Radiology. Cardiothoracic imaging最新文献

Purpose To compare the image quality and temporal resolution of a 32-fold accelerated real-time cine MRI pulse sequence (19.3-msec temporal resolution) with those of a previously described 16-fold accelerated Cartesian real-time cine sequence (39.8-msec temporal resolution) in patients with cardiac implantable electronic devices (CIEDs) and arrhythmias. Materials and Methods This retrospective study included patients with CIEDs and arrhythmias scanned using both radial and Cartesian real-time cine MRI pulse sequences with gradient-recalled echo readouts at 1.5 T from March 2022 to March 2024. Image quality was assessed visually by clinical raters using a five-point Likert scale for each of four categories (namely, conspicuity, temporal fidelity of wall motion, artifact, and noise) and quantitatively using the signal-to-noise-and-artifact ratio metric. The authors used the Wilcoxon signed rank test and paired t test to compare differences for non-normally and normally distributed variables, respectively. Results The study included 23 patients with CIEDs and arrhythmias (nine female and 14 male patients; mean age, 66.5 years ± 13.3 [SD]). The radial real-time cine sequence yielded significantly higher median summed visual scores than the Cartesian real-time cine sequence across all myocardial segments (radial, 17.5-18, Cartesian, 14.5-16; P < .001). The mean signal-to-noise-and-artifact ratio was significantly higher for radial than for Cartesian (radial, 18.3 ± 5.6, Cartesian, 9.4 ± 4.1; P < .001). Conclusion The proposed 32-fold accelerated radial real-time cine MRI pulse sequence provided higher temporal resolution and superior image quality than the 16-fold accelerated Cartesian real-time cine pulse sequence in patients with CIEDs and arrhythmias. Keywords: MR Imaging, Cardiac, Heart, Left Ventricle, Right Ventricle, Artifacts, Cardiac Assist Devices, Imaging Sequences, Radial K-Space, CIED, Arrhythmia, GRASP, Compressed Sensing, Real-Time, Freebreathing Supplemental material is available for this article. © RSNA, 2025.

Purpose To evaluate the potential of dark-field chest radiography to improve the detection and assessment of pneumothorax. Materials and Methods This prospective study was conducted between March 2022 and September 2023. Participants with or without pneumothorax underwent chest radiography using a prototype system that acquires attenuation-based and dark-field images simultaneously. Five blinded readers independently assessed attenuation-only radiographs and then, after a 4-week interval, assessed dark-field overlay images. Sensitivity, specificity, accuracy, reading time, and diagnostic confidence for pneumothorax detection were compared between the two approaches using appropriate statistical tests. Results The sample included 100 participants (median age, 62 years; IQR, 52-71 years; 61 male participants), including 36 individuals with clinically confirmed pneumothorax and 64 healthy controls. A nonsignificant increase in sensitivity for pneumothorax detection was observed with dark-field overlays (87.4% [95% CI: 67.5, 95.8]) compared with attenuation-based radiographs (84.2% [95% CI: 73.2, 91.2], P = .61), whereas specificity was nearly identical (97.6% [95% CI: 94.0, 99.1] vs 97.5 [95% CI: 95.7, 98.6], P = .89). The median reading time decreased from 30.8 seconds to 10.3 seconds (P < .001), and diagnostic confidence improved across all readers (median score: 3 vs 4; P < .001). Conclusion The addition of dark-field radiography to conventional chest radiography improves pneumothorax detection, substantially reduces reading time, and enhances diagnostic confidence without loss of sensitivity and specificity. Keywords: Pneumothorax, Radiography, Dark-Field © RSNA, 2025.

Purpose To compare two rapid late gadolinium enhancement (LGE) cardiac MRI sequences-phase-sensitive inversion recovery (PSIR) single-shot true fast imaging with steady-state precession (TrueFISP) and motion-corrected TrueFISP PSIR (moco PSIR)-with the PSIR turbo fast low-angle shot (turboFLASH) sequence regarding image quality, localization, and quantification of LGE. Materials and Methods This prospective study included consecutive participants who underwent contrast-enhanced cardiac MRI with three LGE sequences between March 2022 and April 2023. TurboFLASH was the reference standard and was compared with the TrueFISP PSIR and moco PSIR sequences. Primary outcomes were overall image quality scores and contrast-to-noise ratios. Secondary outcomes included qualitative and quantitative assessments of LGE and microvascular obstruction. Statistical analyses included t tests, Wilcoxon signed rank tests, Bland-Altman analysis, and intraclass correlation coefficient. Results A total of 187 participants (mean age, 56.7 years ± 15.1 [SD]; 125 male participants) successfully underwent imaging using all three LGE sequences. All 112 LGE-positive (60%) and 67 LGE-negative (36%) participants undergoing turboFLASH sequencing showed identical results using both TrueFISP and moco PSIR. Overall image quality scores and contrast-to-noise ratios were higher for moco PSIR and TrueFISP than for turboFLASH (P < .001). In participants with ischemic heart disease (n = 94), we found no evidence of difference among the three sequences in LGE-positive layers or segment counts, LGE mass, or microvascular obstruction quantification. Bland-Altman and intraclass correlation coefficient analyses showed a strong agreement across sequences (intraclass correlation coefficient, 0.99). Conclusion Good image quality was achieved with the two rapid sequences in a single breath hold or free-breathing state, in addition to accurate LGE localization and quantification in participants with ischemic heart disease. Keywords: MR-Contrast Agent, Cardiac Supplemental material is available for this article. © The Author(s) 2025. Published by the Radiological Society of North America under a CC BY 4.0 license.

