Radiology. Cardiothoracic imaging最新文献

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.

Purpose To evaluate the feasibility of performing pulse oximetry-triggered coronary CT angiography (CCTA) for diagnostic imaging in cardiac participants who cannot or have difficulty being connected to electrocardiographic (ECG) devices. Materials and Methods This prospective study enrolled consecutive participants scheduled for CCTA on a 16-cm z-axis coverage CT from June to July 2023. Half of the study participants underwent CCTA triggered by a simulated virtual ECG signal based on heart rate monitoring via pulse oximetry (pulse oximetry-triggered group), and the other half underwent traditional ECG-triggered CCTA (ECG group). All images were reconstructed using motion correction and deep learning image reconstruction algorithms. Comparisons were made regarding radiation dose, contrast agent dose, examination time, and subjective and objective image quality assessments between the two groups. Results Three hundred participants (mean age ± SD, 57 years ± 12; 161 male) were included. The total examination time of the pulse oximetry-triggered group (n = 150) was significantly lower than that of the ECG group (n = 150) (313.23 seconds ± 59.59 s vs 743.25 seconds ± 75.35; P < .001). There was no evidence of a difference between the pulse oximetry-triggered and ECG groups in terms of radiation and contrast media dose (all P > .05). The pulse oximetry-triggered and ECG groups had comparable values for CT attenuation, image noise, signal-to-noise ratio, and contrast-to-noise ratio of the main coronary vessels, as well as overall image quality (all P > .05). Conclusion The study demonstrated that CCTA with the pulse oximetry-triggered protocol on a 16-cm z-axis coverage CT with cardiac motion correction algorithm and deep learning image reconstruction algorithms provide comparable image quality to traditional ECG-triggered CCTA at similar radiation and contrast doses while significantly reducing examination time. Keywords: Applications-CT, CT-Angiography, CT-Coronary Angiography Supplemental material is available for this article. © RSNA, 2025.

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.