Psychometric properties and measurement invariance of Short-Form Life Attitude Inventory for hospital staff.

BACKGROUND: The life attitude of health care workers can deeply influence the quality of care. Examining the performance of the Short-Form Life Attitude Inventory (SF-LAI), this study analyzes the factorial structure, reliability, and invariance of the revised SF-LAI across genders and professions among the staff of a teaching medical center. METHODS: The SF-LAI was developed for university students in Taiwan. From January to February 2019, we administered a cross-sectional survey of life attitudes by distributing the SF-LAI to all staff members of a medical center in Taiwan. The construct validity was evaluated using a confirmatory factor analysis (CFA). Model fit was assessed in terms of the comparative fit index (CFI), Tucker-Lewis index (TFI), standardized root mean square residual (SRMR), and root mean square of error of approximation (RMSEA). Internal consistency was calculated using Cronbach's alpha and McDonald's omega. We also performed the CFA invariance analysis for the SF-LAI-R across genders and professions (physician, nurse and other hospital staff). RESULTS: Of 884 (24.62%) responses, 835 were valid. The participants had a mean age of 47.8 years, and 20.12% were male. In a comparison of multiple CFAs, a second-order model with six factors outperformed other models. The goodness of fit indices revealed the CFI was 0.955, TFI was 0.952, RMSEA was 0.071, and SRMR was 0.038. The Cronbach's alphas, McDonald's omega coefficients for internal consistency were all greater than 0.8. The first and second-order model had metric and scalar invariance across genders and professions. CONCLUSIONS: As health care demands evolve, humanities are becoming more important in medical education. Life attitude of hospital care worker is a crucial indicator of whether one embodies the ideals of a humanistic education. The revised SF-LAI has acceptable structural validity, internal consistency, and invariance across genders and professions among staff members of a teaching medical center.

Severe, but not mild to moderate, non-alcoholic fatty liver disease associated with increased risk of subclinical coronary atherosclerosis.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is associated with high risk of cardiovascular disease. The prevalence is increasing to 45-65% in the general population with routine health check-up, and most subjects have the mild degree NAFLD in recent years. Moreover, there are no studies on the association between NAFLD severity and coronary atherosclerosis in the real-world setting by ultrasonography. METHODS: The aim of this study was to determine the relationship between the severity of NAFLD and subclinical coronary atherosclerosis. Overall, 817 subjects meet criteria for NAFLD were enrolled in the retrospective cohort study (155 subjects were excluded). The severity of NAFLD was divided into the normal, mild, moderate and severe degree based on the finding of abdominal ultrasonography. The assessment of coronary atherosclerosis was based on CAC scan/coronary CT angiography finding in terms of CAC score ≧ 100, CAC score ≧ 400, CAD-RADS ≧ 3 and presence of vulnerable plaque(s). RESULTS: A significant linear trend was observed between the severity of NAFLD and subclinical coronary atherosclerosis. Compared with the reference group (including normal, mild, and moderate NAFLD), severe degree NAFLD was the independently associated risk of subclinical coronary atherosclerosis in term of CAC score ≧ 100, CAC score ≧ 400, CAD-RADS ≧ 3 and presence of vulnerable plaque(s) based on binary logistic regression after adjustment for FRS score and body fat percentage. CONCLUSIONS: Severe degree, but not mild to moderate, was associated with high risk of subclinical coronary atherosclerosis, independently of FRS score and body-fat percentage.

Natural course of coronary artery calcium progression in Asian population with an initial score of zero.

BACKGROUND: We aimed to investigate the natural course of coronary artery calcium progression in an Asian population with a baseline coronary artery calcium (CAC) score of zero, and to determine subclinical coronary atherosclerosis. METHODS: Four hundred fifty-nine subjects with at least two CAC scans with an initial score of zero were included. CAC progression (+) was defined by the development of any CAC (i.e., CAC > 0) during subsequent CT scans. Clinical characteristics and Framingham risk profiles were also recorded. RESULTS: Among 459 subjects, 106 (23.09%) experienced CAC progression during the average follow-up period of 5.71 ± 2.68 years. Older age, male gender, HDL-C, total cholesterol and higher Framingham risk score were independently associated with CAC progression. Framingham risk score had the better discriminative ability (AUC = 0.660) to predict CAC progression compared to the other parameters with a sensitivity of 75.24% and specificity of 53.95%. For the double zero score with coronary artery atherosclerosis prediction, older age, triglycerides, hypertension, and Framingham risk score were significantly associated with these events. Among these parameters, Framingham risk score may be a relatively acceptable parameter with high negative predictive (NPV = 96.4%) value to rule out double zero score with obstructive coronary artery atherosclerosis scenario with an optimum cut-off value of <16.9 (AUC =0.652, sensitivity of 57.69%; specificity of 68.82%). CONCLUSIONS: A baseline zero CAC score in asymptomatic Chinese population with low to intermediate risk have a low incidence for CAC progression within the 5-years period. For CAC progression prediction, Framingham risk score with the cutoff < 11.1 may help confirm subjects at low risk to improve cardiovascular risk stratification and reclassification in the field of preventive cardiology.