Purpose To determine whether wideband late gadolinium enhancement (LGE) and wideband perfusion pulse sequences suppress image artifacts in children in the presence of a cardiac implantable electronic device (CIED). Materials and Methods In the first experiment of this prospective study, unenhanced cardiac MRI was performed at 1.5 T in 18 healthy pediatric participants (median age, 12 years [range, 10-15 years]; 12 [67%] female) with and without a CIED generator taped in the subclavicular and abdominal positions. LGE and perfusion scans were performed with standard and wideband sequences in each state. Three clinical raters adjudicated the presence or absence of clinically relevant image artifacts. Image artifacts were also quantified. In the second experiment, wideband perfusion and LGE MRI scans with gadolinium-based contrast material administration were performed on four pediatric participants (median age, 15 years [range, 15-19 years]; three [75%] female) with CIEDs in situ. Image quality was graded on a five-point Likert scale by clinical raters (3 = clinically acceptable). Myocardial blood flow was also quantified. Results In the participant experiments, standard LGE produced image artifacts in 61.81% (178 of 288) and 37.15% (107 of 288) of myocardial segments for subclavicular and abdominal IPGs, respectively, and were significantly different (P < .001) from wideband LGE (14.68% [42 of 288] and 0%, respectively) for both positions. Quantitative analysis results were consistent with expert adjudication. Wideband cardiac MRI in four children with CIEDs achieved high image quality (median score ≥ 4.0) and mean resting myocardial blood flow value of 1.06 mL/min/g (n = 3). Conclusion Compared with standard LGE and perfusion MRI, wideband LGE and perfusion MRI produced significantly fewer image artifacts induced by CIEDs in pediatric participants. Keywords: Wideband, Pediatric, Late Gadolinium Enhancement, Perfusion, Pacemaker, Defibrillator Supplemental material is available for this article. © RSNA, 2025.

Purpose To evaluate the feasibility, diagnostic yield, and radiation impact of additional ultra-low-dose CT (ULDCT) covering the entire thorax during coronary CT angiography (CCTA) and coronary artery calcium scoring (CACS) for lung cancer screening. Materials and Methods This prospective multicenter cohort study enrolled asymptomatic participants undergoing either CACS alone or CACS with CCTA between August 2018 and January 2024. Participants with contraindications to iodinated contrast material or who were pregnant were excluded. All participants underwent additional ULDCT for lung cancer screening. Pulmonary nodules were monitored for 2 years with follow-up low-dose CT. Primary outcomes were lung cancer detection rate, radiation exposure, and detection rate of noncancerous findings. Descriptive and multivariable analyses evaluated predictors of lung cancer, assessing calibration, discrimination, and significance. Results Among 2750 participants (mean age, 57 years ± 9.5 [SD]; 2090 men) who underwent coronary assessment, 1353 (49.2%) met U.S. Preventive Services Task Force lung cancer screening eligibility. ULDCT depicted pulmonary nodules in 1045 (38%) participants, with an average diameter of 4.57 mm ± 4.00. A total of 222 of 254 (87%) nodules larger than 6 mm were noncancerous lesions. Lung cancer was ultimately diagnosed in 32 of 2750 (1.16%) participants, including 12 participants with lung cancer that was undetectable within the cardiac field of view. Early-stage disease was identified in 23 of 32 (72%) participants. Additional ULDCT increased radiation dose by 2.03% ± 0.31 for CCTA and 17.12% ± 0.65 for CACS. Conclusion Additional full-chest ULDCT with CCTA and CACS enabled early lung cancer detection with modest radiation dose increase. Keywords: CT, Coronary CT Angiography, Cardiac, Thorax, Lung, Primary Neoplasms, Epidemiology Supplemental material is available for this article. © RSNA, 2025.

