Radiology. Cardiothoracic imaging最新文献

Primary cardiac tumors are extremely rare and mostly benign. Cardiac angiosarcoma is the most common malignant cardiac tumor, known for its late presentation and poor prognosis. This report describes the case of a male patient who presented to the emergency department with chest pain and shortness of breath shortly after a viral infection. Chest CT imaging showed a mycotic right atrial pseudoaneurysm with pericarditis and hemopericardium, without gross or pathologic evidence of malignancy after surgery. However, 2 months after discharge, the patient returned with proven metastatic cardiac angiosarcoma. This case highlights the atypical presentation of this rare disease and difficulties in initial early diagnosis. Keywords: CT, Cardiac, Heart, Thorax, Neoplasms-Primary © RSNA, 2025.

Radiology: Cardiothoracic Imaging publishes research, technical developments, and reviews related to cardiac, vascular, and thoracic imaging. The current review article, led by the Radiology: Cardiothoracic Imaging trainee editorial board, highlights the most impactful articles published in the journal between November 2023 and October 2024. The review encompasses various aspects of cardiac, vascular, and thoracic imaging related to coronary artery disease, cardiac MRI, valvular imaging, congenital and inherited heart diseases, thoracic imaging, lung cancer, artificial intelligence, and health services research. Key highlights include the role of CT fractional flow reserve analysis to guide patient management, the role of MRI elastography in identifying age-related myocardial stiffness associated with increased risk of heart failure, review of MRI in patients with cardiovascular implantable electronic devices and fractured or abandoned leads, imaging of mitral annular disjunction, specificity of the Lung Imaging Reporting and Data System version 2022 for detecting malignant airway nodules, and a radiomics-based reinforcement learning model to analyze serial low-dose CT scans in lung cancer screening. Ongoing research and future directions include artificial intelligence tools for applications such as plaque quantification using coronary CT angiography and growing understanding of the interconnectedness of environmental sustainability and cardiovascular imaging. Keywords: CT, MRI, CT-Coronary Angiography, Cardiac, Pulmonary, Coronary Arteries, Heart, Lung, Mediastinum, Mitral Valve, Aortic Valve, Artificial Intelligence © RSNA, 2025.

Chest CT has become a key component of the diagnostic approach to a wide range of airway and vascular diseases, including asthma, emphysema, chronic airways disease, and pulmonary vascular disorders such as pulmonary embolism. The interaction between ventilation and perfusion is complex but is always aimed at optimal matching to enable efficient gas exchange. If either one or both of these are affected by disease, they have a negative effect on the other. CT is able to define the structure of lung parenchyma, airways, and pulmonary vasculature in great detail. Beyond morphology, increasingly sophisticated scanner and software technology increase the diagnostic scope of CT toward obtaining comprehensive functional information. This paves the way for new understanding of lung function, the effects of various diseases, and the way in which therapeutic interventions have an effect. Greater understanding of the principal components of chest CT and how they are developing into clinical practice is relevant to anyone with an interest in diagnostic chest imaging. Keywords: CT-Spectral Imaging (Dual Energy), Applications-CT, CT-Quantitative, CT-Perfusion, Thorax, Lung © RSNA, 2025.

Purpose To assess the impact of clinical factors, including hemoptysis etiology and embolic agent type, on the prognosis of patients with hemoptysis requiring bronchial artery embolization (BAE). Materials and Methods This retrospective cohort study used data from Japan's national administrative claims database (from January 2014 to December 2022). Patients with hemoptysis requiring BAE were identified using their corresponding diagnostic and procedural codes. Data extracted from the database included the etiology of hemoptysis and the types of embolic agents used. Survival rates after discharge from admission for BAE were assessed using Kaplan-Meier analysis. Independent prognostic factors were identified using multivariable Cox proportional analysis. Results The study included 7277 patients (mean age, 70.6 years ± 12.8 [SD]; 4074 male patients) with hemoptysis requiring BAE. The in-hospital mortality rate was 7.4%. Survival rates after discharge at 1, 3, and 5 years were 85.5%, 72.7%, and 64.4%, respectively. Use of coils as embolic agents was associated with a 17% lower incidence of all-cause mortality compared with use of gelatin sponge (hazard ratio [HR], 0.83 [95% CI: 0.74, 0.9], P = .002). Higher mortality was associated with bronchopulmonary carcinoma (HR, 2.59 [95% CI: 2.31, 2.89], P < .001), acute respiratory infection (HR, 1.26 [95% CI: 1.14, 1.39], P < .001), and chronic pulmonary aspergillosis (HR, 1.47 [95% CI: 1.28, 1.69], P < .001). Conclusion The prognosis of patients with hemoptysis requiring BAE was poor, especially in those with specific underlying etiologies. The use of coils versus gelatin sponge as the embolic agent for BAE was associated with improved survival. Keywords: Embolization, Vascular Supplemental material is available for this article © RSNA, 2025.

