Radiology. Cardiothoracic imaging最新文献

Hypertrophic cardiomyopathy (HCM) requires multimodality imaging for accurate diagnosis, risk assessment, and management strategies. Echocardiography serves as the primary imaging tool, evaluating left ventricular wall thickness, outflow tract gradients, and mitral valve morphology. It provides essential diagnostic information and guides treatment decisions, with stress echocardiography particularly valuable for detecting dynamic gradients in obstructive HCM and supporting preoperative planning for interventions such as myectomy. Cardiovascular MRI complements echocardiography through superior resolution, enabling detailed assessment of myocardial mass, flow dynamics, and comprehensive tissue characterization. Late gadolinium enhancement and extracellular volume measurements enhance prognostic evaluation and risk stratification. Cardiac MRI excels at helping distinguish HCM from phenocopies like infiltrative or storage diseases and detecting myocardial disarray, microvascular dysfunction, and abnormalities in myocardial metabolism. Nuclear imaging proves crucial for identifying HCM phenocopies, including transthyretin amyloidosis and sarcoidosis, providing specific diagnostic capabilities. Cardiac CT, while having a secondary diagnostic role, becomes invaluable for evaluating coronary anatomy in patients considered for septal reduction therapies, ensuring comprehensive preoperative assessment. This integrated multimodal approach provides comprehensive HCM evaluation, enabling precise diagnosis, robust risk stratification, and individualized treatment planning. Each modality contributes unique strengths that collectively enhance clinical decision-making and optimize patient outcomes in this complex myocardial disease. Keywords: Cardiomyopathies, Applications-Multimodal, CT, Echocardiography, MR Imaging, SPECT, SPECT/CT, Cardiac Supplemental material is available for this article. © RSNA, 2025.

Purpose To analyze the totality of available evidence for the diagnostic accuracy of photon-counting detector (PCD) coronary CT angiography (CCTA) as an index test for the diagnosis of obstructive coronary artery disease, as compared with invasive coronary angiography (ICA). Materials and Methods This Bayesian diagnostic test accuracy (DTA) meta-analysis included all types of studies that reported diagnostic accuracy measures for PCD CCTA as an index test and ICA as a reference test. PubMed, Embase, and Cochrane Library databases were searched for eligible studies published up to February 21, 2025. The primary outcomes were (pooled) sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio. A Bayesian bivariate model was fitted under a noninformative prior. Subgroup analysis was performed for ultra-high-resolution (UHR) PCD CCTA. Results Nine studies comprising 843 patients were included in the meta-analysis. PCD CCTA demonstrated a pooled sensitivity of 95.9% (95% credible interval [CrI]: 90.2, 98.7) and pooled specificity of 71.2% (95% CrI: 54.0, 87.4) at the patient level; 90.4% (95% CrI: 83.7, 94.5) and 92.8% (95% CrI: 80.1, 97.8), respectively, at the vessel level; and 94.1% (95% CrI: 76.4, 99.2) and 93.0% (95% CrI: 76.3, 98.2), respectively, at the segment level (all area under the receiver operating characteristic curve values ≥ 0.99). These diagnostic accuracy measures were higher across all levels in UHR mode. Conclusion This Bayesian DTA meta-analysis demonstrated the diagnostic accuracy of PCD CCTA, as compared with ICA, at the patient, vessel, and segment levels. Keywords: Coronary Artery Disease, Photon-counting Detector; Coronary Computed Tomography Angiography, Bayesian, Meta-Analysis, Diagnostic Test Accuracy Supplemental material is available for this article. © RSNA, 2025.