Natural History of Persistent Pulmonary Subsolid Nodules: Long-Term Observation of Different Interval Growth.

BACKGROUND: The long-term natural course and outcomes of subsolid nodules (SSNs) in terms of true growth, substantial growth, and stage shift need to be clarified. METHODS: Between 2002 and 2016, 128 subjects with persistent SSNs of 3cm or smaller were enrolled. The baseline and interval changes in the series computed tomography (CT) findings during the follow-up period were subsequently reviewed. RESULTS: The mean follow-up period was 3.57±2.93years. The cumulative percentage of growth nodules of the part-solid nodule (PSN) group was significantly higher than that of the ground-glass nodule (GGN) group by Kaplan-Meier estimation (all p<0.0001). For true SSN growth, GGNs usually take a median follow-up of 7 years to grow; PSNs usually take a median follow-up of 3 years to grow. For substantial SSN growth, GGNs usually take a median follow-up of 9 years to grow; PSNs usually take a median follow-up of 3 years to grow. For stage shift, GGNs usually take a median follow-up of 12 years to grow; PSNs usually take a median follow-up of 9 years to grow. CONCLUSIONS: The natural course in terms of true growth, substantial growth, and stage shift differed significantly according to their nodule type, which could contribute to the development of follow-up guidelines and management strategy of pulmonary SSNs.

Propensity score analysis of lung cancer risk in a population with high prevalence of non-smoking related lung cancer.

BACKGROUND: Lung cancer has been the leading cause of cancer-related mortality worldwide among both men and women in recent years. There is an increase in the incidence of nonsmoking-related lung cancer in recent years. The purpose of the present study was to investigate multiple potential risk factors for nonsmoking-related lung cancer among Asian Ethnic Groups. METHODS: We used a propensity score-mated cohort analysis for this study. We retrospectively review the medical record of 1975 asymptomatic healthy subjects (40 ~ 80 years old) who voluntarily underwent low-dose chest CT from August 2013 to October 2014. Clinical information and nodule characteristics were recorded. RESULTS: A propensity score-mated cohort analysis was applied to adjust for potential bias and to create two comparable groups according to family history of lung cancer. For our primary analysis, we matched 392 pairs of subjects with family history of lung cancer and subjects without history. Logistic regression showed that female gender and a family history of lung cancer were the two most important predictor of lung cancer in the endemic area with high prevalence of nonsmoking-related lung cancer (OR = 11.199, 95% CI = 1.444-86.862; OR = 2.831, 95% CI = 1.000136-8.015). In addition, the number of nodules was higher in subjects with family history of lung cancer in comparison with subjects without family history of lung cancer (OR = 1.309, 95% CI = 1.066-1.607). CONCLUSIONS: In conclusion, risk-based prediction model based on the family history of lung cancer and female gender can potentially improve efficiency of lung cancer screening programs in Taiwan.

Differential impacts of cardiac and abdominal ectopic fat deposits on cardiometabolic risk stratification.

