Radiology. Cardiothoracic imaging最新文献

Purpose To evaluate cancer outcomes, stage distribution, and mortality among patients with ground-glass nodules (GGNs) detected in a lung cancer screening program. Materials and Methods This retrospective study included patients in a CT lung cancer screening program (January 2015-July 2023) with a dominant GGN and a comparison group of patients with Lung Imaging Reporting and Data System (Lung-RADS) 1. All lung cancers in the GGN group were reviewed to determine whether they originated from the dominant nodule. Cancer stage and cause of death were obtained from medical records. Categorical variables were compared using the χ² test, and cancer development over time was compared using the log-rank test. Results Among 1724 patients (mean age, 65 years ± 6 [SD]; 917 female) in the screening program with a dominant GGN, 114 were diagnosed with lung cancer: 70 (61%) from the dominant GGN and 44 (39%) from another nodule. Stage 0 or I cancers were identified in 66 of 70 (94%) cancers arising from the dominant GGN versus 24 of 44 (55%) cancers from another nodule (P < .001). All 10 lung cancer-related deaths occurred from solid nodules unrelated to the GGNs. Patients with a dominant GGN were more likely than those with Lung-RADS 1 to develop cancers not related to the dominant nodule (P = .007). Conclusion Annual CT follow-up of patients with GGNs appears appropriate, as nearly all cancers were diagnosed at an early stage. However, these patients remain at risk for developing additional, separate lung cancers that may lead to mortality. Keywords: CT, Lung, Ground-Glass Nodules © RSNA, 2026.

Purpose To assess the prognostic value of artificial intelligence (AI)-derived high-risk features obtained from coronary CT angiography (CCTA) in nonculprit vessels of patients who have undergone percutaneous coronary intervention. Materials and Methods This retrospective study included patients who underwent CCTA at a tertiary hospital between June 2013 and June 2023 followed by percutaneous coronary intervention within 3 months. AI-derived high-risk CCTA features were evaluated, including significant stenosis, high-risk plaque, high plaque volume, low CT fractional flow reserve, and high pericoronary adipose tissue attenuation. The primary end point was nonculprit vessel-related major adverse cardiac events (MACE). The prognostic value of high-risk CCTA features was assessed using multivariable Cox regression analyses. Results A total of 1495 patients (mean age, 66 years ± 10; 1100 male patients) with 2014 nonculprit vessels were analyzed with a median follow-up of 3.3 years. MACE occurred in 100 vessels (5.0%). In a multivariable Cox analysis adjusted for high-risk features, vessel-specific CT fractional flow reserve (adjusted hazard ratio, 0.14; 95% CI: 0.03, 0.76; P = .02) and necrotic core volume (adjusted hazard ratio, 1.30; 95% CI: 1.06, 1.59; P = .01) were independent predictors of MACE and showed an incremental prognostic value when added to clinical risk factors (area under the receiver operating characteristic curve, 0.60 vs 0.67; P < .001). Conclusion AI-derived high-risk features at CCTA provided independent and incremental prognostic values for nonculprit vessel-related MACE. Keywords: Computed Tomographic Angiography, High-Risk Plaque, Percutaneous Coronary Intervention Supplemental material is available for this article. © RSNA, 2026.

