Journal of Thoracic Imaging最新文献

Purpose: To investigate imaging phenotypes in posthospitalized COVID-19 patients by integrating quantitative CT (QCT) and machine learning (ML), with a focus on small airway disease (SAD) and its correlation with plethysmography.

Materials and methods: In this single-center cross-sectional retrospective study, a subanalysis of a larger prospective cohort, 257 adult survivors from the initial COVID-19 peak (mean age, 56±13 y; 49% male) were evaluated. Patients were admitted to a quaternary hospital between March 30 and August 31, 2020 (median length of stay: 16 [8-26] d) and underwent plethysmography along with volumetric inspiratory and expiratory chest CT 6 to 12 months after hospitalization. QCT parameters were derived using AI-Rad Companion Chest CT (Siemens Healthineers).

Results: Hierarchical clustering of QCT parameters identified 4 phenotypes among survivors, named "SAD," "intermediate," "younger fibrotic," and "older fibrotic," based on clinical and imaging characteristics. The SAD cluster (n=37, 14%) showed higher residual volume (RV) and RV/total lung capacity (TLC) ratios as well as lower FEF 25-75 /forced vital capacity (FVC) on plethysmography. The older fibrotic cluster (n=42, 16%) had the lowest TLC and FVC values. The younger fibrotic cluster (n=79, 31%) demonstrated lower RV and RV/TLC ratios and higher FEF 25-75 than the other phenotypes. The intermediate cluster (n=99, 39%) exhibited characteristics that were intermediate between those of SAD and fibrotic phenotypes.

Conclusion: The integration of inspiratory and expiratory chest CT with quantitative analysis and ML enables the identification of distinct imaging phenotypes in long COVID patients, including a unique SAD cluster strongly associated with specific pulmonary function abnormalities.

Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by widespread inflammation in the lungs. It is associated with high mortality and morbidity in critically ill patients. ARDS are conditions that cause acute respiratory failure due to noncardiogenic pulmonary edema, leading to severe hypoxemia and diffuse, bilateral lung injury. These conditions represent a spectrum of lung injury with varying severity and complexity. ARDS is a more severe form of ALI. ALI can also describe a range of clinical and paraclinical findings that include one or both pathologic patterns of organizing pneumonia (OP) or diffuse alveolar damage (DAD). The pathologic correlate of ARDS is DAD. This damage can be triggered by various risk factors, including pneumonia, sepsis, trauma, and the inhalation of harmful substances. The alveolar capillary damage that accompanies DAD leads to a loss in barrier function and is associated with the accumulation of fluid into the alveolar space. This fluid accumulation (pulmonary edema), along with subsequent organization and scarring, impairs gas exchange, which leads to hypoxemia and respiratory failure. Despite advances in understanding the pathophysiology of ARDS and improvements in supportive care, the mortality rates from ARDS still range from 25% to 45%. It is crucial to recognize that radiographic and histologic findings in a patient with ARDS can vary significantly depending on the phase of the disease. This is because the pathophysiological processes underlying these conditions evolve over time, leading to changes in both clinical presentation and imaging findings. Misinterpretation of these findings could lead to incorrect diagnoses and inappropriate treatment strategies. Therefore, understanding the temporal evolution of this condition is essential for accurate diagnosis and effective management. Our paper seeks to examine the existing literature focusing on radiology and pathology at different phases of injury and resolution to enhance management of ARDS.

Purpose: Vascular mapping and classification of pulmonary artery pseudoaneurysms (PAPs) using CTA to guide management. Correlation of CTA findings with DSA, considered the gold standard.

Materials and methods: An ambispective study with 45 patients presenting with hemoptysis (2018-2023), diagnosed with PAP on CTA, was included in the study. PAPs were classified into 4 types based on CTA (type A: pure pulmonary artery supply, type B: dual supply from stenosed pulmonary and systemic artery branches, type C: bronchial/nonbronchial systemic supply, type D: depicted only on pulmonary CTA and not on DSA). Based on the CTA classification, PAPs were managed with pulmonary artery embolization (PAE), bronchial artery embolization (BAE), both or percutaneous embolization depending on supply, accessible location, and flow dynamics.

Results: In 45 patients, 54 PAPs were identified on CTA: type A (24), type B (4), type C (19), type D (7). Treatment included BAE (19 patients), PAE (8), both (11), and percutaneous embolization (7). The correlation of CTA with DSA based on classification type (type A: 100%, type B: 75%, type C: 89.4%) and based on predominant vascular supply (type A: 100%, type B: 75%, type C: 52.6%). All type D cases underwent percutaneous embolization.