BACKGROUND: Previous studies have shown that excessive abdominal visceral adipose tissue (AVAT) and epicardial adipose tissue (EAT) are risk factors of cardiometabolic disease; we hypothesized there is differential contribution of abdominal and cardiac fat deposits to the cardiometabolic profiles. METHODS: Two hundred eight consecutive subjects with clinical suspicion of coronary artery disease (CAD) who underwent cardiac and abdominal CT for Agatston score and abdominal visceral fat measurement were retrospectively analyzed. Regional thickness of EAT (EATth), total volume of EAT, total volume of paracardial adipose tissue (PAT) and total volume of AVAT from L2 to L5 level were measured. The relationships between abdominal and cardiac adipose tissue measurements, the number of components of metabolic syndrome, and the severity of Agatston score on a four ranking scale (0, 1-10,11-100, 101-400, >400) were investigated. RESULTS: The amounts of AVAT, EAT, PAT and EATth-LAVG showed a significant linear trend with increasing number (0-5) of components in metabolic syndrome (AVAT, EAT and PAT P for trend <0.0001; EATth-LVAG P for trend <0.001). EATth at left atrioventricular groove (EATth-LAVG) showed significant linear trend with the severity of Agatston score on a four ranking scale (P for trend <0.0001). In multivariate binary regression analysis, total volume of AVAT was the sole adiposity predictor for metabolic syndrome independent to age, gender, and waist circumference (odds ratio of 1.20, 95 % CI 1.08-1.32, p < 0.001) while total volume of EAT, PAT, and EATth-LAVG were not. In contrary, EATth-LAVG was the sole adiposity predictor for Agatston score >400 (odds ratio of 1.11, 95% CI 1.034-1.184, p = 0.004). CONCLUSIONS: Excessive total volume of AVAT appears to be preferentially associated with metabolic syndrome; while EAT, esp. EATth-LAVG is preferentially associated with coronary artery disease. This differential effect of the two adiposities deserves a large-scale cohort study for further investigation.

The relation of location-specific epicardial adipose tissue thickness and obstructive coronary artery disease: systemic review and meta-analysis of observational studies.

BACKGROUND: There is growing evidence about the importance of epicardial adiposity on cardiometabolic risk. However, the relation of location-specific epicardial adipose tissue (EAT) thickness to coronary atherosclerotic burden is still unclear. METHODS: This meta-analysis was used to study the relations between location-specific EAT thickness and obstructive coronary artery disease (CAD). A systemic literature search to identify eligible studies that met the inclusion criteria from the beginning until January 2014 was made. We conducted the meta-analysis of all included 10 published studies. Pre-specified subgroup analyses were performed according to ethnicity, body mass index, diagnostic tools for CAD, and measurement tool if presence of high heterogeneity between studies. Potential publication bias was also assessed. RESULTS: We identified ten observed studies with a total of 1625 subjects for planned comparison. With regard to the association between obstructive CAD and location-specific EAT thickness at the right ventricular free wall, caution is warranted. The pooled estimate showed that location-specific EAT thickness at the right ventricular free wall was significantly higher in the CAD group than non-CAD group (standardized mean difference (SMD): 0.70 mm, 95% CI: 0.26-1.13, P = 0.002), although heterogeneity was high (I2 = 93%). It should be clear that only the result of echocardiography-based studies showed a significant association (SMD: 0.98 mm, 95% CI: 0.43-1.53, P = 0.0005), and the result of all included CT-based studies showed a non-significant association (SMD: 0.06 mm, 95% CI: -0.12-0.25, P = 0.50). In the subgroup analysis, the "diagnostic tools for CAD" or "measurement tool of EAT thickness" are potential major sources of heterogeneity between studies. With regard to location-specific EAT thickness at the left atrioventricular (AV) groove, it was significantly higher in the CAD group than non-CAD group (SMD: 0.74 mm, 95% CI: 0.55-0.92, P <0.00001; I2 = 0%). CONCLUSION: Our meta-analysis suggests that significantly elevated location-specific EAT thickness at the left AV groove is associated with obstructive CAD. Based on the current evidence, the location-specific EAT thickness at the left AV groove appears to be a good predictor in obstructive CAD, especially in Asian populations. Furthermore well-designed studies are warranted because of the current limited number of studies.

Evaluating Efficiency and Adherence in Asian Lung Cancer Screening: Comparing Self-paid and Clinical Study Approaches in Taiwan.