Purpose To determine the prognostic significance of cardiac MRI parameters in patients with moderate-to-severe aortic regurgitation (AR) and minimal or no symptoms through a network meta-analysis. Materials and Methods This systematic review and network meta-analysis searched in PubMed, Embase, and Cochrane Library databases for articles published from January 1, 2000, to March 1, 2024, investigating the prognostic value of cardiac MRI parameters in patients with moderate-to-severe AR. The composite outcome included all-cause death, heart failure hospitalization, aortic valve replacement, new-onset heart failure symptoms, New York Heart Association class progression, and left ventricular ejection fraction less than 50%. Both pairwise and network meta-analyses were performed. Results Eight studies with 1579 patients (1187 male patients [75%]; mean age, 55 years ± 5 [SD]) were included. Aortic regurgitant volume and regurgitant fraction were associated with a higher incidence of adverse events (pooled hazard ratio [HR], 1.04 per 1 mL increase [95% CI: 1.01, 1.06] and pooled HR, 1.09 per 1% increase [95% CI: 1.03, 1.16], respectively). Adverse remodeling, reflected by increased end-diastolic or end-systolic volume (pooled HR, 1.02 per 1 mL/m² [95% CI: 1.01, 1.03] and pooled HR, 1.02 per 1 mL/m² [95% CI: 1.01, 1.04], respectively), was predictive of worse outcome. Late gadolinium enhancement was associated with a twofold increased risk of developing the study end point (pooled HR, 1.86; 95% CI: 1.20, 2.89). T1 mapping and extracellular volume could not be assessed. Network meta-analysis disclosed that late gadolinium enhancement (P = .884) and regurgitant fraction (P = .727) were the most important prognostic factors. Conclusion This network meta-analysis demonstrated the strong prognostic value of regurgitant fraction and left ventricular adverse remodeling as assessed with cardiac MRI in risk stratification of patients with moderate-to-severe AR and no or minimal symptoms. Keywords: Meta-Analysis, Aortic Regurgitation, Late Gadolinium Enhancement, Cardiac MRI Supplemental material is available for this article. © RSNA, 2025.

Prosthetic heart valve (PHV) dysfunction is increasingly seen due to the increase in the number of PHV that are being implanted worldwide. Cardiac CT imaging has emerged as a valuable tool to assess PHVs and determine the cause of dysfunction. This consensus document first summarizes the available techniques for PHV assessment. Then the use of CT in PHV (dys)function assessment is discussed in detail including consensus statements for correct indications and patient selection for CT assessment of PHVs, image acquisition, reconstruction and measurement protocols and how to interpret and report the CT findings for specific types of PHV dysfunction. This article was published in Journal of Cardiovascular Computed Tomography, Budde RPJ et al, Cardiac computed tomography for prosthetic heart valve assessment: An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the European Society of Cardiovascular Radiology (ESCR), the North American Society for Cardiovascular Imaging (NASCI), the Radiological Society of North America (RSNA), the Society for Cardiovascular Angiography & Interventions (SCAI), and the Society of Thoracic Surgeons (STS). The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation may be used when referencing this document. © 2025 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. on behalf of the Society of Cardiovascular Computed Tomography. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Keywords: Computed Tomography, Valve, Cardiac, Imaging, Dysfunction, Prosthetic.

