced. The accuracymeasurements denote how close the final needle position wasto the needle position marked by the physician at the start ofthe procedure.

MA TERIALS AND METHODS: 38 patients ( 21 male & 17female) with diabetes mellitus who required contrastangiography or venography were prospectively studied. AIJpatients had a pre-procedure serum creatinine within 5 daysof their procedure and post procedure serum creatinine levelwithin 72 hours. 25 were outpatients and 13 in patients. Alipatients received either isosmolar or low osmolar contrastmaterial with a range ofbetween 20 -325 cc (mean 111.3 cc).Fenoldopam infusion levels varied between 0.2 ug/kg/dl and0.6 ug/kg/dl (mean 0.38 ug/kg/rnin). Infusion was initiated in

CONCLUSION: Based on our data, to optimize both safetyand efficacy of FEN for RCN prevention, we believe thatfenoldopam should be started at 0.1 mcg/kg/min, and, iftolerated by blood pressure, to a maximum dose of 0.2 mcg/kg/min.

Dosa Baseline 0v1 Acetylcysteine Pre-Procedure Contrasl ReN HypolensionReglmen SCr Fluids Volume (evalu'

able)High 1.8(0.7) :36% :36% 1081 (1=) 175(110) 15.8% 3.5%(n =28) (n=19)Medium 2.1 (0.6) 32% 15% 836(891) 154(90) 8.8% 11%(n=47) (n =34)Low 1.9 (0.7) 33% 37"'" 653(1021) 170(80) 22% Ol'.(n =27) (n =18)ReN = radiocontrast nephropathy, DM = diabetes mellilus, Dala are Means (SD), unlessotherwise noled

Patient Procedure SCr baseline (mg/dl) SCr 48 hours (mg/dl)1 Ao Runoff 2.9 2.62 Renal Angio 3.1 2.73 Ao Runo« 2.9 2.94 Renal Angio (BIL) 2.7 3.05 Carotid Angio 3.3 3.06 Renal PTA 2.9 327 Renal Angin 4.8 5.38 TIPS 3.6 5.5Mean (SD) 3.3±0.7 3.5± 1.2Ao = aorlic, angio = angiography, PTA = pereutaneous transluminal angioplasty, TIPS= transjugular intrahepatie portosystemie shunt, SCr = serum ereatinine

RESULTS: From our experience using FEN in 62 consecutivepatients, 12 (19%) had SCr ~ 2.5 mg/dL (mean 3.0 ±0.67 mg/dL] and of these, 7 (58%) were diabetic. Intravenous fluidvolume was 1035 ± 357 mL. FEN (mean maximum dose 0.39± 0.14 mcg/kg/min) was administered for 5.3 ± 2.0 hours.SBP pre-procedure was 156 ± 36 rnrnHg and 120.3 ± 32mrnHg at its nadir. Nadir SBP was 95 - 100 mrnHg in 2 patientsand 85 - 90 mmHg in 2 patients. Cr data for the 8 patients thathad both baseline and 48 hour SCr are shown in the Table.Only 1/8 (12.5%) of these high risk patients developed CNoThe patient developing CN had liver failure, diabetes, andbaseline serum Cr of 3.6 mg/dL and underwent a TlPSprocedure.

CONCLUSION: Patients coming to interventional radiologyfrequently have advanced renal disease. FEN was well toleratedby patients with serum Cr ? 2.5 mg/dL at doses of 0.1 - 0.5mcg/kg/min and its use was associated with markedlydiminished risk of CN.

AbstractNo.175

Abstract No. 174

5:44PM

CO2

Spleooportography: A Minimally Invasive Way ToEvaluate the Splenic and Portal Veins.er. Burke, University oj North Carolina, Chapel Hill, NC,USA - M. Mauro - P. Jaques - S. Weeks

PURPOSE: To describe a rninimally invasive way ofevaluatingthe splenic and portal veins.

MATERIALS AND METHODS: Fourteen CO2splenoportograms performed from 1/2000 to 10/2002 intwelve patients were reviewed retrospectively. Five studieswere performed as part of a pretransplant evaluation, and theremaining nine studies were performed to evaluate ultrasoundabnormalities in patients who have previously undergone livertransplant. Each study was performed by placing a 21G or27G needle into the splenic parenchyma with ultrasoundguidance, and up to 20cc CO

2was injected and filmed with

OSA imaging.

