title: Predictors of pneumothorax after CT-guided transthoracic needle lung biopsy: the role of quantitative CT.
abstract: OBJECTIVE
  To evaluate the association of quantitative computed tomography (CT) measures of emphysema with the occurrence of pneumothorax after CT-guided needle lung biopsy (NLB) accounting for other risk factors.
  
  
  METHODS
  One hundred and sixty-three CT-guided NLBs performed between 2008 and 2013 with available complete chest CT within 30 days were reviewed for the occurrence of post-procedure pneumothorax. Percent emphysema was determined quantitatively as the percentage of lung voxels below -950 HU on chest CT images using automated software. Multivariable regression was used to assess the association of percent emphysema volume with the occurrence of post-procedure pneumothorax. The association of percent emphysema volume with the pneumothorax size and need for chest tube placement after NLB was also explored.
  
  
  RESULTS
  Percent emphysema was significantly associated with the incidence of post-NLB pneumothorax (OR=1.10 95% confidence interval: 1.01-1.15; p=0.03) adjusting for lower-lobe lesion location, needle path length, lesion size, number of passes, and pleural needle trajectory angle. Percent emphysema was not associated with the size of the pneumothorax, nor the need for chest tube placement after NLB.
  
  
  CONCLUSIONS
  Percent emphysema determined quantitatively from chest CT is a significant predictor of post-NLB pneumothorax.
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.
authors.forename: H A
authors.initials: HA
authors.lastname: Chami
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: W
authors.initials: W
authors.lastname: Faraj
authors.affiliation: Department of Radiology, Division of Interventional Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Z A
authors.initials: ZA
authors.lastname: Yehia
authors.affiliation: Department of Radiology, Division of Interventional Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: S A
authors.initials: SA
authors.lastname: Badour
authors.affiliation: Department of Radiology, Division of Interventional Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: P
authors.initials: P
authors.lastname: Sawan
authors.affiliation: Department of Radiology, Division of Interventional Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: K
authors.initials: K
authors.lastname: Rebeiz
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: R
authors.initials: R
authors.lastname: Safa
authors.affiliation: Department of Radiology, Division of Interventional Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: C
authors.initials: C
authors.lastname: Saade
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: B
authors.initials: B
authors.lastname: Ghandour
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: A
authors.initials: A
authors.lastname: Shamseddine
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: D
authors.initials: D
authors.lastname: Mukherji
authors.affiliation: Department of Radiology, Division of Interventional Radiology, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: ah24@aub.edu.lb.
authors.forename: A A
authors.initials: AA
authors.lastname: Haydar
mesh_terms: D001707:Biopsy, Needle / Q000379:methods; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000473:pathology*; D011237:Predictive Value of Tests; D015641:Radiography, Interventional; D015203:Reproducibility of Results; D012307:Risk Factors; D014057:Tomography, X-Ray Computed