A Deep Learning Approach to Classify Fabry Cardiomyopathy from Hypertrophic Cardiomyopathy Using Cine Imaging on Cardiac Magnetic Resonance.

A challenge in accurately identifying and classifying left ventricular hypertrophy (LVH) is distinguishing it from hypertrophic cardiomyopathy (HCM) and Fabry disease. The reliance on imaging techniques often requires the expertise of multiple specialists, including cardiologists, radiologists, and geneticists. This variability in the interpretation and classification of LVH leads to inconsistent diagnoses. LVH, HCM, and Fabry cardiomyopathy can be differentiated using T1 mapping on cardiac magnetic resonance imaging (MRI). However, differentiation between HCM and Fabry cardiomyopathy using echocardiography or MRI cine images is challenging for cardiologists. Our proposed system named the MRI short-axis view left ventricular hypertrophy classifier (MSLVHC) is a high-accuracy standardized imaging classification model developed using AI and trained on MRI short-axis (SAX) view cine images to distinguish between HCM and Fabry disease. The model achieved impressive performance, with an F1-score of 0.846, an accuracy of 0.909, and an AUC of 0.914 when tested on the Taipei Veterans General Hospital (TVGH) dataset. Additionally, a single-blinding study and external testing using data from the Taichung Veterans General Hospital (TCVGH) demonstrated the reliability and effectiveness of the model, achieving an F1-score of 0.727, an accuracy of 0.806, and an AUC of 0.918, demonstrating the model's reliability and usefulness. This AI model holds promise as a valuable tool for assisting specialists in diagnosing LVH diseases.

Right ventricular scalloping index as cardiac magnetic resonance-derived marker for diagnosis of arrhythmogenic right ventricular cardiomyopathy.

BACKGROUND: The cardiac magnetic resonance (CMR) evaluation of right ventricular (RV) morphologic abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) is subjective. Here, we aimed to use a quantitative index, the right ventricular scalloping index (RVSI), to standardize the measurement of RV free wall scalloping and aid in the imaging diagnosis. METHODS: We retrospectively included 15 patients with definite ARVC and 45 age- and sex-matched patients with idiopathic right ventricular outflow tract ventricular arrhythmia (RVOT-VA) as controls. The RVSI was measured from cine images on four-chamber view to evaluate its ability to distinguish between ARVC and RVOT-VA patients. Other cardiac functional parameters including strain analysis were also performed. RESULTS: The RVSI was significantly higher in the ARVC than RVOT-VA group (1.56 ± 0.23 vs 1.30 ± 0.08, p < 0.001). The diagnostic performance of the RVSI was superior to the RV global longitudinal, circumferential, and radial strains, RV ejection fraction, and RV end-diastolic volume index. The RVSI demonstrated high intraobserver and interobserver reliability (intraclass correlation coefficient, 0.94 and 0.96, respectively). RVSI was a strong discriminator between ARVC and RVOT-VA patients (area under curve [AUC], 0.91; 95% CI, 0.82-0.99). A cutoff value of RVSI ≥1.49 provided an accuracy of 90.0%, specificity of 97.8%, sensitivity of 66.7%, positive predictive value (PPV) of 90.9%, and a negative predictive value (NPV) of 89.8%. In a multivariable analysis, a family history of ARVC or sudden cardiac death (odds ratio, 38.71; 95% CI, 1.48-1011.05; p = 0.028) and an RVSI ≥1.49 (odds ratio, 64.72; 95% CI, 4.58-914.63; p = 0.002) remained predictive of definite ARVC. CONCLUSION: RVSI is a quantitative method with good performance for the diagnosis of definite ARVC.

Working from home: Changes in radiologist reporting behavior in response to the COVID-19 pandemic.

BACKGROUND: Remote reporting is an important preventive measure against coronavirus disease 2019 (COVID-19) for radiology departments; it reduces the chance of cross-infections between coworkers. The purpose of this study was to evaluate how the preferred locations that radiologists filed reports from changed in response to COVID-19 by measuring the use of internal teleradiology workstations. METHODS: Data were obtained from the radiological information system (RIS) database at our institution, which recorded the reporting workstation for each radiological examination. The reporting activities in 2021 were divided into computed radiography (CR) and computed tomography (CT)/magnetic resonance imaging (MRI) groups. The Wilcoxon signed-rank test was used to measure differences in the use of off-site workstations in prepandemic, midpandemic, and postpandemic periods. RESULTS: There were statistically significant increases in the number of reports filed from off-site workstations for each attending physician from the prepandemic period to the midpandemic period in both the CR (15.1%-25.4%, p = 0.041) and CT/MRI (18.9%-28.7%, p = 0.006) groups. There was no significant difference noted between the prepandemic and postpandemic periods for either the CR (15.1% vs 18.4%, p = 0.727) or CT/MRI group (18.9% vs 23.3%, p = 0.236). CONCLUSION: In response to the COVID-19 outbreak, radiologists used internal teleradiology to report CR and CT/MRI examinations significantly more frequently. In contrast to the predictions of previous studies, the use of internal teleradiology returned to baseline levels after the pandemic was under control.