5:33PM

Attenuation effect oC Gadodiamide Versus DifferentDilutions of lohexol: An In Vitro Comparison Model.M. Itkin, University ojPennsylvania, Philadelphia, PA, USA-M. O'Sf1ea -r.W.I. Clark -S.O. Trerotola -R.J. Harp­S. W. Stavropoulos

PURPOSE: Gadolinium based contrast agents are used as asubstitute for iodine based agents in patients with poor renalfunction, despite decreased image quality and increased cosl.Using lower concentrations of iodinated contrast has beenproposed to increase the amount of contrast available for use,while minimizing total iodinated contrast dose. An in vitromodel was designed to establish the dilution of iohexol thatresults in similar attenuation properties to fuU strengthgadodiarnide.

MATERIALS AND METHODS: Five holes (8 mm diameterand 2 mm depth) were creatęd in a 2 cm thick, Lucite plate.Each hole was filled with gadodiamide 0.5 mmol/l or iohexol inthe following dilutions: 300 mgI/ml (fuli strength), 150 mgI/rnl (112 strength), 75 mgI/rnl (114 strength), 35.5 mgI/ml(1/8strength). To simulate the attenuation effect of the body a 20cm thick block of Lucite was placed under the plate. Thephantom was exposed to x-rays over the range 60-109 kVp.Three triais of the experiment were performed. For ea~h trialthe contrast index(CI) [(Background mean pixel value-contrastagent mean pixel value)/background mean pixel value] ofeachagent was calculated.

RESULTS: At 90 kVp the gadodiamide yielded a CI of4.33%.At the same kVp the CI for iohexol dilutions was the following:fuli strength 10.39%, 112 strength 6.22%, 114 strength 3.88%,1/8 strength 2.15%. At 60 kVp the gadodiamide yielded a CIof 5.4%. The CI for the iohexol at 60 kVp was: full strength20.2%,112 strength 12.5%, 1/4 strength 7.34%, 1/8 strength3.8%. There was no significant difference in mean CI between1/4 iohexol and gadodiamide at 70 kVp(P=0.52), 81 kVp(P=0.43) or 90 kVp (P=0.31, two-tailed unpaired t-test).Unlike the iohexol, the gadodiamide showed linie change in CI(4.14% - 5.36%) over the tested energy range. Less than 10%variance was showed for the three iterations of the experirnent.

CONCLUSION: A 1/4 dilution of iohexol gives equivalent aCI to gadodiarnide over the 70-90 kVp range, while a 1/8iohexol dilution has a Cliower and 112 iohexol dilution has aCI higher than gadodiamide over entire tested range. Becausegadodiamide has a naITOW CI range between kVp 70 and 90,the higher kVp should be used clinically due to dose rateconsiderations.

Abstract No. 1735:22PM

Renoprotective Effects of Fenoldopam in Patients withSerum Creatinine ~ 2.5 mg/dL.G. Niedzwiecki, Mease Countryside Hospital, SaJetyHarhor; FL, USA -J. Hill- V. Mathur

PURPOSE: Risk of contrast nephropathy (CN) increaseswith increasing baseline serum creatinine (sCr). In other studies,fenoldopam (FEN) reduced risk of CN in patients with meanSCr 2.0 - 2.6 mg/dL. To determine efficacy of FEN in veryhigh risk patients, we describe the results of 12 consecutivelytreated patients with baseline serum Cr ~ 2.5 mg/dL.

MATERIALS AND METHODS: In our protocol for FEN, weselect patients with SCr > 1.5 mg/dL and administer FENstarting at 0.1 mcg/kg/min, titrating every 15 - 20 minutes to amaximum dose of 0.5 mcg/kg/min pre-procedure x 4 - 6 hourswhile maintaining systolic blood pressure (SBP) of > 100mrnHg. CN was defined as a ~ 25% increase in SCr within 48hours of the procedure. Data are expressed as mean ± SD,uniess otherwise noted.