Purpose To compare the performance of cardiac CT-derived hybrid aortic valve area (AVA) and planimetry, in combination with aortic valve calcium (AVC) or AVC density (AVCd), for assessing low-gradient aortic stenosis (LGAS). Materials and Methods This retrospective analysis included patients with LGAS (mean gradient < 40 mm Hg) who underwent echocardiography and cardiac CT from November 2018 to March 2022. The performance of absolute and indexed hybrid AVA and planimetry, combined with either absolute AVC or AVCd, was compared by time-to-event analysis and outcome classification ability. Results A total of 215 patients (mean age, 79.2 years ± 8.4 [SD]; 118 male patients) were included in the study. Of these, 74.4% (160 of 215) experienced a composite outcome of valve intervention or all-cause mortality during follow-up. Specifically, 11% (23 of 215) underwent surgical aortic valve replacement, 59% (126 of 215) underwent transcatheter aortic valve replacement, and 15% (32 of 215) died. The median follow-up duration was 478 days (IQR, 283-716 days). Indexed AVA measures performed better than absolute AVA. All models showed comparable discrimination, as measured by Harrell C statistic. The highest performing model was indexed AVA calculated using left ventricular outflow tract area derived from minimum CT diameter combined with absolute AVC (hazard ratio, 2.29; 95% CI: 1.66, 3.15; P < .001; C statistic, 0.60). The lowest performing model was absolute AVA planimetry with AVCd (hazard ratio, 1.62; 95% CI: 1.19, 2.22; P = .002; C statistic, 0.55). Conclusion Diagnostic strategies involving hybrid AVA and AVC or AVCd demonstrated comparable performance in LGAS assessment. Indexed hybrid AVA measures performed better alone or in combination with AVC compared with the absolute AVA measures. Keywords: Aortic Valve Calcium, Cardiac CT, Low-Gradient Aortic Stenosis Supplemental material is available for this article. © RSNA, 2025.

Purpose To assess the diagnostic accuracy of 12-lead electrocardiography (ECG) in detecting, quantifying, and localizing prior myocardial infarction (pMIs) using cardiac MRI as the reference standard. Materials and Methods In this retrospective study, consecutive patients referred for cardiac MRI and their recorded digital ECGs were evaluated between January 2018 and August 2020. Patients underwent cardiac MRI assessment for coronary artery disease or cardiomyopathy. Late gadolinium enhancement was assessed across a 17-segment heart model for patients with and without ischemia. Two blinded cardiologists independently applied the fourth universal definition of myocardial infarction ECG criteria to identify pMIs. Diagnostic accuracy of ECG in detecting pMI was assessed by calculating accuracy, sensitivity, and specificity; χ² test was used to assess the independence of observed frequencies. Results Among 1038 patients (median age, 63 years; IQR, 52-75 years, 405 female patients), ECG detection accuracy for pMI was 78.6% (88.4% specificity and 39.4% sensitivity). Using ECG, 40.2% of all transmural pMIs and 12.3% of all subendocardial pMIs were detected. ECG did not detect pMIs in 126 of 208 (60.6%) patients, particularly in the lateral (69.3%) and inferior (52.3%) regions. ECG did not detect 72.6% and 48.0% of subendocardial and transmural pMIs, respectively. Detection rates decreased further in the presence of complete left or right bundle branch block. Nonspecific conduction disturbances were more common in patients with pMIs (5.3% vs 1.6%, P = .003), especially those with transmural pMIs (6.9% vs 1.6%, P = .002). Conclusion The Fourth Universal Definition of Myocardial Infarction ECG criteria provided high specificity but limited sensitivity for detecting pMI, particularly subendocardial and lateral infarcts. Keywords: Electrocardiogram, Cardiovascular Magnetic Resonance, Myocardial Infarction, Late Gadolinium Enhancement, Fourth Universal Definition of Myocardial Infarction Supplemental material is available for this article. © RSNA, 2025.

Chronic thromboembolic pulmonary hypertension (CTEPH) can lead to right ventricular (RV) ischemia and dysfunction due to chronic pulmonary artery obstruction and increased afterload. While cardiovascular MRI (CMR) enables noninvasive assessment of myocardial perfusion, its role in CTEPH remains unclear. The authors report adenosine stress perfusion CMR findings from two patients with CTEPH before and after pulmonary thromboendarterectomy (PTE). Both showed reduced biventricular perfusion before PTE; one demonstrated post-PTE improvement. Perfusion findings aligned with invasive hemodynamics, suggesting that CMR-derived myocardial perfusion reserve may serve as a valuable tool for assessing treatment response and RV pathophysiologic characteristics in CTEPH. Keywords: Cardiac, Pulmonary Arteries, Chronic Thromboembolic Pulmonary Hypertension, Pulmonary Thromboendarterectomy, Quantitative Perfusion Cardiovascular MRI, Myocardial Blood Flow, Myocardial Perfusion Reserve Supplemental material is available for this article. © RSNA, 2025.

