Radiology. Cardiothoracic imaging最新文献

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.

Pleuroparenchymal fibroelastosis (PPFE) is an interstitial lung disease (ILD) characterized at CT by upper lobe-predominant pleural thickening and subpleural fibrosis and histologically by visceral pleural fibrosis and subpleural fibroelastosis. Although initially classified as a rare idiopathic interstitial pneumonia, many cases are related to known risk factors, particularly hematopoietic stem cell and lung transplant, or observed in association with other ILDs. This review summarizes the diagnostic criteria for PPFE and illustrates the CT and histologic manifestations, aiming to familiarize the radiologist with the range of findings suggestive of the diagnosis. Keywords: Conventional Radiography, CT, Pulmonary, Thorax, Lung, Pleura, Complications, Transplantation, Fibrosis © RSNA, 2025.

Purpose To evaluate heart rate as a patient-related confounder in a commonly applied T2 balanced steady-state free precession (bSSFP) mapping sequence used for myocardial tissue characterization. Materials and Methods This retrospective analysis included prospectively (from December 2013 to November 2021) acquired cardiac MRI (1.5 T) datasets with T2 bSSFP mapping from 69 healthy volunteers. Phantom studies and Bloch simulations were performed with heart rates of 60-130 beats per minute and different resting periods (three, six, or nine R-R intervals). Sequence parameters (repetition time, echo time, flip angle, echo train length) were matched across volunteer, phantom, and simulation measurements. Reference values covered clinically relevant T1 and T2 properties found in native myocardium (short, 1041 and 44 msec; medium, 1293 and 43 msec; long, 1534 and 40 msec). A mixed linear model assessed the effect of heart rate on T2 values in volunteer measurements. Results The study included 69 healthy volunteers (median age, 34 years; 44 female and 25 male). Heart rate influenced T2 values acquired with three R-R resting periods (r = -0.38, P = .002; linear regression slope, -0.7 msec/10 beats per minute [95% CI: -1.2, -0.1]). In simulation and phantom measurements, T2 values acquired with three R-R resting periods strongly correlated with heart rate, irrespective of myocardial T1 and T2 properties (r ≤ -0.88; P < .01 for all measurements). Heart rate dependency was reduced with increased resting periods in simulations and phantom measurements. Short myocardial T1 and T2 values derived from T2 bSSFP with nine R-R resting periods were not dependent on heart rate (r = -0.41; P = .33). Conclusion T2 bSSFP with three R-R resting periods underestimates T2 values with increasing heart rates. Use of longer resting periods with T2 bSSFP mapping sequences reduced heart rate dependency. Keywords: Cardiac, Phantom Studies, Myocardium, MRI, Confounding Variables Supplemental material is available for this article. Published under a CC BY 4.0 license.

Purpose To evaluate the accuracy of detection based on level of interpreter experience when reporting coronary artery calcium (CAC) on dual-energy (DE) posteroanterior (PA) and lateral chest radiographs and demonstrate the accuracy of specific imaging clues. Materials and Methods Retrospective review of 45-70-year-old patients who underwent DE PA and lateral chest radiography between March 1, 2021, and June 30, 2021, and also underwent noncontrast chest CT scan within 3 years. Following instruction of DE principles and the appearance of CAC, seven readers interpreted the DE chest radiographs to state if CAC was possibly present, definitely present, or not present; estimate ordinal CAC score; and report imaging clues present. Results Ninety-nine patients were selected (mean age, 58.6 years; 53 male and 46 female patients). Among the 62 patients with CAC, the median score was 92. The median CAC score among seven readers when detected ranged from 120 to 203 and when not detected ranged from 18.9 to 39. Among all readers, sensitivity ranged from 71% to 84% in detecting CAC as possibly or definitely present with a specificity range of 54%-92%, and the area under the receiver operating characteristic curve range was 0.767 to 0.906. The interreader agreement κ statistic ranged from 0.488 to 0.750. Conclusion DE lateral chest radiographs demonstrated CAC better than DE PA radiographs, with relatively high accuracy and with moderate and substantial interreader agreement. Preclinical detection of CAC presents an opportunity for early intervention in coronary atherosclerotic disease, which may be augmented by machine learning tools. Keywords: Dual Energy Chest Radiography, Lateral Chest Radiography, Lateral Chest X-ray Coronary Calcium, Coronary Calcium Screening, Coronary Calcium Detection Supplemental material is available for this article. © RSNA, 2025.