S60

MATERIALS AND METHODS: Institutional review boardapproval was obtained for this retrospective analysis. Four

CT Angiography Using Intraarterial Gadolinium inAzotemic Patients Undergoing Aortic EndograftEvaluation.K. Dowling, Albany Medical Center Hospital, Albany, Nr.USA. M. Mehta • G.P. Siskin • S.D. Quarfordt • T.WHughes • K. Mandato, et al.

PURPOSE: The purpose of this study is to evaluate the useof intraarterial gadolinium enhanced eTA in the evaluation ofendograft candidates with abdominal aortic aneurysm andazotemia.

RESULTS: Six of the fourteen COzsplenoportograms werenormai and no further imaging was performed. Five of thesepatients subsequently underwent liver transplantation withoutcomplication. The sixth patient has continued to do well andhas been followed clinically. MRI was perfonned within 24hours in two patients and confinned findings of nonnal portalvein in one patient and portal vein occlusion in the other.Direct transhepatic portography was performed in fourpatients as a result of abnormal findings on the CO zsplenoportogram. Of these, one was normal, and onedemonstrated a mild stenosis without a pressure gradient.Focal stenoses were confirmed in the remaining two, and thelesions were treated with balloon angioplasty. Nocomplicalions were reported with this procedure.

CONCLUSION: CO z splenoportography provides aminimally invasive way to accurately and safely evaluate thesplenic and portal veins.

S61

Abstract No. 1786:17PM

french catheters were placed by standard angiographictechnique, COzangiograms were performed prior to the CTA.The catheter was placed in the mid descendjng thoracic aortafor the administration ofgadolinium. Sixty cc of gadodiamidediluted with 60cc of normai saline was admiIlistered intra­arterially during the contrasted portion of the CTA.

RESULTS: Fourteen patients were evaluated by this technique.Ali were male, mean age 74 years ± S (5S-S7years). Theaverage AAA was 5.9cm ± 1.1 (4.7-S.0).ln all cases thrombuswas seen on the gadodiamide contrasted study when nonewas detectable on the non-contrasted CT. In 29%(4/14) of thecases the gadodiarrude enhancement changed the managementof the patient by detecting thrombus that would changetreatment from endograft to surgery. The average pre-studycreatinine was 2.3mg Idl (± .S) (0.9-3.6mg/dl). Post study theaverage creatinine decreased by 0.2mg/dl. The largest rise increatinine post study was 0.1 mg/dl. No angiographiccomplications were encountered. Twenty-one percent (3/14)of the patients were treated by endograft, 36% (5/14) weretreated surgically and 43% (6/14) either refused treatment orare currently being folIowed.

CONCLUSION: Intraarterial gadolinium CTA is a safe andeffective means to evaluate azotemic patients with abdorninalaortic aneurysm for endovascular therapy.

MRA-Guided VascuIar Interventions: In-Vivo Evaluationof the Combined Use of Carbon Dioxide and a B1ood­Pool Agent.F.K. Wacker, Case Western Reserve University/UniversityHosp., Cleveland, OH, USA • R.M. Maess • S.G. Nour •f L Duerk • f.S. Lewin

PURPOSE: Direct intraarterial injections of dilutedparamagnetic compounds such as Gd-DTPA have majorlimitations. l) They rapidly diffuse into the extracellular spaceresulting in background enhancement, 2) they impose anegative effect on kidney function in larger quantities, and 3)they are not helpful in combination with intravascular contrastagents which can be used to improve and prolong the vesselconspicuity during MRI guided vascular procedures. In thissituation a dark blood contrast agent is needed. The aim ofthis study was to test the combined use of carbon dioxide(COz) and a GD-based blood pool agent for MRl-guidedvascular procedures in an animaI model.

MATERIALS AND METHODS: After an initial IV injectionof Gadomer-17 (Schering AG, Gennany) repeated intraarterialCOz injections were performed in the aorta and after selectivecatheterization of the renal arteries of two swine. Real-timeimages were acquired using near real time gradient echosequences (trueFISP: TRlTE: 3.0/1.5 ms, 5-7 mm slicethickness, flip angle 40-70°,3 images/s; FLASH: 2.7/1.2 ms,5-7 mm slice thickness, flip angle 30°, 3 images/s) throughoutthe CO z injections. SI measurements and subjectiveassessment of the vessel conspicuity before, during and afterCOz injections were obtained.