Conclusion: CTA shows excellent concordance with DSA for type A and B PAPs and moderate agreement for type C. It effectively guides targeted endovascular treatment, improving both technical and clinical success rates. In addition, CTA reduces unnecessary vessel cannulation and contrast exposure, aiding in the efficient management of moderate to massive hemoptysis.

Chest wall reconstruction (CWR) is a complex and evolving field that clinically benefits from the use of multimodal radiologic imaging. This review summarizes the essential role of multimodal imaging, such as ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), in preoperative and postoperative CWR evaluation. Preoperative CWR planning involves characterization of defects, assessment of surrounding structures, and guidance for surgical approach and implant selection. Postoperative CWR evaluation focuses on monitoring graft/flap viability, assessing structural integrity, and identifying complications such as infection or hardware failure. This article guided radiologists in approaching CWR cases and creating effective reports to guide patient management.

Purpose: To identify preoperative CT findings linked to retrosternal adherence-related intraoperative cardiovascular injury and develop predictive scores with the potential to guide surgical planning.

Materials and methods: A retrospective study was conducted on patients undergoing CT within 30 days of sternotomy (first sternotomy or resternotomy) from 2019 to 2023. CT images were reviewed for retrosternal adherence patterns, classified as distance, contact, or adherence, and localized by segment (upper, middle, or lower retrosternal thirds) or by organ (innominate vein, aorta, right ventricle, right atrium, or pulmonary artery). Logistic regression was used to identify the significant predictors from which the scores were developed.

Results: Out of 429 patients, 105 (24%) had cardiovascular injuries, including re-entry and postcardiopulmonary bypass injuries. Middle third adherence (P<0.001), calcification (P<0.001), and age (P=0.002) were significant predictors in the segment approach. Aortic (P=0.001) and right atrial (P=0.034) adherence, calcification (P<0.001), and age (P=0.001) were significant predictors in the organ-specific approach. CAST (Calcification, Age, Sternal Thirds) and ARCA (Aorta, Right Atrium, Calcification, Age) scores were derived to predict intraoperative cardiovascular injuries.

Conclusions: Preoperative CT can identify patients at high risk for intraoperative cardiovascular injury during sternotomy. The CAST and ARCA scores offer a reliable, CT-based approach for assessing this risk, potentially enhancing surgical planning and preemptive intervention strategies, thereby improving outcomes in high-risk cardiac reoperations.

Purpose: The diagnosis of connective tissue disease-associated interstitial lung diseases (CTD-ILD) is connected to radiation exposure due to periodical CT scans. This study aims to investigate the alternative imaging method, Phase-Resolved Functional Lung (PREFUL), regarding its performance in low-field MRI. A comparison of PREFUL, photon-counting CT (PCCT) and pulmonary function tests (PFT) was performed to identify correlations that could restructure the diagnostics of CTD-ILD.

Materials and methods: In this prospective single-center study, free-breathing PREFUL acquisitions of CTD-ILD patients were done after clinically indicated PCCT imaging. The severity and extent of CTD-ILD in PCCT were assessed via the Warrick score and used as a reference. Spearman's correlation coefficient (r) was calculated to examine the association between PREFUL, PCCT, and PFT.

Results: The data of 31 CTD-ILD patients (64.32±12.36 y, 10 men) were evaluated. Most correlations of PREFUL parameters with PFT were found with the Tiffeneau-Pinelli index (FEV1/FVC). The Warrick score showed excellent inter-rater agreement and correlations (P<0.05) with the PFT parameters forced vital capacity (FVC) and the diffusing capacity of the lung for carbon monoxide corrected for hemoglobin (DLCOc) [FVC: r=-0.43, DLCOc SB: r=-0.65, DLCOc/VA: r=-0.50]. No correlation was found between PREFUL parameters and PCCT.

Conclusions: The feasibility of PREFUL using low-field MRI was demonstrated in patients with CTD-ILD. Several correlations between PREFUL and PFT parameters were found, indicating that MRI can quantify lung function impairment. Nevertheless, CT remains the gold standard for CTD-ILD assessment and further research in PREFUL is needed.