Sarcoidosis is a multisystem inflammatory disorder characterized by noncaseating granulomas. The diagnosis of sarcoidosis is based on three criteria: clinical history, consistent imaging findings, and histopathology. Radiologists play an important role for the diagnosis and follow-up evaluation of patients with sarcoidosis, which often require a multimodal approach. This imaging essay will explore the typical and atypical imaging manifestations of sarcoidosis at chest radiography, CT, PET/CT, and MRI, provide imaging examples, and discuss relevant differential diagnoses for clinical practice. Keywords: Thorax, MR-Imaging, Staging, PET/CT, CT, Conventional Radiography, Sarcoidosis, Thoracic Imaging, Scintigraphy Supplemental material is available for this article. © RSNA, 2025.

Purpose To evaluate the accuracy of chest ultra-low-dose CT (ULDCT) as compared with normal-dose CT in the evaluation of pneumonia in individuals who are immunocompromised. Materials and Methods This prospective study included 54 adults who were immunocompromised (median age, 62 years [IQR, 47.75-69.25 years]; 34 [63%] male participants) referred for a chest CT scan between September 2020 and December 2022 to evaluate for pneumonia. Each participant underwent two scans: normal-dose CT (120 kVp and automatic current modulation) and ULDCT (100 kVp and constant current of 10 mA). ULDCT images underwent a postprocessing procedure using an artificial intelligence algorithm to reduce image noise. Two radiologists, blinded to all clinical information, examined the images obtained from the three methods (normal-dose CT, ULDCT, and denoised ULDCT) for the presence of pneumonia and associated findings. The normal-dose CT was used as the reference standard, and sensitivity, specificity, positive and negative predictive values, and accuracy were calculated. Results The median effective radiation dose of ULDCT scans (0.12 mSV) was 1.95% of that of the normal-dose CT (6.15 mSV). Ten of the 54 participants were correctly identified as having no pneumonia, with similar accuracy between denoised ULDCT and ULDCT (100% vs 96%-98%, respectively). Both methods allowed for detection of pneumonia and features associated with invasive fungal pneumonia, but accuracy was slightly better with denoised ULDCT (accuracy, 100% vs 91%-98%). Fine details were better visualized in denoised ULDCT images: tree-in-bud pattern (accuracy, 93% vs 78%-80%), interlobular septal thickening (accuracy, 78%-83% vs 61%-67%), and intralobular septal thickening (accuracy, 85%-87% vs 0%). Conclusion Denoised ULDCT imaging showed better accuracy than ULDCT in identifying lungs with or without pneumonia in individuals who were immunocompromised. Keywords: CT, Pulmonary, Lung, Infection, Technology Assessment Supplemental material is available for this article. © RSNA, 2025.

Purpose To evaluate the relationship between cardiac radiation doses and subclinical changes in cardiac function using cardiac MRI during 2 years of follow-up in patients with breast cancer treated with radiation therapy without chemotherapy after lumpectomy. Materials and Methods This prospective multicenter study (NCT03297346) enrolled female individuals with breast cancer treated with radiation therapy between December 2017 and September 2019. Participants underwent cardiac MRI at baseline, 6 months, and 24 months. Cardiac radiation doses were assessed for the whole heart (WH) and right and left ventricles (LV). A persistent decrease in LV global longitudinal strain (GLS) from baseline to the other two measurement points over the 2-year follow-up was considered an adverse subclinical change in cardiac function. Statistical analysis included Wilcoxon tests for continuous variables and odds ratios for risk assessment. Results The study included 138 female participants (mean age, 58.4 years ± 8.0 [SD]). Mean WH and LV doses were 1.42 Gy (IQR, 1.03-2.01) and 1.46 Gy (IQR, 0.64-2.34). At the 2-year follow-up, all participants had reduced LV end-diastolic volume (EDV) (-4.0% ± 13.2; P < .001) and stroke volume (-3.4% ± 15.2; P < .001), preserved LV ejection fraction, and increased LV remodeling (LV mass/EDV ratio) (4.2% ± 18.1; P < .04) without associated symptoms. Twenty-three (16.6%) participants showed a persistent decrease in LV GLS and received higher mean WH and LV doses compared with participants without persistent decrease in LV GLS (WH: 2.09 Gy [IQR, 1.50-2.45] vs 1.36 Gy [IQR, 1.01-1.87], P < .001; LV: 2.40 Gy [IQR, 1.09-2.88] vs 1.34 Gy [IQR, 0.63-2.02], P = .002). The relative changes in LV EDV and LV mass/EDV were -12.7% ± 9.0 versus -2.2% ± 13.3 (P < .001) and 14.2% ± 15.5 versus 2.2% ± 18.1 (P = .002), respectively, in participants with and without a persistent decrease in LV GLS. A higher WH cardiac radiation dose was associated with a higher risk of a persistent decrease in LV GLS (odds ratio, 1.09 [95% CI: 1.02, 1.16]). Conclusion In participants with recent breast cancer radiation therapy, a modest but persistent reduction in LV GLS over a 2-year follow-up period was associated with the cardiac radiation dose. Keywords: Radiotherapy, Magnetic Resonance Imaging, Cardiotoxicity, Strain Clinical trial registration no. NCT03297346 Supplemental material is available for this article. © RSNA, 2025.

