Radiology. Cardiothoracic imaging最新文献

Purpose To evaluate the relationship between cardiac radiation doses and subclinical changes in cardiac function using cardiac MRI during 2 years of follow-up in patients with breast cancer treated with radiation therapy without chemotherapy after lumpectomy. Materials and Methods This prospective multicenter study (NCT03297346) enrolled female individuals with breast cancer treated with radiation therapy between December 2017 and September 2019. Participants underwent cardiac MRI at baseline, 6 months, and 24 months. Cardiac radiation doses were assessed for the whole heart (WH) and right and left ventricles (LV). A persistent decrease in LV global longitudinal strain (GLS) from baseline to the other two measurement points over the 2-year follow-up was considered an adverse subclinical change in cardiac function. Statistical analysis included Wilcoxon tests for continuous variables and odds ratios for risk assessment. Results The study included 138 female participants (mean age, 58.4 years ± 8.0 [SD]). Mean WH and LV doses were 1.42 Gy (IQR, 1.03-2.01) and 1.46 Gy (IQR, 0.64-2.34). At the 2-year follow-up, all participants had reduced LV end-diastolic volume (EDV) (-4.0% ± 13.2; P < .001) and stroke volume (-3.4% ± 15.2; P < .001), preserved LV ejection fraction, and increased LV remodeling (LV mass/EDV ratio) (4.2% ± 18.1; P < .04) without associated symptoms. Twenty-three (16.6%) participants showed a persistent decrease in LV GLS and received higher mean WH and LV doses compared with participants without persistent decrease in LV GLS (WH: 2.09 Gy [IQR, 1.50-2.45] vs 1.36 Gy [IQR, 1.01-1.87], P < .001; LV: 2.40 Gy [IQR, 1.09-2.88] vs 1.34 Gy [IQR, 0.63-2.02], P = .002). The relative changes in LV EDV and LV mass/EDV were -12.7% ± 9.0 versus -2.2% ± 13.3 (P < .001) and 14.2% ± 15.5 versus 2.2% ± 18.1 (P = .002), respectively, in participants with and without a persistent decrease in LV GLS. A higher WH cardiac radiation dose was associated with a higher risk of a persistent decrease in LV GLS (odds ratio, 1.09 [95% CI: 1.02, 1.16]). Conclusion In participants with recent breast cancer radiation therapy, a modest but persistent reduction in LV GLS over a 2-year follow-up period was associated with the cardiac radiation dose. Keywords: Radiotherapy, Magnetic Resonance Imaging, Cardiotoxicity, Strain Clinical trial registration no. NCT03297346 Supplemental material is available for this article. © RSNA, 2025.

Purpose To develop and evaluate a free-breathing, highly accelerated, multisection, single-beat cine sequence for cardiac MRI. Materials and Methods This prospective study, conducted from July 2022 to December 2023, included participants with various cardiac conditions as well as healthy participants who were imaged using a 3-T MRI system. A single-beat sequence was implemented, collecting data for each section in one heartbeat. Images were acquired with an in-plane spatiotemporal resolution of 1.9 × 1.9 mm² and 37 msec and reconstructed using resolution enhancement generative adversarial inline neural network (REGAIN), a deep learning model. Multibreath-hold k-space-segmented (4.2-fold acceleration) and free-breathing single-beat (14.8-fold acceleration) cine images were collected, both reconstructed with REGAIN. Left ventricular (LV) and right ventricular (RV) parameters between the two methods were evaluated with linear regression, Bland-Altman analysis, and Pearson correlation. Three expert cardiologists independently scored diagnostic and image quality. Scan and rescan reproducibility was evaluated in a subset of participants 1 year apart using the intraclass correlation coefficient (ICC). Results This study included 136 participants (mean age [SD], 54 years ± 15; 69 female, 67 male), 40 healthy and 96 with cardiac conditions. k-Space-segmented and single-beat scan times were 2.6 minutes ± 0.8 and 0.5 minute ± 0.1, respectively. Strong correlations (P < .001) were observed between k-space-segmented and single-beat cine parameters in both LV (r = 0.97-0.99) and RV (r = 0.89-0.98). Scan and rescan reproducibility of single-beat cine was excellent (ICC, 0.97-1.0). Agreement among readers was high, with 125 of 136 (92%) images consistently assessed as diagnostic and 133 of 136 (98%) consistently rated as having good image quality by all readers. Conclusion Free-breathing 30-second single-beat cardiac cine MRI yielded accurate biventricular measurements, reduced scan time, and maintained high diagnostic and image quality compared with conventional multibreath-hold k-space-segmented cine images. Keywords: MR-Imaging, Cardiac, Heart, Imaging Sequences, Comparative Studies, Technology Assessment Supplemental material is available for this article. © RSNA, 2025.

