Radiology. Cardiothoracic imaging最新文献

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.

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.