Purpose To investigate whether pericoronary adipose tissue attenuation (PCATa) provides incremental prognostic value over commonly used coronary CT angiography (CCTA) parameters for predicting major adverse cardiovascular and cerebrovascular events (MACCE) in individuals with diabetes mellitus (DM). Materials and Methods This prospective study included consecutive patients with type 2 DM who underwent CCTA due to suspected coronary artery disease between January 2015 and December 2017. PCATa of three coronary arteries was measured and evaluated. Cox proportional hazards regression was performed to investigate the prognostic value of PCATa for predicting MACCE. The incremental prognostic value of PCATa for MACCE was evaluated by comparing area under the receiver operating characteristic curve (AUC) values of four models (model 1: clinical characteristics, model 2: model 1 + conventional CCTA findings [coronary artery calcium score, Leiden score], model 3: model 2 + advanced CCTA findings [high-risk plaque, CT fractional flow reserve], model 4: model 3 + PCATa). Results Of the 1029 participants (mean age, 60.2 years ± 9.9 [SD]; 539 male) included in the study, 152 (14.8%) experienced MACCE during a median follow-up of 56.5 months. PCATa independently predicted MACCE after adjustment for clinical characteristics and commonly used CCTA findings (hazard ratio, 1.86 [95% CI: 1.24, 2.80]; P = .003). The model incorporating PCATa improved predictive performance for MACCE compared with the model including clinical characteristics and conventional and advanced CCTA parameters (AUC, 0.75 [95% CI: 0.71, 0.79] vs 0.73 [95% CI: 0.68, 0.77]; P = .009). Conclusion PCATa provided incremental prognostic value beyond clinical characteristics and other CCTA findings for prediction of MACCE in individuals with DM. Keywords: CT Angiography, Cardiac, Coronary Arteries, Inflammation, Outcomes Analysis, Coronary Computed Tomography Angiography, Diabetes Mellitus, Coronary Inflammation, Pericoronary Adipose Tissue Attenuation Supplemental material is available for this article. © RSNA, 2025.

Purpose To estimate the extent in which coronary artery calcium (CAC) score and incident lung cancer diagnosis are associated and determine if use of CAC score to predict lung cancer could improve lung cancer screening (LCS). Materials and Methods This retrospective analysis analyzed data from an ongoing, prospective, population-based cohort study (Heinz Nixdorf Recall study) in which participants aged 45-75 years underwent electron-beam CT of the heart. The association between CAC score and incident lung cancer was assessed using Cox proportional hazard regression models adjusted for potential confounders. The area under the receiver operating characteristic curve (AUC) was used to assess predictive performance of CAC score for lung cancer in all participants, eligible participants, and ineligible participants for LCS. Results The study included 4605 participants (mean age, 59.7 [SD, 7.8] years; 2328 female). During a median follow-up time of 15.2 years, incident lung cancer was diagnosed in 111 participants. CAC score as a continuous variable (log CAC+1) was associated with incident lung cancer (hazard ratio [HR] in the fully adjusted model: 1.21 [95% CI: 1.10, 1.32]). A CAC score of 400 or higher versus 0 was associated with a more than fourfold higher risk of lung cancer (adjusted HR: 4.31 [95% CI: 2.19, 8.51]). CAC score alone showed poor performance for predicting lung cancer in the total study sample (AUC, 0.63) and subgroups of participants eligible (AUC, 0.56) and ineligible (AUC, 0.61) for LCS. Conclusion CAC score was associated with incident lung cancer but did not demonstrate potential to improve the efficiency of LCS. Keywords: Epidemiology, Screening, Arteriosclerosis, Cardiac, Thorax, CT, Lung Cancer Supplemental material is available for this article. © RSNA, 2025.