RATIONALE AND OBJECTIVES: This study aimed to assess how different screening methods, specifically self-paid screening versus participation in clinical studies, affect screening efficiency and adherence in a real-world Asian lung cancer screening population. MATERIALS AND METHODS: This study collected 4166 participants from our hospital imaging database who underwent baseline low-dose computed tomography (LDCT) between January 2014 and August 2021. Adherence status was determined by counting CT scans, with one check indicating non-adherence and two or more checks indicating adherence. The primary objective was to investigate adherence to LDCT follow-up schedules among individuals with baseline pure ground-glass nodules (GGNs) based on different screening settings and to evaluate adherence status and CT follow-up clinical profiles. RESULTS: Of the 4166 participants in the study, 3619 in the self-paid group and 547 in the clinical study group were men, with an average follow-up period of 4.5 years. Significant differences were observed in the proportions of Lung-RADS 4 lesions, subsolid nodules, and pure GGN lesions between the self-paid and clinical trial groups. A significant difference was found in adherence rates between the self-paid screening group (60.5%) and the clinical study group (84.8%) (p < 0.001). Adherence status rates significantly increased with larger GGN sizes across categories (p < 0.001). Multivariate logistic regression revealed that age (odds ratio [OR], 1.025; p = 0.012), smoking habits (OR, 1.744; p = 0.036), and clinical study screening type (OR, 3.097; p < 0.001) significantly influenced the adherence status. CONCLUSION: The disparities in Asian lung cancer screening emphasize the need for increased efficacy, public awareness, and culturally sensitive approaches to mitigate overdiagnosis and enhance adherence among self-paying groups.

Eplerenone improves hyperglycemia and sympathetic excitation in chronic renocardiac syndrome in rats.

We aimed to assess the efficacy of eplerenone, a steroidal mineralocorticoid receptor antagonist known to reduce blood pressure and mitigate cardiovascular disease (CVD) progression, in retarding the progression of chronic kidney disease (CKD) and CVD in a rat model of type 4 cardiorenal syndrome (CRS). We grouped rats into four experimental categories: sham surgery, sham treatment with eplerenone, nephrectomy without eplerenone (Nx), and nephrectomy with eplerenone (Nx + EP). For the Nx + EP group, rats received five-sixths nephrectomy, inducing CKD and CVD conditions such as renal hypertension and hyperglycemia, and were then treated with eplerenone (100 mg/kg/day, orally) over 4 weeks after an initial 4-week observation period. Heart rate, blood pressure, blood sugar levels, and sympathetic nerve excitation were monitored biweekly. In addition, assessments of renal and cardiac tissues, including evaluation of renal tubulointerstitial injury, glomerular injury, and cardiomyocyte hypertrophy, were conducted at week 8. Eplerenone administration mitigated CKD and CVD progression in the Nx + EP group, evident by improved blood pressure (217.3 ± 5.4 versus 175.3 ± 5.6), blood sugar (121.8 ± 1.3 versus 145.6 ± 6.0) level, reduced sympathetic nerve excitation, and cardiomyocyte hypertrophy compared to the Nx group. However, renal tubulointerstitial injury, glomerular injury, and cardiovascular dysfunction, which were increased in rats with type 4 CRS, did not show significant changes with eplerenone treatment. Our study demonstrated that eplerenone treatment did not exacerbate type 4 CRS but improved blood pressure, blood sugar levels, sympathetic nerve excitation, and cardiomyocyte hypertrophy in this model.

Prediction of the stage shift growth of early-stage lung adenocarcinomas by volume-doubling time.

Background: Prediction of subsolid nodule (SSN) interval growth is crucial for clinical management and decision making in lung cancer screening program. To the best of our knowledge, no study has investigated whether volume doubling time (VDT) is an independent factor for predicting SSN interval growth, or whether its predictive power is better than that of traditional semantic methods, such as nodular diameter or type. This study aimed to investigate whether VDT could provide added value in predicting the long-term natural course of SSNs (<3 cm) regarding stage shift. Methods: This retrospective study enrolled 132 patients with spectrum lesions of lung adenocarcinoma who underwent two consecutive computed tomography (CT) examinations before surgical tissue proofing between 2012 and 2021 in Kaohsiung Veterans General Hospital. The VDTs were manually calculated from the volumetric segmentation using Schwartz's approximation formula. We utilized logistic regression to identify predictors associated with stage shift progression based on the VDT parameter. Results: The average duration of follow-up period was 3.629 years. A VDT-based nomogram model (model 2) based on CT semantic features, clinical characteristics, and the VDT parameter yielded an area under the curve (AUC) of 0.877 [95% confidence interval (CI): 0.807-0.928]. Compared with model 1 (CT semantic features and clinical characteristics), model 2 exhibited the better predictive performance for stage shift (AUC model 1: 0.833 versus AUC model 2: 0.877, P=0.047). In model 2, significant predictors of stage shift growth included initial nodule size [odds ratio (OR) =4.074, 95% CI: 1.368-12.135; P=0.012], SSN classification (OR =0.042; 95% CI: 0.006-0.288; P=0.001), follow-up period (OR =1.692, 95% CI: 1.337-2.140; P<0.001), and VDT classification (OR =2.327, 95% CI: 1.368-3.958; P=0.002). For the stage shift, the mean progression time for the VDT (>400 d) group was 7.595 years, and median progression time was 7.430 years. Additionally, a VDT ≤400 d is an important prognostic factor associated with aggressive growth behavior with a stage shift. Conclusions: VDT is crucial for predicting SSN stage shift growth irrespective of clinical and CT semantic features. This highlights its significance in informing follow-up protocols and surgical planning, emphasizing its prognostic value in predicting SSN growth.