Purpose To assess the predictive value of left atrial (LA) fast long-axis strain derived from cardiac MRI for thrombotic events (TEs) in individuals with hypertrophic cardiomyopathy (HCM). Materials and Methods This secondary analysis of an ongoing prospective trial (Chinese Clinical Trial Registry: ChiCTR1900024094) included consecutive participants with HCM without atrial fibrillation (AF) who underwent cardiac MRI from January 2012 to December 2020. The LA fast long-axis strain was obtained by semiautomatically tracking the distance between the atrioventricular junction and the midposterior LA wall. The primary end point was the occurrence of TEs, including ischemic stroke, transient ischemic attack, and systemic thromboembolism. The predictive value of LA strain was determined with Cox analysis. Results Overall, 714 participants with HCM (mean age ± SD, 50.1 years ± 14.3; 441 men, 273 women; obstructive HCM, n = 289; apical HCM, n = 144) were included (median follow-up: 51 months). Twenty-eight (3.9%) participants with HCM experienced TEs, 60% (17 of 28) of whom had no new-onset AF. Those who experienced TEs had lower LA reservoir and conduit strains (16.2% ± 7.3 vs 21.8% ± 8.3, P = .001; 5.9% ± 3.5 vs 9.7% ± 5.5, P = .01, respectively), with no evidence of a difference in LA booster strain between groups. LA reservoir and conduit strain were independent predictors of TEs in different multivariable models, even after adjusting for age, diabetes, and left ventricular ejection fraction (adjusted hazard ratios: reservoir strain [per 5% decrease], 1.29-1.34 [95% CI: 1.05, 1.50]; conduit strain [per 5% decrease], 1.42-1.47 [95% CI: 1.04, 1.67]). Conclusion Cardiac MRI-derived LA reservoir and conduit strain were independent predictors for the occurrence of TEs in individuals with HCM without AF. Keywords: MR-Imaging, Left Atrium, Cardiomyopathies, Hypertrophic Cardiomyopathy, Thromboembolism, Cardiac Magnetic Resonance Chinese Clinical Trial Registry no. ChiCTR1900024094 Supplemental material is available for this article. © RSNA, 2025.

Purpose To assess the repeatability of real-time cine pulmonary MRI measures of metronome-paced tachypnea (MPT)-induced dynamic hyperinflation and its relationship with chronic obstructive pulmonary disease (COPD) severity. Materials and Methods SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) (ClinicalTrials.gov identifier no. NCT01969344) is a multicenter prospective cohort study that recruited individuals with COPD with 20 or more pack-years smoking history and controls aged 40-80 years. SPIROMICS-HF is a cross-sectional study evaluating cardiopulmonary interactions in COPD from December 2019 to April 2024. Two-dimensional coronal real-time cine pulmonary MRI (3.2 frames/sec) was performed during MPT twice. Lung masks and lung MR images from an independent study were used for transfer learning to segment real-time cine pulmonary MR images. Dynamic hyperinflation was evaluated as the increase in end-expiratory lung volume (EELV) during tidal breathing to the end of MPT. Repeatability was assessed with intraclass correlation coefficients, and multivariable associations with COPD severity were examined. Results Of the 70 participants (mean age, 67 years ± 10 [SD]; 37 male, 33 female) included in the study, 59% had COPD. The transfer learning model achieved high accuracy in lung segmentation (Dice similarity coefficient, 0.94 ± 0.03). There was good scan-rescan agreement for EELV and dynamic hyperinflation (intraclass correlation coefficient, 0.99 and 0.87, respectively). Dynamic hyperinflation was associated with COPD severity (P trend = .01, with a mean difference between severe COPD and controls of 0.24 L). Conclusion A transfer learning model yielded reproducible quantification of MPT-induced dynamic hyperinflation at real-time cine pulmonary MRI, with greater dynamic hyperinflation in participants with more severe COPD. Keywords: Chronic Obstructive Pulmonary Disease, MR Imaging, Pulmonary, Lung, Technology Assessment Supplemental material is available for this article. ClinicalTrials.gov identifier: NCT01969344 © RSNA, 2025.

Purpose To investigate the prognostic value of T1 mapping, extracellular volume fraction (ECV), and T2 mapping in a large cohort of patients with acute myocarditis. Materials and Methods This retrospective study included patients with acute myocarditis who underwent cardiac MRI (3.0 T) between March 2016 and October 2022. Diagnosis was confirmed by diagnostic cardiac MRI criteria or endomyocardial biopsy. The primary end point was major adverse cardiovascular events (MACEs), defined as the composite of cardiac death, heart failure hospitalization, heart transplantation, sustained ventricular arrhythmia, and recurrent myocarditis. Univariable and multivariable Cox regression analyses were performed to assess the association of clinical and cardiac MRI variables with the primary end point. The prognostic value of each model was assessed using the Harrell C index. Results A total of 235 patients (mean age, 32 years ± 13 [SD]; 150 [63.8%] men) were included. During a mean follow-up of 1637 days (IQR: 1441-1833 days), MACEs occurred in 45 (19%) patients. Patients with MACEs had higher global native T1, ECV, and T2 values (1342 msec ± 64 vs 1263 msec ± 48; P < .001; 39.1% ± 8.7 vs 32.7% ± 5.7; P < .001; 61.1 msec ± 10.0 vs 55.3 msec ± 9.4; P = .03, respectively). In a series of multivariable Cox regression models, native T1 (per 10-msec increase: hazard ratio, 1.61; 95% CI: 1.31, 1.98; P < .001) and ECV (per 5% increase: hazard ratio, 1.70; 95% CI: 1.38, 2.08; P < .001) independently predicted MACE occurrence, and the addition of native T1 (Harrell C index = 0.76) or ECV (Harrell C index = 0.79) to the model including only clinical variables, left ventricular ejection fraction, and septal late gadolinium enhancement (Harrell C index = 0.72) improved discrimination for the primary end point. Conclusion Cardiac MRI-derived native T1 and ECV were independent predictors of MACEs in patients with acute myocarditis and provided incremental prognostic value when combined with conventional parameters. Keywords: MRI, Cardiac, Heart, Inflammation Supplemental material is available for this article. © RSNA, 2025.

