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We assessed for the first time the safety and efficacy of bronchoscopically inserted cs‐FM for CyberKnife® SBRT delivery. We show that this technique is safe and resulted in a very high PPL tracking rate enabling optimal SBRT delivery. See Cover Image See related https://onlinelibrary.wiley.com/doi/full/10.1111/resp.14040

BackgroundAlthough ultrashort echo time (UTE) sequences allow excellent assessment of lung parenchyma, image quality remains lower than that of computed tomography (CT).PurposeTo investigate a high‐frequency noninvasive ventilation (HF‐NIV) technique allowing a stabilized inspiration and to compare image quality with current dedicated MR sequences.Study TypeProspective.PopulationTen healthy volunteers.Field Strength/Sequence3D radial UTE sequence at 1.5T.AssessmentUTE‐HF‐NIV sequence was compared with UTE‐free‐breathing (UTE‐FB), reconstructed at end expiration (UTE‐Exp) and average (UTE‐Avg), and breath‐hold VIBE sequences. The distance from lung apex to the dome of the right hemidiaphragm was measured. Visual assessment of the visibility and sharpness of normal anatomical structures was carried out. Dedicated software also quantitatively evaluated vessel–lung and right lung–liver interface sharpness. Apparent signal ratio (Sr) and contrast ratios (Cr) were quantitatively evaluated.Statistical TestsWilcoxon signed rank test for visual scores, paired t‐test for continuous variables, significance at P < 0.05.ResultsThe distance between apex and the right hemidiaphragmatic dome was significantly larger (P < 0.001) with UTE‐HF‐NIV compared with UTE‐FB and VIBE acquisitions. Vessel and airway visibility had identical median visual scores with all UTE methods. Median visual scores for sharpness of vessels and airways were significantly higher (P < 0.001) with HF‐NIV (vessels = 3; airways = 2) than in UTE‐FB (vessels = 2; airways = 1) and VIBE (vessels = 1; airways = 1). Software‐based vessel sharpness evaluation resulted in larger values in 8/10 volunteers with UTE‐HF‐NIV (67.3 ± 9.8) compared with UTE‐Avg (62.3 ± 12.6) but the average difference was not significant (P = 0.28). The sharpness of the lung–liver interface was significantly higher (P < 0.001) with HF‐NIV (17.3 ± 5.3) compared with UTE‐Avg (14.1 ± 3.9). Significantly higher values (P < 0.01) of Sr and Cr were observed with UTE‐HF‐NIV compared with UTE‐FB and VIBE.Data ConclusionHF‐NIV allowing acquisition at full inspiration significantly improves image quality for lung imaging. This could offer the option to alternate some follow‐up CT studies by using this technique. Level of Evidence: 2 Technical Efficacy: Stage 1J. Magn. Reson. Imaging 2019;50:1789–1797.

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Pulmonary infection by Mycoplasma hominis (M hominis) in lung transplant (LTx) recipients is an uncommon yet potentially severe complication. Bronchial dehiscence in the context of M hominis infection has not been previously reported. In this report, we discuss a case of donor‐derived M hominis infection in a LTx recipient with bilateral bronchial anastomoses dehiscence and stenosis. The infection was managed using a multidisciplinary approach: repeat surgical revision of the necrotic anastomosis; targeted antibiotic therapy with the combination of oral and inhaled fluoroquinolones, and oral doxycycline and continuous ventilatory support. Response to therapy was monitored through repeat bronchoscopy and serial quantitative PCR assays for M hominis in bronchoalveolar lavage and aspiration. The rare nature of M hominis infection after LTx, its difficult detection in conventional cultures and innate resistance to beta‐lactams make diagnosis and timely treatment of this organism challenging. We recommend that transplant centers have a low threshold for screening for Mycoplasma infection, particularly in patients with unsatisfactory postoperative course and little response to broad‐spectrum antimicrobial and antifungal coverage. Monitoring with PCR may help to adapt the duration of antibiotic therapy.

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