Purpose To perform a systematic review and meta-analysis to assess the association between epicardial adipose tissue (EAT) attenuation on CT images and atrial fibrillation (AF). Materials and Methods The Medline, Embase, and Cochrane databases were systematically searched to identify studies published up to July 2023 that assessed the association between CT-derived EAT attenuation and AF prevalence, type, or recurrence after ablation. Meta-analyses were performed to assess the relationship between EAT attenuation and AF outcomes, expressed as the standardized mean difference (SMD). Effect sizes were considered small/modest (around 0.2), moderate (around 0.5), or large (around 0.8). Sensitivity analyses were performed based on voltage selection. Results Sixteen articles, encompassing 4175 patients, were included. Overall, CT EAT attenuation was not associated with AF prevalence (SMD, 0.33 [95% CI: -0.14, 0.79]; P = .17; I² = 90%), AF type (SMD, -0.09 [95% CI: -0.37, 0.20]; P = .56; I² = 77%), or AF recurrence (SMD, -0.01 [95% CI: -0.21, 0.19]; P = .92; I² = 84%). However, in studies using consistent or corrected tube voltage settings, higher CT EAT attenuation was moderately associated with higher AF prevalence (SMD, 0.52 [95% CI: 0.07, 0.97]; P = .02; I² = 81%) and modestly associated with a lower risk of AF recurrence after ablation (SMD, -0.15 [95% CI: -0.27, -0.04]; P = .01; I² = 0%); EAT attenuation remained unassociated with AF type. Conclusion Higher CT EAT attenuation was associated with higher AF prevalence and lower risk of AF recurrence after ablation in studies using consistent or corrected tube voltage settings, highlighting the need for methodologically uniform studies to clarify the prognostic value of EAT attenuation in AF. Keywords: Epicardial Fat, CT, Atrial Fibrillation Supplemental material is available for this article. © RSNA, 2025.

Over the past decade, coronary CT angiography (CCTA) has seen major advancements in spatial and temporal resolution, as well as postprocessing software that now integrates artificial intelligence-based quantitative plaque (AI-QP) analysis tools. This review highlights the clinical significance of plaque quantification, examines the validation status of various AI-QP vendors, and discusses implications for patient care and outcomes. As plaque burden and progression are increasingly recognized as key prognostic indicators in patients with coronary artery disease (CAD), AI-QP has the potential to more accurately identify individuals at risk for adverse events and thereby influence patient management. However, several challenges must be addressed. The incremental prognostic value of AI-QP over established measures of plaque burden, such as the coronary artery calcium score, must be further established. For monitoring CAD progression, the reproducibility of AI-QP across CCTA scans must also be validated, and clinically meaningful thresholds for plaque progression need to be defined. Although AI-QP shows promise for improving risk stratification and guiding treatment, further evidence is needed to confirm its clinical utility and overcome barriers to widespread implementation in clinical practice. Keywords: CT-Coronary Angiography, Applications - CT, Artificial Intelligence © RSNA, 2025.

Purpose To evaluate a novel continuous-acquisition cardiac MRI method that integrates non-contrast-enhanced and contrast-enhanced imaging within a single 20-minute, free-breathing, non-electrocardiographically (ECG) gated scan. Materials and Methods A three-dimensional (3D) stack-of-stars T2-prepared fast low angle shot (FLASH) pulse sequence, combined with a 3D multitasking reconstruction and multiparametric mapping framework, was developed to jointly reconstruct coregistered precontrast and postcontrast images. A prospective study conducted from September 2021 to February 2022 involved 10 healthy human volunteers (mean age, 37 years ± 21 [SD]; eight male, two female) and four pigs with reperfusion injury. Quantitative and qualitative MRI measurements were verified in a digital phantom and in vivo. Statistical analysis included intraclass correlation coefficient, Bland-Altman analysis, and paired t tests to compare the proposed method against reference methods. Results Multitasking T1 measurements were highly correlated with two-dimensional (2D) inversion recovery spin-echo-T1 (R² > 0.99) and T2 measurements with 2D spin-echo-T2 (R² > 0.960) in the phantom study. In vivo, multitasking provided higher myocardial T1 values than did modified Look-Locker inversion recovery (MOLLI) (1383 msec ± 37.8 vs 1217 msec ± 16.3; P < .001) and higher myocardial T2 values than did T2-prep FLASH (43.9 msec ± 1.4 vs 40.0 msec ± 1.6; P < .001). There was no evidence of a difference between multitasking and MOLLI extracellular volume (ECV) values (27.5% ± 1.4 and 27.9% ± 1.8; P = .52). In pigs, the proposed method depicted increased precontrast T1 and ECV in ischemic injury regions, aligning well with reference measurements. Conclusion The novel 3D multitasking method enables a comprehensive, 20-minute, push-button cardiac MRI examination without ECG gating or breath holding, providing cardiac function, T1, T2, ECV, and late gadolinium enhancement measurements. Keywords: Cardiac MRI, Cardiac MRI Multitasking, Continuous-Acquisition Cardiac MRI, All-in-One Cardiac MRI Supplemental material is available for this article. © RSNA, 2025.