Purpose To evaluate the predictive value of myosteatosis as an opportunistic finding in coronary artery calcium (CAC) CT scans for clinically diagnosed chronic obstructive pulmonary disease (COPD) and compare it with an artificial intelligence (AI)-measured biomarker of emphysema derived from the same scans. Materials and Methods In this prospective study, baseline CAC CT scans and 20-year follow-up data were analyzed. Myosteatosis was defined as the lowest quartile of thoracic skeletal muscle mean attenuation (males < 33.5 HU, females < 27.0 HU). The emphysema-like lung biomarker was quantified as the percentage of lung voxels below -950 HU in CAC CT scans. COPD was identified using the International Classification of Diseases, Ninth Revision, Clinical Modification, and International Classification of Diseases, 10th Revision, Clinical Modification diagnostic codes from hospital discharge records. Hazard ratios (HRs) for COPD were calculated using proportional hazard regression models, comparing the bottom versus top quartiles of myosteatosis and emphysema-like lung measurements. Results Among 5535 participants in the Multi-Ethnic Study of Atherosclerosis (mean age ± SD, 62.2 years ± 10.3, 47.6% males), 396 (7.1%) were diagnosed with COPD over the 20-year follow-up period. Myosteatosis showed a stronger association with COPD than emphysema (unadjusted HRs, 5.98 [95% CI: 4.14, 8.63] and 2.12 [95% CI: 1.61, 2.78], respectively [P < .001]). After adjusting for covariates (age, sex, smoking status, body mass index, race, asthma, physical activity, inflammatory markers, and insulin resistance), the HRs were reduced to 2.74 (95% CI: 1.81, 4.16) and 1.50 (95% CI: 1.12, 2.00), respectively (P = .02). Conclusion AI-measured myosteatosis in CAC CT scans strongly predicted future diagnosed COPD independently of known risk factors. Keywords: Applications-CT, Pulmonary, Thorax, Adipose Tissue (Obesity Studies), Chronic Obstructive Pulmonary Disease, Metabolic Disorders, Myosteatosis, Coronary Artery Calcium Scan, Emphysema, AI-CVD ClinicalTrials.gov: NCT00005487 Supplemental material is available for this article. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license.

Purpose To determine the prevalence of apical scarring-which has recently also been referred to as pleuroparenchymal fibroelastosis (PPFE)-like lesions, a characteristic finding at chest CT in idiopathic PPFE-in apparently healthy individuals, to identify associated clinical features, and to evaluate their progression over time. Materials and Methods This retrospective study included individuals without underlying diseases known to cause PPFE, who underwent comprehensive health checkups including chest CT between April 2014 and March 2015 (cohort 1: n = 1737; cohort 2: n = 1126). Clinical features associated with the presence of apical scarring were analyzed using propensity score matching and logistic regression analysis. Furthermore, in a subset of individuals with available follow-up data, radiologic progression of apical scarring was evaluated over a 4-year period from baseline, and potential risk factors were evaluated using a logistic regression model. Results Among 2863 individuals (median age, 57 years [IQR, 49-65 years]; 2299 male), 158 (5.5%) had apical scarring, with prevalence rates of 1.6%, 3.9%, and 8.1% in individuals aged 20-39 years, 40-59 years, and 60 years and older, respectively. Older age and lower body mass index, body fat, and waist circumference were associated with apical scarring. These findings were consistent in both cohorts. Among the 158 individuals with apical scarring, at least 20 (12.7%) demonstrated radiologic progression over 4 years, which was more common in those with more extensive lesions at baseline (progression rate: grade 1 lesions, 19.2% vs grade 2 lesions, 66.7%; P = .006). Conclusion Among apparently healthy individuals, the prevalence of apical scarring increased with age, and its presence was associated with a lean body habitus. Radiologic progression was observed in some individuals. Keywords: CT, Thorax, Lung, Epidemiology, Apical Cap, Interstitial Lung Disease, PPFE, PPFE-like lesions, Pleuroparenchymal Fibroelastosis Supplemental material is available for this article. © RSNA, 2026.

Purpose To assess the feasibility of a deep learning (DL) system to fully automate systemic and pulmonary blood flow measurement with four-dimensional (4D) flow MRI. Materials and Methods A total of 188 clinical 4D flow MRI examinations were retrospectively collected to develop a DL system that serially performs (a) three-dimensional localization and (b) two-dimensional segmentation to compute net aortic and pulmonary artery flow. For each vessel, the system computes the means and SDs (σ) across multiple locations. In a separate composite population of 71 patients with and without shunts, automated and manual measurements from trained physicians were compared with ground truth measurements from a senior radiologist using Pearson correlation and Bland-Altman analysis. Results Automated aortic and pulmonary artery flow estimates and shunt fraction calculations were performed in all 71 patients. Correlation with ground truth was strong (ρ = 0.832, 0.863, and 0.861, respectively; P < .001) with low mean bias (0.40 L/min, 0.20 L/min, and -0.10). High certainty (σ < 0.5 L/min) was observed in 83% (59 of 71) of aortic, 75% (53 of 71) of pulmonary, and 65% (46 of 71) of both aortic and pulmonary flow measurements. Within these subsets, correlations improved (ρ = 0.881, 0.989, and 0.948; P < .001) and closely matched expert readers. Conclusion A DL system can automatically measure blood flow from 4D flow MRI with accuracy comparable to that of trained physicians. Keywords: Deep Learning, Congenital Heart Disease, Shunt Severity, 4D Flow MRI, Convolutional Neural Networks Supplemental material is available for this article. © RSNA, 2026.