RESULTS: During the COzinjections, the gas fonned a movingcolumn resulting in an immediate statistically significantdecrease in signal intensity in the aortic lumen with animmediate signal increase as the gas left the vessel segment.Hence, one bolus injection allowed assessment of the flownot only during the actual injection of the contrast agent butalso when the bright Gadomer-17 enhanced blood returned.Confirmation of the intravascular catheter-tip position andassessment of the patency of the arteries distal to the cathetertip was achieved repeatedly and reliably throughout the triais.

Abstract No. 176

AbstractNo.177

5:55PM

6:06PM

COz as an Alternative to lodinate Contrast Medium forUterine Fibroid Embolization.f. Golzarian, Erame Hospital, Brussels, Brabant, Belgium.M. Laureys • F. Tannouri • S. Murgo. f. Struyven

p URPOSE: To evaluate the feasibility and accuracy ofcarbondioxide (COz) injection for localizing uterine arteries (UAs)and guiding fibroid embolization.

MATERIALS AND METHODS: Twelve consecutive patientsunderwent uterine fibroid embolization (UFE) using COr Allpatients had an antero-posterior aorto-iliac arteriogram usinga pigtail catheter (60 cc of COl 40 cc per sec) for theidentification of the UAs. Selective UA catheterization wasperfonned using a 4 Fr Cobra catheter under COz guidance(30cc/15cc per sec). Finally, CO z was used after UAcatheterization during and at the end of embolization (20/1 O).

RESULTS: COzallowed the demonstration of UA origin in allpatients. lntra UA injection was associated with transientpain in S patients. COz injections demonstrated well the fineuterine vascular structure, the anastomoses between UAs andthe contralateral UA in ten patients. These communicationswere not demonstrated by Iodinate contrast agents. COzinjection during embolization permitted to follow preciselythe extent and the evolution of the embolization in ninepatients. The endpoint ofembolization was best demonstratedby Iodinate contrast agents.

CONCLUSION: Although CO) njection in UA can be painful,it is a valuable altemative to iodinate contrast medium. Itallows accurate localization of UA and demonstrates the intra­uterine arterial structure and anastomoses.

Scientific Session 23Image Guided Biopsy: Chest

CONCLUSION: The double contrast technique using apolymeric Gadolinium based contrast agent in combinationwith CO

2, an inexpensive contrast agent with a favorable

safety profile, provides immediate information about thecatheter position and the blood f10w distal to the catheterduring an interventional procedure. It is a safe andstraightforward method to facilitate MR imaging guidance forvascular procedures.

CT-Integrated Prógrammable Robot for Image-GuidedProcedures: Comparison of Free-Hand and Robot­Assisted Techniques.BJ Wood, NIH, Bethesda, MD, USA - F. Banovac - M.Friedman - Z. Varro - K Cleary - 1. Yanof, et al.

PURPOSE: To compare the accuracy and speed of biopsieswith and without a CT-integrated, programrnable, automatedrobotic system.

MATERIALS AND METHODS: A programmable robot with6 degrees of freedom and a laser guide was rigidly attached toa CT scanner (PQ6000, Philips Medical Systems) andregistered into its 3D coordinate system.After scanning ananthropomorphit abdominal phantom with a lmm targetdeeply embedded in the liver dome, the target and insertionpoints were marked on the interface.The virtual needle wasalso displayed with MPR views.The virtual needle coordinateswere sent to the robot, which automatically aligned its laserwith the planned multi-angled trajectory.The physical needlewas aligned with the laser, and inserted in seconds, in onepass.The distance between the center of the target and theneedle tip was measured.Differences in means were assessedusing a two-tailed Student's T-test.8 simulated one-passbiopsies were performed at depths ranging from 10 to 15 cm,using targets in the dome of the liver: 4 with the guidancesystem, and 4 using conventional CT grids and free-handangle estimates by an expeńenced interventionalist.AII targetsrequired craniocaudal angulation to avoid pleural transgression.