Purpose: Acute pulmonary embolism (APE) is the third leading cardiovascular cause of death. Current risk assessment approaches emphasize right ventricular (RV) dysfunction and thrombus burden quantification via computed tomography pulmonary angiography (CTPA). Traditional scoring systems, such as the Modified Miller Score (MMS) or Refined Miller Score (RMS), estimate thrombus burden but tend to oversimplify partial vessel occlusion. This study proposes a novel Obstruction Index (OI) derived from direct thrombus and vessel area measurements from CTPA imaging to improve quantification accuracy.

Materials and methods: This retrospective study analyzed imaging data from 20 patients with intermediate- to high-risk APE. Pre-randomization and posttreatment CTPA scans were assessed for RV/LV ratio, MMS, RMS, and OI. OI was derived from measured thrombus and vessel areas at defined pulmonary artery levels and from the calculated obstruction ratio. Correlations between RV/LV ratio reduction and reduction of MMS, RMS, and OI were evaluated using the Spearman correlation.

Results: Mean RV/LV ratio reduced significantly post treatment (1.498±0.396 to 1.156±0.275), as did MMS (-4.5±4.3), RMS (-4.925±4.2), and OI (-4.49±3.9). OI demonstrated a stronger correlation with RV/LV ratio reduction (r=0.448, P=0.048) compared with MMS (r=0.279, P=0.234) and RMS (r=0.261, P=0.265).

Conclusions: The OI outperforms MMS and RMS in accuracy when reflecting thrombus burden reduction and shows statistically significant correlation with RV/LV ratio reduction. Direct thrombus and vessel area measurements appear to be superior for precise and reproducible APE quantification, and are especially useful for posttreatment imaging follow-ups.

Purpose: To investigate the feasibility of using 60 kVp coronary CT angiography (CCTA) combined with deep learning-based CT reconstruction as a screening tool on asymptomatic patients.

Materials and methods: A total of 156 asymptomatic patients (body mass index, 24.4 ± 2.2 kg/m2) with at least one coronary artery disease (CAD) risk factor were prospectively enrolled for taking an experimental ultra-low dose 60 kVp CCTA followed by a routine 120 kVp CCTA. Stenosis detection, plaque analysis, and image quality assessment were performed on both scans, with 120 kVp CCTA serving as the reference.

Results: The mean effective dose and mean contrast medium (CM) dosage were 0.4 ± 0.1 mSv and 27.0 ± 3.2 mL, respectively, for 60 kVp CCTA, corresponding to a 91.5% and 50.0% reduction as compared with 120 kVp CCTA. In both analyses for all plaque types and noncalcific plaques, the sensitivity, specificity, and accuracy in stenosis detection were >92% with 60 kVp CCTA on per-segment, per-vessel, and per-patient basis, and in particular, the negative predictive value was ≥ 97%. However, compared to 120 kVp CCTA, 60 kVp CCTA led to a significant overestimation in plaque volume and stenosis severity (P<0.01), as well as inferior subjective scores regarding vessel and lumen delineation (P<0.05).

Conclusions: Despite overestimation in plaque volume and stenosis severity, 60 kVp CCTA showed excellent stenosis detection capability with ultra-low radiation dose and reduced CM dosage that may potentially be adopted as a screening tool for asymptomatic patients in routine practice.

Purpose: Accurate lung cancer TNM staging depends on macroscopic and microscopic tumor evaluation of resection specimens. However, small nodules (<1 cm) are difficult to extract and correlate with in vivo imaging. We investigated whether microCT could better localize lesions or guide pathology to otherwise undetected abnormalities.

Materials and methods: Paired ex vivo CT and microCT were performed after inflating and freezing surgically removed lung lobes (resolution 80 to 120 µm). Rigorous matching between CT, microCT, and histopathology was performed on areas containing abnormalities on microCT.

Results: A total of 57 lobectomy specimens were analyzed. MicroCT-guided microscopic examination led to 2 additional primary carcinomas, 2 separate tumor nodules from the primary lung tumor, and 1 atypical adenomatous hyperplasia lesion that were not evident before surgery. For both patients with separate tumor nodules, the cT1 stage was upgraded to a pT3. In addition, the microCT provided insight into underlying structural disease (ie, emphysema and fibrosis).

Conclusions: In 5 out of 57 resection specimens (9%), microCT showed additional (pre-)cancerous lesions. This explorative study suggests that lobar microCT could serve as a valuable guide for pathologists by pointing them toward areas that may warrant further investigation. In this way, it is a practical and beneficial tool, capable of facilitating a more precise TNM classification in tumor resection specimens, which needs further validation in a prospective study.