A 12‐year‐old male was admitted to the Medical Intensive Care Unit for respiratory failure requiring temporary tracheostomy secondary to an extensive necrotizing methicillin‐resistant Staphylococcus aureus pneumonia. Imaging revealed destructive bronchiectasis and multifocal lung abscesses, more advanced in the right lung. He was discharged home after 42‐day hospital admission. 3.5 months after his discharge, he re‐presented to the Emergency Department with a large right pneumothorax and a pneumatocele measuring 10.2 × 6.2 cm2. He was admitted to the hospital and while his pneumothorax resolved in 2 days, the size of the pneumatocele was noted to fluctuate with different phases of respiration. A computed tomography scan of the chest demonstrated a fistula between the pneumatocele and right upper lobe bronchus. Following discussion between Pulmonary medicine and Interventional radiology, transbronchial closure of the air leak was planned. Intubation was done with a dual‐lumen endotracheal tube. Bronchography was performed using a diagnostic catheter. A large air leak was noted from the anterior segment of the right upper lobe bronchus. Embolization of the fistula was performed using n‐butyl cyanoacrylate (nBCA, glue) injected through a second catheter under fluoroscopic guidance. The residual pneumatocele slowly resolved over 2 months. Endobronchial embolization has been described in the literature as a treatment strategy for air leaks, largely in adult patients. Endobronchial embolization of large pneumatoceles and bronchopleural fistulas may offer an alternative treatment option with less morbidity than the classic surgical approach.
Background
Diffusion‐weighted MRI (DW‐MRI) of the kidneys is a technique that provides information about the microstructure of renal tissue without requiring exogenous contrasts such as gadolinium, and it can be used for diagnosis in cases of renal disease and assessing response‐to‐therapy. However, physiological motion and large geometric distortions due to main B0 field inhomogeneities degrade the image quality, reduce the accuracy of quantitative imaging markers, and impede their subsequent clinical applicability.
Purpose
To retrospectively correct for geometric distortion for free‐breathing DW‐MRI of the kidneys at 3T, in the presence of a nonstatic distortion field due to breathing and bulk motion.
Study Type
Prospective.
Subjects
Ten healthy volunteers (ages 29–38, four females).
Field Strength/Sequence
3T; DW‐MR dual‐echo echo‐planar imaging (EPI) sequence (10 b‐values and 17 directions) and a T2 volume.
Assessment
The distortion correction was evaluated subjectively (Likert scale 0–5) and numerically with cross‐correlation between the DW images at b = 0 s/mm2 and a T2 volume. The intravoxel incoherent motion (IVIM) and diffusion tensor (DTI) model‐fitting performance was evaluated using the root‐mean‐squared error (nRMSE) and the coefficient of variation (CV%) of their parameters.
Statistical Tests
Statistical comparisons were done using Wilcoxon tests.
Results
The proposed method improved the Likert scores by 1.1 ± 0.8 (P < 0.05), the cross‐correlation with the T2 reference image by 0.13 ± 0.05 (P < 0.05), and reduced the nRMSE by 0.13 ± 0.03 (P < 0.05) and 0.23 ± 0.06 (P < 0.05) for IVIM and DTI, respectively. The CV% of the IVIM parameters (slow and fast diffusion, and diffusion fraction for IVIM and mean diffusivity, and fractional anisotropy for DTI) was reduced by 2.26 ± 3.98% (P = 6.971 × 10−2), 11.24 ± 26.26% (P = 6.971 × 10−2), 4.12 ± 12.91% (P = 0.101), 3.22 ± 0.55% (P < 0.05), and 2.42 ± 1.15% (P < 0.05).
Data Conclusion
The results indicate that the proposed Di + MoCo method can effectively correct for time‐varying geometric distortions and for misalignments due to breathing motion. Consequently, the image quality and precision of the DW‐MRI model parameters improved.
Level of Evidence
2
Technical Efficacy Stage
1
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.