Left Ventricular Apical Aneurysm in Fabry Disease: Implications for Clinical Significance and Risk Stratification.

Background A previously underrecognized phenotype of left ventricular apical aneurysm (LVAA) has been increasingly identified in Fabry disease. This study explored LVAA's clinical prevalence and its prognostic implications over a long-term follow-up. Methods and Results We retrospectively analyzed 268 consecutive patients with Fabry disease at a tertiary medical center. Patients with increased left ventricular mass index were recognized as having left ventricular hypertrophy (LVH). LVAA was identified using either echocardiography or cardiovascular magnetic resonance imaging. Two patients with ischemic LVAA were excluded. The primary end point was a composite of cardiovascular events, including heart failure hospitalization, sustained ventricular tachycardia, ischemic stroke, and all-cause mortality. Of 266 enrolled patients, 105 (39.5%) had LVH (age 58.5±11.9 years, 48.6% men), and 11 (10.5%) had LVAA. Over 49.3±34.8 months of follow-up, 25 patients with LVH experienced composite events, including 9 heart failure hospitalizations, 4 sustained ventricular tachycardia, 6 ischemic strokes, and 15 mortalities. In patients with LVH, those with LVAA had a significantly higher risk of composite events and lower event-free survival than those without LVAA (8 [72.7%] versus 17 [18.1%], log-rank P<0.001). LVAA was independently associated with an increased risk of composite events (hazard ratio, 3.59 [95% CI, 1.30-9.91]; P=0.01) after adjusting for age, sex, advanced heart failure, renal function, dyslipidemia, atrial fibrillation, left ventricular ejection fraction, left ventricular diastolic function, and left ventricular mass index. Conclusions LVAA is present in approximately 10% of patients with Fabry disease and LVH. It is associated with an increased risk of adverse cardiovascular events and may necessitate aggressive treatment.

Recommendations for additional magnetic resonance imaging in abdominal computed tomography.

BACKGROUND: Reporting the findings from radiologic images is an important method for radiologists to communicate with referring physicians. The purpose of this study was to evaluate the effectiveness of the recommendations for additional imaging (RAIs) after abdominal computed tomography (CT) studies for abdominal magnetic resonance (MR) imaging. METHODS: The institutional review board approved this retrospective study, which includes data collected from the radiology information system (RIS) database of a tertiary medical referral center. Associations between abdominal CT and subsequent abdominal MR were recorded. The effectiveness of RAIs in an abdominal report was determined. The influence of the wording and the location of the RAIs were also analyzed. RESULTS: The presence of RAIs in an abdominal CT report for an abdominal MR examination was more likely to result in a subsequent MR examination within 120 days (36.7% vs. 4.0%). RAIs were also associated with a reduction in the time interval between the CT and MR examinations (29.0 days vs. 39.0 days). The most effective recommendations included wording that advocated for further evaluation and were mentioned in both the context and conclusion of the report. CONCLUSION: RAIs have a significant influence on clinical decisions. Radiologists should be aware of the power of RAIs and be prudent and conscientious when making recommendations in radiology reports.

Risk factors for pneumothorax and pulmonary hemorrhage following computed tomography-guided transthoracic core-needle biopsy of subpleural lung lesions.