RESULTS: The robotic guidance system was integratedseamlessly into one unified platform for imaging, treatmentplanning, and intervention.The time required for planning andplacing the needles was much shorter with the roboticsystem.The average distance from the target to the needle tipwas 2.5 mm with robotic guidance and 19 mm withoutguidance, giving a p value ofO.02.The first needle placed withrobotic assistance along a complex XYZ angulation trajectoryactually hit the lmrn target, embedded at a depth of 14 cm inthe liver.One of the free-hand punctures traversed lung.

CONCLUSION: Greater accuracy could translate into fewerneedle insertions, and fas ter and safer procedures.With theadvent of ablation technologies and proteomic and genomicspatial profiling of tumors, the accuracy of instrumentpJacement will becorne more vital in the future.Preliminaryresults indicate that the CT-integrated, programrnable robothas the potential to improve the speed and accuracy ofabdominal biopsy procedures and that further investigation iswarranted.

CT-Guided Percutaneous Needle Biopsy: Factors ThatAffect Risk of Pneurnothorax.KN. Morar, Providence Hospital, Southfield, MI, USA ­TM. Hall

Abstract No. 181

Abstract No. 180

5:22PM

PURPOSE: To analyze the influence of Jesion size, location,approach, lesion depth from pleura and skin surface on therate of pneumothorax associated with CT- guided percutaneousneedJe biopsies.

MATERIALS AND METHODS: Age, gender, location of lunglesion, size, distance from the pleural edge, distance from theskin surface to the pleural edge, and needle approach weremeasured retrospectiveJy in 261 patients. Post biopsypneumothorax size was measured. The percentage ofpneumothorax overall, within each lobe, and with eachapproach was calculated. A statisticaJ analysis involving thelesion size, distance from the pleura, and distance from theskin surface was performed using t-test for equality of means.

RESULTS: 61 patients (23.4%) had a post-biopsypneumothorax. In the patients with pneumothoraces theaverage mass size was 2.63cm and 3.43cm in patients withouta pneumothorax. The average distance from the mass to thepleura in patients with pneumothoraces was 1.74 cm and1.12 cm in patients without. The average distance from thepleura to the skin surface in patients with pneumothoraceswas 3.68cm and 4.33cm in patients without. A t-test forequality of means when equal variances not assumeddemonstrated a t value of - 4.063 for mass size (P< .000),3.026 for mass-pleura distance (P= .003), and - 3.081 forpleura-skin surface distance (P= .003).

CONCLUSION: Our statistics show that the average size ofthe mass in patients who developed a pneumothorax wassignificantly smaller than in the group that did not.Pneumothorax patients demonstrated a significantly largermass to pleural distance when compared to the non­pneumothorax group. However, interestingly patients whodeveloped pneumothraces had a significantly small~r skin topleura distance when compared to those that did not. To ourknowledge this observation has never been reported.

5:11PM

Risk Factors for Pneumothorax and B1eeding after CT­Guided Coaxial Cutting Needle Biopsy of Lung Lesions:Retrospect.KM. Yeow, Chang Gung Memoriał Hospitał, Kwei Shan,Tao Yuan, Taiwan, R. O. e. - KP. Tsay - KW Lui - K T Pan- Y. e. Cheung -A.S.B. Chou

PURPOSE: To identify risk factors for pneumothorax andbleeding after CT-guided coaxial cutting needle biopsy oflunglesions.

MATERIALS AND METHODS: From March 1995 to August2001,5 radiologists performed 660 consecutive CT-guidedcoaxial cutting needle biopsies on focal lung lesions in 649patients. There were 424 males and 225 females, mean agewas 62.6 years (95% confident interval, 61.5-63.6).Complications presented as pneurnothorax, lung parenchymableeding and hemoptysis were recorded prospectively.VariabIes thought to affect pneumothorax, lung parenchymaIbleeding and hemoptysis were categorized into factors relatedto 1) patient (CT sign ofemphysema, chest wall thickness),2) lung lesions (lesion size, lesion necrosis, lesion cavitation.pleural effusion), 3) biopsy tecJmique (needle size, nurnber ofcutting specimens) and 4) radiologists (individual performanceof 5 radiologists). The incidence of pneumothorax and bleeding

Abstract No. 1795:00PM

Sunday, March, 30, 20035:00 PM - 6:30 PMModerator(s): Marshall Hicks, MD

Dieter Liermann, MD

562