New look at the power of zero coronary artery calcium (CAC) in Asian population: a systemic review and meta-analysis.

Background: Numerous studies have validated a 5-year warranty period for heart health in Western populations with a coronary artery calcium (CAC) score of zero. While the calcium score is a crucial cardiovascular risk indicator, its interpretation in Asian populations remains unclear. This meta-analysis aimed to clarify the uncertainty surrounding the prevalence, warranty period, and prognostic implications of zero CAC scores in Asian populations. It also examined the impact of sex on subclinical CAC progression. While the calcium score is a crucial cardiovascular risk indicator, its interpretation in Asian populations remains unclear. The study aimed to shed light on these issues by exploring the specificities of subclinical CAC progression in the Asian context. Methods: Our systematic literature search, from the study's inception to October 2023, targeted studies on subclinical CAC progression in the Asian population with a zero CAC score. We searched the Cochrane Library, and PubMed. The search terms included "zero score", "coronary calcification", "zero CAC score", and "CAC scan". Results: We evaluated seven published studies through a meta-analysis and assessed the risk of bias using the Newcastle-Ottawa Scale (NOS). In this meta-analysis of three observational studies addressing zero CAC prevalence (n=7,661), the pooled prevalence of zero CAC scores in the Asian population was 18.2% [95% confidence interval (CI): 12.5-25.9%]. A significant difference in follow-up warranty period was observed between the CAC zero group and subclinical CAC progression group (mean difference, 1.26 years; 95% CI: 0.94-1.58; P<0.001). Furthermore, the conversion rate of subclinical CAC progression differed significantly between males and females (risk ratio, 2.37; 95% CI: 1.98-2.84; P<0.001). Analysis of four studies revealed a notable discrepancy in the major adverse cardiovascular event (MACE) rate between the CAC (-) and CAC (+) groups (risk ratio, 4.78; 95% CI: 2.21-10.36; P<0.001). Conclusions: The meta-analysis of zero CAC scores in Asian populations suggested an 18.2% prevalence. A 5-year warranty period was noted, with heightened subclinical CAC progression likelihood after this duration. Additionally, sex-based differences were observed in subclinical CAC progression rates. These findings will provide clinical cardiovascular risk stratification for guiding gender-specific clinical decision-making in asymptomatic in Asian individuals.

LASSO-derived model for the prediction of lean-non-alcoholic fatty liver disease in examinees attending a routine health check-up.

BACKGROUND: Lean individuals with non-alcohol fatty liver disease (NAFLD) often have normal body size but abnormal visceral fat. Therefore, an alternative to body mass index should be considered for prediction of lean-NAFLD. This study aimed to use representative visceral fat links with other laboratory parameters using the least absolute shrinkage and selection operator (LASSO) method to construct a predictive model for lean-NAFLD. METHODS: This retrospective cross-sectional analysis enrolled 2325 subjects with BMI < 24 kg/m2 from medical records of 51,271 examinees who underwent a routine health check-up. They were randomly divided into training and validation cohorts at a ratio of 1:1. The LASSO-derived prediction model used LASSO regression to select 23 clinical and laboratory factors. The discrimination and calibration abilities were evaluated using the Hosmer-Lemeshow test and calibration curves. The performance of the LASSO model was compared with the fatty liver index (FLI) model. RESULTS: The LASSO-derived model included four variables-visceral fat, triglyceride levels, HDL-C-C levels, and waist hip ratio-and demonstrated superior performance in predicting lean-NAFLD with high discriminatory ability (AUC, 0.8416; 95% CI: 0.811-0.872) that was comparable with the FLI model. Using a cut-off of 0.1484, moderate sensitivity (75.69%) and specificity (79.86%), as well as high negative predictive value (95.9%), were achieved in the LASSO model. In addition, with normal WC subgroup analysis, the LASSO model exhibits a trend of higher accuracy compared to FLI (cut-off 15.45). CONCLUSIONS: We developed a LASSO-derived predictive model with the potential for use as an alternative tool for predicting lean-NAFLD in clinical settings.

