Radiology. Cardiothoracic imaging最新文献

Mitral annular disjunction (MAD) refers to atrial displacement of the hinge point of the mitral valve annulus from the ventricular myocardium. MAD leads to paradoxical expansion of the annulus in systole and may often be associated with mitral valve prolapse (MVP), leaflet degeneration, myocardial and papillary muscle fibrosis, and, potentially, malignant cardiac arrhythmias. Patients with MAD and MVP may present similarly, and MAD is potentially the missing link in explaining why some patients with MVP experience adverse outcomes. Patients with a 5 mm or longer MAD distance have an elevated risk of malignant cardiac arrhythmia compared with those with a shorter MAD distance. Evaluation for MAD is an important component of cardiac imaging, especially in patients with MVP and unexplained cardiac arrhythmias. Cardiac MRI is an important diagnostic tool that aids in recognizing and quantifying MAD, MVP, and fibrosis in the papillary muscle and myocardium, which may predict and help improve outcomes following electrophysiology procedures and mitral valve surgery. This article reviews the history, pathophysiology, controversy, prevalence, clinical implications, and imaging considerations of MAD, focusing on cardiac MRI. Keywords: MR-Dynamic Contrast Enhanced, Cardiac, Mitral Valve, Mitral Annular Disjunction, Mitral Valve Prolapse, Floppy Mitral Valve, Cardiac MRI, Arrhythmia, Sudden Cardiac Death, Barlow Valve © RSNA, 2023.

Purpose To evaluate the performance of a new artificial intelligence (AI)-based tool by comparing the quantified stenosis severity at coronary CT angiography (CCTA) with a reference standard derived from invasive quantitative coronary angiography (QCA). Materials and Methods This secondary, post hoc analysis included 120 participants (mean age, 59.7 years ± 10.8 [SD]; 73 [60.8%] men, 47 [39.2%] women) from three large clinical trials (AFFECTS, P3, REFINE) who underwent CCTA and invasive coronary angiography with QCA. Quantitative analysis of coronary stenosis severity at CCTA was performed using an AI-based coronary stenosis quantification (AI-CSQ) software service. Blinded comparison between QCA and AI-CSQ was measured on a per-vessel and per-patient basis. Results The per-vessel AI-CSQ diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 80%, 88%, 86%, 65%, and 94%, respectively, for diameter stenosis (DS) 50% or greater; and 78%, 92%, 91%, 47%, and 98%, respectively, for DS 70% or greater. The areas under the receiver operating characteristic curve (AUCs) to predict DS of 50% or greater and 70% or greater on a per-vessel basis were 0.92 (95% CI: 0.88, 0.95; P < .001) and 0.93 (95% CI: 0.89, 0.97; P < .001), respectively. The AUCs to predict DS of 50% or greater and 70% or greater on a per-patient basis were 0.93 (95% CI: 0.88, 0.97; P < .001) and 0.88 (95% CI: 0.81, 0.94; P < .001), respectively. Conclusion AI-CSQ at CCTA demonstrated a high diagnostic performance compared with QCA both on a per-patient and per-vessel basis, with high sensitivity for stenosis detection. Keywords: CT Angiography, Cardiac, Coronary Arteries Supplemental material is available for this article. Published under a CC BY 4.0 license.

Leukemias are hematopoietic malignancies characterized by the production of abnormal leukocytes in the bone marrow. Clinical manifestations arise from either bone marrow suppression or leukemic organ infiltration. Lymphadenopathy is the most common direct manifestation of intrathoracic leukemia. However, leukemic cells may also infiltrate the lungs, pleura, heart, bones, and soft tissues. Pulmonary complications in patients with leukemia typically include pneumonia, hemorrhage, pulmonary edema, and sequelae of leukemia treatment. However, pulmonary abnormalities can also be related directly to leukemia, including leukemic pulmonary infiltration. The direct, non-treatment-related effects of leukemia on intrathoracic structures will be the focus of this imaging essay. Given the typical anatomic approach for image interpretation, an organ-based depiction of common and less common intrathoracic findings directly caused by leukemic involvement is presented, emphasizing imaging findings with pathologic correlations. Keywords: Leukemia, Pulmonary, Thorax, Soft Tissues/Skin, Hematologic, Bone Marrow © RSNA, 2023.

Purpose To determine if proton (¹H) MRI-derived specific ventilation is responsive to bronchodilator (BD) therapy and associated with clinical biomarkers of type 2 airway inflammation and airways dysfunction in severe asthma. Materials and Methods In this prospective study, 27 participants with severe asthma (mean age, 52 years ± 9 [SD]; 17 female, 10 male) and seven healthy controls (mean age, 47 years ± 16; five female, two male), recruited between 2018 and 2021, underwent same-day spirometry, respiratory oscillometry, and tidal breathing ¹H MRI. Participants with severe asthma underwent all assessments before and after BD therapy, and type 2 airway inflammatory biomarkers were determined (blood eosinophil count, sputum eosinophil percentage, sputum eosinophil-free granules, and fraction of exhaled nitric oxide) to generate a cumulative type 2 biomarker score. Specific ventilation was derived from tidal breathing ¹H MRI and its response to BD therapy, and relationships with biomarkers of type 2 airway inflammation and airway dysfunction were evaluated. Results Mean MRI specific ventilation improved with BD inhalation (from 0.07 ± 0.04 to 0.11 ± 0.04, P < .001). Post-BD MRI specific ventilation (P = .046) and post-BD change in MRI specific ventilation (P = .006) were greater in participants with asthma with type 2 low biomarkers compared with participants with type 2 high biomarkers of airway inflammation. Post-BD change in MRI specific ventilation was correlated with change in forced expiratory volume in 1 second (r = 0.40, P = .04), resistance at 5 Hz (r = -0.50, P = .01), resistance at 19 Hz (r = -0.42, P = .01), reactance area (r = -0.54, P < .01), and reactance at 5 Hz (r = 0.48, P = .01). Conclusion Specific ventilation evaluated with tidal breathing ¹H MRI was responsive to BD therapy and was associated with clinical biomarkers of airways disease in participants with severe asthma. Keywords: MRI, Severe Asthma, Ventilation, Type 2 Inflammation Supplemental material is available for this article. © RSNA, 2023 See also the commentary by Moore and Chandarana in this issue.

Arrhythmogenic cardiomyopathy is an inherited cardiomyopathy that can involve both ventricles. Several genes have been identified as pathogenic in arrhythmogenic cardiomyopathy, including TMEM43. However, there are limited data on cardiac MRI findings in patients with TMEM43 variants to date. In this case series, cardiac MRI findings and clinical outcomes are described in 14 patients with TMEM43 variants, including eight (57%) with the pathogenic p.Ser358Leu variant (six female patients; mean age, 33 years ± 15 [SD]) and six (43%) with a TMEM43 variant of unknown significance (three female patients; mean age, 38 years ± 11). MRI findings demonstrated left ventricular systolic dysfunction in eight (57%) patients and right ventricular dysfunction in four (29%) patients. Among the nine patients with late gadolinium enhancement imaging, left ventricular late gadolinium enhancement was present in seven (78%; all subepicardial) patients. In summary, TMEM43 variants are associated with high prevalence of subepicardial late gadolinium enhancement and left ventricular dysfunction. Keywords: Arrhythmogenic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy, TMEM43, Cardiac MRI, Genetic Variants Supplemental material is available for this article.