Purpose To investigate the potential of using a three-dimensional (3D) ultrashort echo time (UTE) cardiovascular MRI sequence in conjunction with ferumoxytol for imaging extracardiac vascular stents. Materials and Methods Children and young adults with extracardiac vascular stents (n = 30) who underwent cardiovascular MRI were recruited for this prospective study. Ferumoxytol, a T1-shortening blood pool contrast agent with purely intravascular distribution, was used to acquire 3D whole-heart images with both the clinical standard 3D balanced-steady state free precession (bSSFP) and the 3D UTE sequences. Image quality was evaluated using a three-point scale, and the apparent contrast-to-noise ratio (aCNR) was calculated. Statistical analysis was performed to determine the significance of differences in image quality scores and aCNR between the two sequences. Results The 3D UTE sequence provided significantly better image quality for stent visualization compared with the 3D bSSFP sequence, with reviewer 1 scoring it as a mean (±SD) of 2.3 ± 0.6 versus 1.3 ± 0.5 and reviewer 2 scoring it as 2.5 ± 0.6 versus 1.3 ± 0.5 (both P < .01). However, interreviewer agreement on image quality was low for both sequences, with κ values indicating only slight agreement. The aCNR within the stent region for the 3D UTE sequence was also significantly higher than the 3D bSSFP sequence (median, 37.1 vs 12.9; P < .01). Conclusion The 3D UTE sequence was effective in depicting stents and reducing stent-related artifacts compared with the clinical standard 3D bSSFP sequence. It may serve as a valuable complementary tool for imaging extracardiac vascular stents in clinical practice. Keywords: 3D bSSFP, 3D UTE, Cardiovascular Magnetic Resonance, Cardiovascular Stents, Ferumoxytol Supplemental material is available for this article. © RSNA, 2026.

Purpose To evaluate whether left atrial (LA) function assessed with cardiac MRI provides incremental prognostic value beyond biventricular function in children with repaired tetralogy of Fallot (rTOF). Materials and Methods In this prospective study, pediatric participants with rTOF were consecutively recruited between August 2019 and December 2021 and healthy controls from July 2017 to August 2018. All participants underwent cardiac MRI. Measurements included LA size, ejection fraction (EF), strain, and strain rate across reservoir, conduit, and pump phases, and biventricular volumes, mass, and global longitudinal strain (GLS). Late gadolinium enhancement was assessed in rTOF. End point events were heart failure hospitalization and reoperation. Cox regression analysis was performed. Model performance was assessed using Harrell concordance index, integrated discrimination improvement, and net reclassification improvement. Results Seventy-eight participants with rTOF (mean age, 10.73 years ± 3.66 [SD]; 47 male) and 30 controls (mean age, 11.06 years ± 2.97; 21 male) were included. Compared with controls, participants with rTOF demonstrated LA dysfunction, with lower reservoir EF, strain, and strain rate, lower conduit EF and strain, and higher pump EF, while biventricular GLS remained normal. Over a median follow-up of 2 years, impaired LA conduit strain (<15.83%), impaired right ventricular (RV) GLS (<22.66%), and higher end-systolic volume index were independently associated with end point events (hazard ratio = 4.72, 2.75, and 1.02, respectively). Adding impaired LA conduit strain into the RV GLS model increased the concordance index from 0.74 to 0.82 (P < .001) with an integrated discrimination improvement of 0.13 (P = .006) and net reclassification improvement of 0.89 (P < .001). Conclusion In pediatric rTOF with preserved ventricular EF and GLS, LA dysfunction at cardiac MRI was evident. Incorporating LA conduit strain alongside established RV functional parameters improved prognostic assessment during follow-up. Keywords: Pediatrics, MR Imaging, Cardiac, Left Atrium, Right Ventricle, Congenital, Outcomes Analysis, Cardiac MRI, Congenital Heart Disease, Tetralogy of Fallot, Left Atrial Function Supplemental material is available for this article. © RSNA, 2026.