Purpose To assess the influence of deep learning (DL)-based image reconstruction on acquisition time, volumetric results, and image quality of cine sequences in cardiac MRI. Materials and Methods This prospective study (performed from January 2023 to March 2023) included 55 healthy volunteers who underwent a noncontrast cardiac MRI examination at 1.5 T. Short-axis stack DL cine sequences of the left ventricle (LV) were performed over one (1RR), three (3RR), and six cardiac (6RR) cycles and compared with a standard cine sequence (without DL, performed over 10-12 cardiac cycles) in regard to acquisition time, subjective image quality, edge sharpness, and volumetric results. Results Total acquisition time (median) for a short-axis stack was 47 seconds for the 1RR cine, 108 seconds for 3RR cine, 184 seconds for 6RR cine, and 227 seconds for the standard sequence. Volumetric results showed no difference for the conventional cine (median LV ejection fraction [EF] 63%), 6RR cine (median LVEF, 62%), and 3RR cine (median LVEF, 61%). The 1RR cine sequence significantly underestimated EF (57%) because of a different segmentation of the papillary muscles. Subjective image quality (P = .37) and edge sharpness (P = .06) of the three-heartbeat DL cine did not differ from the reference standard, while both metrics were lower for single-heartbeat DL cine and higher for six-heartbeat DL cine. Conclusion For DL-based cine sequences, acquisition over three cardiac cycles appears to be the optimal compromise, with no evidence of differences in image quality, edge sharpness, and volumetric results, but with a greater than 50% reduced acquisition time compared with the reference sequence. Keywords: MR Imaging, Cardiac, Heart, Technical Aspects, Cardiac MRI, Deep Learning, Clinical Imaging, Accelerated Imaging Supplemental material is available for this article. © RSNA, 2024.

Purpose To evaluate pectoralis muscle thickness at routine cardiac MRI as a marker of sarcopenia, including prognostic significance for major adverse cardiac events (MACE), interobserver agreement, and correlation with physiologic parameters. Materials and Methods This retrospective cohort study included adult patients undergoing cardiac MRI for assessment of suspected cardiomyopathy between October 2018 and February 2020. Measurements of maximum pectoralis major thickness were performed by two experienced radiologists using axial images at the level of the carina. A random subset of 50 patients were re-evaluated to assess intra- and interobserver agreement. The primary end point was MACE, defined as a composite of cardiac death, resuscitated sudden cardiac death, appropriate implantable cardioverter defibrillator discharge, or hospitalization for heart failure. Prognostic significance of pectoralis major thickness measurements for MACE was assessed using Cox proportional hazard models, and correlation between muscle thickness measurements and cardiopulmonary exercise testing (CPET), performed within 1 year of MRI, was assessed using Spearman correlation. Results The study included 1045 patients (mean age, 50 years ± 17 [SD]; 642 male, 403 female). After median follow-up of 3.3 years (IQR: 2.3-3.9 years), MACE occurred in 66 patients. In multivariable models adjusted for patient age, left ventricular ejection fraction, late gadolinium enhancement, and cardiomyopathy cause, pectoralis major muscle thickness was predictive of MACE in both male (hazard ratio [HR], 0.89 [95% CI: 0.85, 0.94]; P < .001) and female patients (HR, 0.85 [95% CI: 0.76, 0.96]; P = .008), with improved model fit in nested models. Pectoralis muscle thickness measurements had excellent intra- and interobserver agreement (intraclass correlation coefficient, 0.99 and 0.95, respectively) and correlated with absolute peak oxygen uptake (r = 0.65, P < .0001) and oxygen uptake efficiency slope (r = 0.61, P < .001) in the subset who underwent CPET within 1 year of MRI (n = 258). Conclusion Pectoralis major muscle thickness at routine cardiac MRI is a simple, reproducible measure of sarcopenia that was associated with MACE occurrence in male and female patients and correlated with CPET parameters. Keywords: Cardiac, Cardiomyopathies, MR Imaging Supplemental material is available for this article. © RSNA, 2024.