Purpose To assess the inter- and intrareader agreement of the 2020 Society for Vascular Surgery/Society of Thoracic Surgeons (SVS/STS) reporting standards in patients with acute uncomplicated type B aortic dissection (uTBAD). Materials and Methods CT angiograms, obtained between January 2001 and December 2013, from 37 patients (mean age ± SD, 48.5 years ± 15.6; 24 male) with uTBAD were retrospectively reviewed by 14 cardiovascular radiologists and surgeons. The entry tear and proximal and distal extent of each dissection were allocated to aortic zones according to the 2020 SVS/STS reporting standards. Inter- and intrareader agreement was assessed using Cohen κ. Causes of discrepant classifications were analyzed. Results Interreader agreement among all 14 readers (eight radiologists, four cardiothoracic surgeons, and two vascular surgeons) were fair for the entry tear (к = 0.33, 0.40, 0.22, and 0.40), poor to moderate for the proximal extent (к = 0.30, 0.37, 0.20, and 0.41), and moderate to substantial for the distal dissection extent (к = 0.65, 0.80, 0.41, and 0.77). Interreader agreement between individuals was poor to substantial for the entry tear (к = 0.04-0.71; 78% discrepancy) and proximal extent (к = 0.00-0.62; 68% discrepancy), and fair to excellent for the distal extent (к = 0.33-0.92; 35% discrepancy). The causes for discrepancies were unclear definitions of aortic zones, anatomic complexity of lesions, and poor image quality. Intrareader agreement was moderate for the entry tear (к = 0.41-0.57), fair to moderate for the proximal extent (к = 0.37-0.58), and substantial to excellent for the distal extent (к = 0.66-0.92). Conclusion The 2020 SVS/STS reporting standards for acute uTBAD were poorly reproducible among experienced cardiovascular radiologists and surgeons. Keywords: Vascular, Aorta, Dissection, Aortic Dissection, SVS/STS Reporting Standards, CT Angiography, Interobserver Study, Intraobserver Study Supplemental material is available for this article. © RSNA, 2025.

Purpose To evaluate whether adding costal cartilage calcification (CCC) to coronary artery calcium (CAC) scores from chest CT improves coronary heart disease (CHD) prediction in patients with chronic kidney disease (CKD). Materials and Methods This study was a secondary analysis of the Multi-Ethnic Study of Atherosclerosis. Participants (April 2010 to January 2012) were stratified into low- and high-risk CKD groups based on Kidney Disease Improving Global Outcomes staging. CAC and CCC were measured from noncontrast CT scans. The primary outcome was incident CHD. Cox proportional hazards regression was performed for each group, with clinical risk factors and CAC (conventional CAC model), and with the addition of CCC (CCC model). Discriminative power was assessed using the area under the receiver operating characteristic curve (AUC). Results A total of 2355 participants (1314 female; median age, 68 years; IQR, 62-76) were included. Median baseline CAC scores were 22 (IQR, 0-183) and 133 (IQR, 20-649), and median CCC scores were 2055 (IQR, 900-4405) and 3187 (IQR, 1370-6516), for low- and high-risk CKD groups, respectively (P < .001 for CAC and P < .05 for CCC). The conventional CAC model showed lower discriminative power for CHD among the high-risk group (AUC, 0.70; 95% CI: 0.56, 0.84) versus the low-risk group (AUC, 0.74; 95% CI: 0.70, 0.78). Adding CCC improved the AUC to 0.75 (95% CI: 0.61, 0.89) in the high-risk group (P = .04), although there was no evidence of improved discrimination in the low-risk group (AUC, 0.74; 95% CI: 0.69, 0.78). Conclusion Clinical and conventional CAC models showed lower discriminative power for predicting CHD in the high-risk CKD group versus the low-risk group. In the high-risk group, adding CCC improved prediction over clinical models. Keywords: CT, Cardiac, Coronary Arteries, Coronary Artery Calcium Score, Costal Cartilage Calcification, Chronic Kidney Disease, Cardiovascular Disease, Coronary Heart Disease ClinicalTrials.gov identifier: NCT00005487 © RSNA, 2025.