BACKGROUND: Identifying the risk factors for complications may alert the physicians and help them adjust their plans before performing computed tomography-guided lung biopsies. Reportedly, a pleura-nodule distance longer than 2.0 cm is a strong predictor for pneumothorax and pulmonary hemorrhage. However, the rate and risk factors of biopsy-associated complications in subpleural lesions have not been assessed. This study aimed to identify the risk factors for pneumothorax and pulmonary hemorrhage in subpleural lesions ≤2.0 cm in depth. METHODS: Altogether, 196 patients (196 subpleural lesions, lesion depth: 0.1-2.0 cm) who underwent computed tomography-guided transthoracic core-needle biopsies between March 2017 and November 2017 were retrospectively analyzed. Univariate analysis of risk factors including patient-related, lesion-related, and procedure-related characteristics was performed for pneumothorax ≥1 cm and pulmonary hemorrhage ≥2 cm after the biopsy. Multivariate logistic regression analysis was performed to identify the independent risk factors. RESULTS: Pneumothorax ≥1 cm and pulmonary hemorrhage ≥2 cm were identified in 35 (17.9%) and 32 (16.3%) cases, respectively. In the multivariate analysis, a longer needle path (odds ratio [OR], 1.976; 95% confidence interval [CI], 1.113-3.506; p = 0.020) and low attenuation along the biopsy tract (OR, 3.080; 95% CI, 1.038-9.139; p = 0.043) were predictors of pneumothorax ≥ 1 cm. Ground-glass lesions (OR, 2.360; 95% CI, 1.009-5.521; p = 0.048) and smaller needle-pleura angle (OR, 0.325; 95% CI, 0.145-0.728; p = 0.006) were associated with pulmonary hemorrhage ≥2 cm. CONCLUSION: For subpleural lesions ≤2.0 cm in depth, a puncture route having a shorter needle path and passing through the lung parenchyma with higher attenuation may reduce the risk of biopsy-associated pneumothorax ≥1 cm. A higher needle-pleura angle may reduce the risk of pulmonary hemorrhage ≥2 cm in the short axis.

Intrathoracic myolipoma from parietal pleura with oestrogen and progesterone receptor.

Myolipoma is a rare benign lipomatous soft tissue neoplasm, occurring most frequently in adults in the abdomen, pelvis or retroperitoneum. We presented a case of a 39-year-old female with an epipleural lesion at the left paraspinal region identified using computed tomography. Magnetic resonance imaging revealed a fat-containing lesion attached to the pleura over the left paraspinal region. Surgical resection was performed, and histopathological analysis revealed a tumour composed of interlacing bundles of neoplastic smooth muscle cells with low cellularity and rare mitotic figures intermixing with mature adipocytes. The presence of oestrogen and progesterone receptors in smooth muscle cells was noted. The mass was reported as myolipoma. To the best of our knowledge, this case is the first description of an intrathoracic myolipoma.

Uncommon liver tumors: Case report and literature review.

BACKGROUND: Beside hepatocellular carcinoma, metastasis, and cholangiocarcinoma, the imaging findings of other relatively uncommon hepatic lesions are less discussed in the literature. Imaging diagnosis of these lesions is a daily challenge. In this article, we review the imaging characteristics of these neoplasms. METHODS: From January 2003 to December 2014, 4746 patients underwent liver biopsy or hepatic surgical resection in our hospital. We reviewed the pathological database retrospectively. Imaging of these lesions was reviewed. RESULTS: Imaging findings of uncommon hepatic lesions vary. We discuss the typical imaging characteristics with literature review. Clinical and pathological correlations are also described. Primary hepatic lymphoma consists only of 1% of the extranodal non-Hodgkin lymphoma, and is defined as the one involving only the liver and perihepatic lymph nodes within 6 months after diagnosis. Combined hepatocellular and cholangiocarcinoma (cHCC-CC) shares some overlapping imaging characteristics with both HCC and cholangiocarcinoma because of being an admixture of them. Angiosarcoma is the most common hepatic mesenchymal tumor and is hypervascular in nature. Inflammatory pseudotumor is often heterogeneous on ultrasonography and with enhanced septations and rims in the portovenous phase after contrast medium. Angiomyolipoma (AML) typically presents with macroscopic fat components with low signal on fat-saturated magnetic resonance imaging (MRI) and presence of drainage vessels. Intraductal papillary neoplasm of the bile duct (IPNB) is thought of as a counterpart to the pancreatic intraductal papillary mucinous neoplasm. Most of the IPNBs secrete mucin and cause disproportional dilatation of the bile ducts. Mucinous cystic neoplasm (MCN) contains proteinaceous and colloidal components without ductal communication and characterizes with hyperintensity on T1-weighted imaging. Other extremely rare lesions, including epithelioid hemangioendothelioma and inflammatory pseudotumor-like follicular dendritic cell sarcoma, are also discussed. Hepatoblastoma and mesenchymal hamartoma, mostly in children, are also briefly reviewed as well. CONCLUSION: It is important for radiologists to be familiar with the typical imaging features of the uncommon hepatic neoplasms. If imaging findings are not typical or diagnostic, further biopsy is required.