The ninth edition of the TNM staging classification of pleural mesothelioma is an update in the TNM staging, refining the tumor descriptors with the first-time use of a size criteria for tumor evaluation in addition to invasion of adjacent structures. There are no changes to the N and M categories. These modifications aim to improve staging accuracy and guide clinical decision-making. Keywords: Thorax, Pleura, Neoplasms-Primary, Staging © RSNA, 2025.

Purpose To assess the feasibility of extrapleural air injection as a simple technique to protect intercostal nerves against thermal injury during image-guided percutaneous cryoablation of peripheral lung tumors. Materials and Methods This retrospective single-center interventional cohort study analyzed data from patients who underwent cryoablation of peripheral lung tumors combined with air injection deep to the endothoracic fascia between August 2022 and November 2024. Technical success was defined as the presence of extrapleural air at the level of the shortest tumor-pleura distance on intraprocedural CT images. Patients were evaluated for pain, pneumothorax, and hemoptysis immediately following and at 1 day, 1 week, and 1 month after the procedure. Adverse events were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Results Injection of extrapleural air deep to the endothoracic fascia was performed during 27 sessions targeting 31 lung tumors (81% [25 of 31] of metastases from extrathoracic primary malignancies; median tumor size, 9.0 mm; range, 4.0-35.0 mm) in 26 patients (mean age, 64 years ± 15 [SD]; 17 female; Eastern Cooperative Oncology Group performance status 0-2). Technical success was achieved in 24 sessions (89%; 24 of 27 [95% CI: 72, 96]). No adverse events related to extrapleural air injection occurred. Among patients with successful air injection, none reported intercostal neuralgia. No adverse events with a CTCAE grade of 4 or higher occurred. Conclusion This study suggests feasibility of extrapleural air injection into the endothoracic fascia as a simple technique to protect intercostal nerves from thermal injury during cryoablation of peripheral lung tumors. Keywords: Lung Tumors, Image-guided Thermal Ablation, Percutaneous Cryoablation, Intercostal Neuralgia, Cryosurgery, Ablation Techniques, Percutaneous, Thorax, Lung © RSNA, 2025.

