Radiology. Cardiothoracic imaging最新文献

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 measure the frequency of electrocardiographic (ECG) gating errors and to assess whether convolutional neural networks (CNNs) can reduce such errors. Materials and Methods ECG tracings from 120 patients who underwent cine cardiac MRI at 1.5 T and 3.0 T, along with an external dataset of ECG tracings from 47 patients, were retrospectively collected (August 2022-April 2023). The frequency of arrhythmias and ECG-gating errors was determined by manual annotation of R waves. A CNN was developed for R-wave detection using data from 79 MRI and six external patients; the remaining data were used for testing. CNN performance was compared using signal processing algorithms, including vectorcardiographic (VCG) gating and the Hamilton algorithm. Results The mean age of the 120 patients undergoing cardiac MRI was 53.7 years ± 19.8 (SD), with 72 male patients. ECG-gating errors were observed in 8.1% of patients at 1.5 T and 15.2% at 3.0 T. At 1.5 T, CNN achieved a higher F1 score (99.1%) than did VCG (98.1%; P = .048). At 3.0 T, CNN achieved a higher F1 score (99.1%) than did the Hamilton algorithm (92.4%; P = .049) and was not statistically different than VCG (95.1%; P = .68). The CNN demonstrated a lower false-positive rate (0.1%) than did the Hamilton algorithm (7.4%; P = .02) at 3.0 T and was not statistically different than VCG (4.5%; P = .28). The feasibility of retrospective image reconstruction to improve cardiac MRI quality was also demonstrated. Conclusion CNNs offer a robust method for ECG R-wave detection, particularly in the presence of MRI-induced artifacts at 3.0 T. These findings support the potential of CNNs to enhance ECG gating and improve cardiac MR image quality. Keywords: Convolutional Neural Network, ECG Gating, Deep Learning R-Wave Detection, Cardiac MRI Reconstruction 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.

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.

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.