Researchers developed a model to predict a type of liver disease called non-alcoholic fatty liver disease (NAFLD) in lean individuals.The model accurately detects NAFLD in lean individuals using factors like visceral fat, triglyceride levels, and waist-to-hip ratio, aiding in identifying the disease in normal-weight people with abnormal fat distribution.

Comparison between one-stage and two-stage CT-guided localization of lung nodules with surgical resection: a single medical center experience.

BACKGROUND: This retrospective study aimed to compare the efficacy and safety of one-stage computed tomography (OSCT)- to that of two-stage computed tomography (TSCT)-guided localization for the surgical removal of small lung nodules. METHODS: We collected data from patients with ipsilateral pulmonary nodules who underwent localization before surgical removal at Veteran General Hospital Kaohsiung between October 2017 and January 2022. The patients were divided into the OSCT and TSCT groups. RESULTS: We found that OSCT significantly reduced the localization time and risky time compared to TSCT, and the success rate of localization and incidence of pneumothorax were similar in both groups. However, the time spent under general anesthesia was longer in the OSCT group than in the TSCT group. CONCLUSIONS: The OSCT-guided approach to localize pulmonary nodules in hybrid operation room is a safe and effective technique for the surgical removal of small lung nodules.

Reliable categorisation of visual scoring of coronary artery calcification on low-dose CT for lung cancer screening: validation with the standard Agatston score.

OBJECTIVES: To validate the reliability of the visual coronary artery calcification score (VCACS) on low-dose CT (LDCT) for concurrent screening of CAC and lung cancer. METHODS: We enrolled 401 subjects receiving LDCT for lung cancer screening and ECG-gated CT for the Agatston score (AS). LDCT was reconstructed with 3- and 5-mm slice thickness (LDCT-3mm and LDCT-5mm respectively) for VCACS to obtain VCACS-3mm and VCACS-5mm respectively. After a training session comprising 32 cases, two observers performed four-scale VCACS (absent, mild, moderate, severe) of 369 data sets independently, the results were compared with four-scale AS (0, 1-100, 101-400, >400). RESULTS: CACs were present in 39.6 % (146/369) of subjects. The sensitivity of VCACS-3mm was higher than for VCACS-5mm (83.6 % versus 74.0 %). The median of AS of the 24 false-negative cases in VCACS-3mm was 2.3 (range 1.1-21.1). The false-negative rate for detecting AS ≥ 10 on LDCT-3mm was 1.9 %. VCACS-3mm had higher concordance with AS than VCACS-5mm (k = 0.813 versus k = 0.685). An extended test of VCACS-3mm for four junior observers showed high inter-observer reliability (intra-class correlation = 0.90) and good concordance with AS (k = 0.662-0.747). CONCLUSIONS: This study validated the reliability of VCACS on LDCT for lung cancer screening and showed that LDCT-3mm was more feasible than LDCT-5mm for CAD risk stratification. KEY POINTS: • Low-dose computed tomography (LDCT) rarely misses significant coronary artery calcification (CAC). • Visual scoring of CAC on LDCT is highly concordant with Agatston scoring. • LDCT-3mm is more feasible than LDCT-5mm for CAD risk stratification. • CAC assessment enriched the screening information for LDCT lung cancer screening.

Inflow-weighted pulmonary perfusion: comparison between dynamic contrast-enhanced MRI versus perfusion scintigraphy in complex pulmonary circulation.