Purpose To evaluate the prognostic value of the periaortic fat attenuation index (FAI), which noninvasively captures vascular inflammation on noncontrast CT images, in managing uncomplicated type B aortic dissection (TBAD). Materials and Methods In this retrospective multicenter study (January 2011-December 2022), an automated machine learning algorithm measured periaortic FAI of the descending thoracic aorta at noncontrast CT. Patients who underwent CT for chest or back pain were included to compare FAI between those with acute aortic dissection, including both type A and B, and those without. Further, prognostic evaluation of patients with uncomplicated TBAD was conducted using multivariable Cox proportional hazards regression. Results A total of 688 patients (median age, 69 years [IQR, 56-79]; 400 male patients), including 380 with acute aortic dissection and 308 without, were analyzed for the diagnostic characteristics of FAI, and 135 patients with uncomplicated TBAD (median age, 70 years [IQR, 59-79]; 90 male patients) were followed up for prognosis. FAI values at initial presentation were higher in patients with acute aortic dissection than in those without (median, -74.5 vs -78.7 HU; P < .001). In patients with uncomplicated TBAD, FAI values peaked on the 6th day after onset. These patients were divided into two groups according to the median peak FAI value of -64 HU. During a median follow up of 529 days, those with higher peak FAI values (≥-64 HU) had higher rates of all-cause death and aortic events (log-rank P < .001). High peak FAI independently predicted these events (adjusted hazard ratio, 4.54 [95% CI: 1.69, 12.21]; P = .003). Conclusion A higher peak FAI value was an independent risk factor for adverse events in patients with uncomplicated TBAD. Keywords: Acute Aortic Dissection, Fat Attenuation Index, Noncontrast CT, Perivascular Adipose Tissue, Prognosis UMIN Clinical Trials Registry (AIDFAI study no. UMIN000053435). 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 compare left ventricular (LV) peak early diastolic strain rate (PEDSR) and peak late diastolic strain rate (PLDSR) using cardiac MRI feature tracking (FT) across a spectrum of diastolic dysfunction and determine the association between diastolic strain rates and cardiac remodeling. Materials and Methods Between October 2008 and December 2022, cardiac MRI and echocardiography were performed in prospectively recruited cohorts with type 2 diabetes mellitus, heart failure with preserved ejection fraction, and severe aortic stenosis, as well as asymptomatic participants without diabetes. Diastolic dysfunction was classified using established echocardiography guidelines. Global circumferential and longitudinal PEDSR and PLDSR were measured at cardiac MRI. Linear regression was performed to identify independent associations between LV diastolic strain rates and remodeling. Results A total of 600 participants (mean age, 65.2 years ± 8.4 [SD]; 361 of 600 male participants [60%]) were included. Proportions of participants with normal diastolic function and those with grade 1, indeterminate, and grade 2 or 3 diastolic dysfunction were 92 of 600 (15%), 401 of 600 (67%), 85 of 600 (14%), and 22 of 600 (4%), respectively. Compared with participants who had normal function, PEDSR decreased in those with grade 1 dysfunction (circumferential PEDSR, 0.99 sec^-1 ± 0.22 vs 0.81 sec^-1 ± 0.24 [P < .001]; longitudinal PEDSR, 0.79 sec^-1 ± 0.19 vs 0.60 sec^-1 ± 0.19 [P < .001]) and remained low throughout worsening stages of diastolic dysfunction. In contrast, compared with participants who had normal diastolic function, PLDSR increased in those with grade 1 dysfunction (circumferential PLDSR, 0.70 sec^-1 ± 0.17 vs 0.82 sec^-1 ± 0.23 [P < .001]; longitudinal PLDSR, 0.73 sec^-1 ± 0.18 vs 0.80 sec^-1 ± 0.27 [P < .001]) and declined progressively with worsening diastolic dysfunction. After multivariable adjustment for risk factors, inverse associations persisted between PEDSR and PLDSR with cardiac remodeling. Conclusion A distinctive pattern of cardiac MRI FT early and late diastolic strain rates was observed across the range of diastolic dysfunction. Keywords: Diastolic Dysfunction, Peak Early Diastolic Strain Rate, Peak Late Diastolic Strain Rate, Feature Tracking 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 define criteria for evaluating the diagnostic adequacy of expiratory CT and use these criteria to evaluate how expiratory quality affects the performance of quantitative air trapping in predicting the presence and progression of chronic lung allograft dysfunction (CLAD). Materials and Methods Consecutive post-lung transplantation inspiratory-expiratory chest CT scans acquired at the authors' institution between March 2020 and November 2023 were retrospectively evaluated for diagnostic adequacy by grading the tracheal morphology on expiratory CT scans and comparing CT lung volume measurements with spirometry data. Lung volumes and voxelwise air trapping were measured using a deep learning algorithm. Air trapping was compared against changes in spirometry data at baseline and follow-up using Pearson correlation and receiver operating characteristic curve analysis. Results A total of 603 inspiratory-expiratory chest CT scans in 192 patients who underwent lung transplantation (mean age, 57.2 years ± 13.3 [SD]); 121 male patients) were evaluated. Tracheal morphology was identified as predominantly convex on 29% (175 of 613) of the CT scans, resulting in an overestimation of the expiratory volume in these studies. The correlation of the lung volume measurements between CT and spirometry improved with tracheal concavity. A baseline air trapping level of 50% had 82.6% specificity and 34.0% sensitivity for diagnosing CLAD on studies with predominantly concave or flat morphology and a volume change of 1.0 L or greater. A 20% increase in air trapping resulted in 92.1% specificity and 20.0% sensitivity for a concurrent 10% decline in the forced expiratory volume in 1 second (FEV₁). Conclusion Tracheal morphology was used to assess the diagnostic adequacy of expiratory phase CT. Increased air trapping was highly specific, but not very sensitive, for predicting an FEV₁ decline and helped in the diagnosis and monitoring of CLAD progression. Keywords: CT, CT-Quantitative, Pulmonary, Lung, Physiological Studies, QA/QC, Transplantation, Technology Assessment, Quality Assurance, Artificial Intelligence, Air Trapping, Bronchiolitis Obliterans, Lung Transplant Supplemental material is available for this article. © RSNA, 2025.