A 72-year-old man presented with progressive shortness of breath and increasing consolidation. Extensive workup eventually led to the diagnosis of lipoid pneumonia, attributed to an unusual source of inhaled aerosolized essential oils in a commercially available breath freshening spray. This case illustrates the clinical and radiologic manifestations of exogenous lipoid pneumonia from an unreported entity and highlights the value of interdisciplinary discussion, detailed analysis of every imaging study, proper pathologic sample preparation, and the limited value of functional imaging in this condition. Keywords: PET/CT, Biopsy/Needle Aspiration, Thorax, Lung, Inflammation, Observer Performance © RSNA, 2025.

Purpose To compare the performance of improved nonenhanced whole-heart balanced steady-state free precession (bSSFP) coronary MR angiography (CMRA) with that of the modified Dixon (mDixon) water-fat separation method at 3-T imaging. Materials and Methods From September 2023 to December 2023, patients with suspected coronary artery disease who underwent bSSFP and mDixon CMRA after coronary CT angiography (CCTA) were consecutively recruited. The two sequences' acquisition success rates, subjective image quality scores, objective image quality measurements, and diagnostic performance for coronary stenosis with CCTA as the reference standard were analyzed. Results Sixty-two participants completed two CMRA sequences. Data from 49 participants (30 male and 19 female participants; mean age, 62 years ± 10 [SD]) were ultimately analyzed. The acquisition success rates, overall subjective image quality scores, apparent signal-to-noise ratios, and contrast-to-noise ratios of bSSFP and mDixon were significantly different: 93.5% versus 80.6% (P = .021), 5 versus 4 (P < .001), 33.4 ± 10.6 versus 20.7 ± 7.5 (P < .001), and 14.9 ± 6.2 versus 7.0 ± 3.1 (P < .001), respectively. The sensitivity and specificity of bSSFP in predicting stenosis greater than or equal to 50% were 94.7% (95% CI: 71.9, 99.7) and 96.7% (95% CI: 80.9, 99.8) per participant, 95.8% (95% CI: 76.9, 99.8) and 96.7% (95% CI: 91.3, 98.9) per vessel, and 96.6% (95% CI: 80.4, 99.8) and 99.0% (95% CI: 97.3, 99.7) per segment, respectively. Conclusion Compared with the mDixon water-fat separation method, the improved nonenhanced whole-heart bSSFP sequence performed excellently at 3-T imaging. Nonenhanced bSSFP CMRA sequences at 3-T imaging may be recommended for broader clinical applications. Keywords: Coronary Arteries, Imaging Sequences, Comparative Studies, Technology Assessment, Cardiac, MR Angiography, Coronary Angiography, MRI, Image Quality Enhancement Supplemental material is available for this article. © RSNA, 2025.

Purpose To evaluate a noncontrast electrocardiographically triggered, navigator-gated, three-dimensional, balanced steady-state free precession MR angiography (MRA) research sequence on a wide-bore 0.55-T commercial low-field-strength system, by comparing image quality and aortic dimension measurements against images obtained at 1.5 T. Materials and Methods Ten healthy volunteers (28.8 years ± 9.0 [SD]; four male) and 10 participants being evaluated for dilated thoracic aorta (53.6 years ± 10.7; six male) underwent noncontrast MRA scans at both 1.5 T and 0.55 T. Overall image quality, intrarater and interrater agreement in aortic dimensions, and diagnostic accuracy were evaluated between field strengths for both groups of individuals using Wilcoxon test, intraclass correlation coefficient, and Bland-Altman plots. Results Median image quality scores remained comparable between volunteers and participants across field strengths. Blood signal variability was greater at the ascending aorta at 1.5 T for volunteers (P = .01) and participants (P = .02). Blood-myocardium contrast was significantly higher at the ascending aorta and proximal arch at 1.5 T for volunteers and participants (P < .05). Excellent intra- and interrater agreement (intraclass correlation coefficient > 0.9) was demonstrated at 0.55 T and 1.5 T. Aortic dimensions (intraclass correlation coefficient > 0.9) and diagnosis of aortic dilatation did not demonstrate significant interfield differences. Conclusion Noncontrast, three-dimensional, balanced steady-state free precession MRA at 0.55 T demonstrated adequate image quality and no significant differences in quantitative measurements or diagnostic accuracy compared with 1.5 T. Keywords: Noncontrast MR Angiography, Low Field, 0.55 T, Obesity, Thoracic Aorta © RSNA, 2025.