BACKGROUND: Due to the different properties of the contrast agents, the lung perfusion maps as measured by 99mTc-labeled macroaggregated albumin perfusion scintigraphy (PS) are not uncommonly discrepant from those measured by dynamic contrast-enhanced MRI (DCE-MRI) using indicator-dilution analysis in complex pulmonary circulation. Since PS offers the pre-capillary perfusion of the first-pass transit, we hypothesized that an inflow-weighted perfusion model of DCE-MRI could simulate the result by PS. METHODS: 22 patients underwent DCE-MRI at 1.5T and also PS. Relative perfusion contributed by the left lung was calculated by PS (PS(L%)), by DCE-MRI using conventional indicator dilution theory for pulmonary blood volume (PBV(L%)) and pulmonary blood flow (PBFL%) and using our proposed inflow-weighted pulmonary blood volume (PBV(iw)(L%)). For PBViw(L%), the optimal upper bound of the inflow-weighted integration range was determined by correlation coefficient analysis. RESULTS: The time-to-peak of the normal lung parenchyma was the optimal upper bound in the inflow-weighted perfusion model. Using PSL% as a reference, PBV(L%) showed error of 49.24% to -40.37% (intraclass correlation coefficient R(I) = 0.55) and PBF(L%) had error of 34.87% to -27.76% (R(I) = 0.80). With the inflow-weighted model, PBV(iw)(L%) had much less error of 12.28% to -11.20% (R(I) = 0.98) from PS(L%). CONCLUSIONS: The inflow-weighted DCE-MRI provides relative perfusion maps similar to that by PS. The discrepancy between conventional indicator-dilution and inflow-weighted analysis represents a mixed-flow component in which pathological flow such as shunting or collaterals might have participated.

Aortic intramural hematoma with pulmonary artery extension mimics pulmonary embolism.

A 59-year-old woman presented to emergency department with sudden onset of chest tightness and shortness of breath. Laboratory test revealed elevated D-dimer (1558 ng/mL). The electrocardiogram revealed right axis deviation, S1Q3T3 pattern, and T-wave inversion in leads V1 to V6. Computed tomographic angiography (CTA) was performed with 64-slice computed tomography for suspicious of pulmonary embolism. Contrast-enhanced CTA showed no filling defect in the pulmonary arteries; however, luminal narrowing of the right pulmonary artery was noted. Nonenhanced computed tomographic scan showed smooth eccentric high attenuation change along the wall of main pulmonary artery and right pulmonary artery and also along the ascending and descending aorta. The high attenuation lesions in both of the aorta and pulmonary artery showed no contrast enhancement indicating presence of intramural hematoma (IMH). Based on the image findings, a diagnosis of type A aortic IMH with pulmonary artery extension, instead of chronic pulmonary embolism, was made. Follow-up CTA 3 months later showed much improved of the right pulmonary artery narrowing and nearly complete resolution of the IMH.

An integrated nomogram combined semantic-radiomic features to predict invasive pulmonary adenocarcinomas in subjects with persistent subsolid nodules.

Background: Patients with persistent pulmonary subsolid nodules have a relatively high incidence of lung adenocarcinoma. Preoperative early diagnosis of invasive pulmonary adenocarcinoma spectrum lesions could help avoid extensive advanced cancer management and overdiagnosis in lung cancer screening programs. Methods: In total, 260 consecutive patients with persistent subsolid nodules ≤30 mm (n=260) confirmed by surgical pathology were retrospectively investigated from February 2016 to August 2020 at the Kaohsiung Veterans General Hospital. All patients underwent surgical resection within 3 months of the chest CT exam. The study subjects were divided into a training cohort (N=195) and a validation cohort (N=65) at a ratio of 3:1. The purpose of our study was to develop and validate a least absolute shrinkage and selection operator-derived nomogram integrating semantic-radiomic features in differentiating preinvasive and invasive pulmonary adenocarcinoma lesions, and compare its predictive value with clinical-semantic, semantic, and radiologist's performance. Results: In the training cohort of 195 subsolid nodules, 106 invasive lesions and 89 preinvasive lesions were identified. We developed a least absolute shrinkage and selection operator-derived combined nomogram prediction model based on six predictors (nodular size, CTR, roundness, GLCM_Entropy_log10, HISTO_Entropy_log10, and CONVENTIONAL_Humean) to predict the invasive pulmonary adenocarcinoma lesions. Compared with other predictive models, the least absolute shrinkage and selection operator-derived model showed better diagnostic performance with an area under the curve of 0.957 (95% CI: 0.918 to 0.981) for detecting invasive pulmonary adenocarcinoma lesions with balanced sensitivity (92.45%) and specificity (88.64%). The results of Hosmer-Lemeshow test showed P values of 0.394 and 0.787 in the training and validation cohorts, respectively, indicating good calibration power. Conclusions: We developed a least absolute shrinkage and selection operator-derived model integrating semantic-radiomic features with good calibration. This nomogram may help physicians to identify invasive pulmonary adenocarcinoma lesions for guidance in personalized medicine and make more informed decisions on managing subsolid nodules.