Coronary artery calcium quantification: comparison between filtered-back projection, hybrid iterative reconstruction, and deep learning reconstruction techniques.

BACKGROUND: The reference protocol for the quantification of coronary artery calcium (CAC) should be updated to meet the standards of modern imaging techniques. PURPOSE: To assess the influence of filtered-back projection (FBP), hybrid iterative reconstruction (IR), and three levels of deep learning reconstruction (DLR) on CAC quantification on both in vitro and in vivo studies. MATERIAL AND METHODS: In vitro study was performed with a multipurpose anthropomorphic chest phantom and small pieces of bones. The real volume of each piece was measured using the water displacement method. In the in vivo study, 100 patients (84 men; mean age = 71.2 ± 8.7 years) underwent CAC scoring with a tube voltage of 120 kVp and image thickness of 3 mm. The image reconstruction was done with FBP, hybrid IR, and three levels of DLR including mild (DLRmild), standard (DLRstd), and strong (DLRstr). RESULTS: In the in vitro study, the calcium volume was equivalent (P = 0.949) among FBP, hybrid IR, DLRmild, DLRstd, and DLRstr. In the in vivo study, the image noise was significantly lower in images that used DLRstr-based reconstruction, when compared images other reconstructions (P < 0.001). There were no significant differences in the calcium volume (P = 0.987) and Agatston score (P = 0.991) among FBP, hybrid IR, DLRmild, DLRstd, and DLRstr. The highest overall agreement of Agatston scores was found in the DLR groups (98%) and hybrid IR (95%) when compared to standard FBP reconstruction. CONCLUSION: The DLRstr presented the lowest bias of agreement in the Agatston scores and is recommended for the accurate quantification of CAC.

A Novel Computed Tomography Image Reconstruction for Improving Visualization of Pulmonary Vasculature: Comparison Between Preprocessing and Postprocessing Images Using a Contrast Enhancement Boost Technique.

OBJECTIVE: This study aimed to evaluate chest computed tomography (CT) angiography image quality using the contrast enhancement (CE)-boost technique compared with conventional images. METHODS: Forty patients who underwent contrast-enhanced chest CT were included. Combined CT angiography images of the iodinated image obtained from the subtraction of nonenhanced CT images and CT angiography images were used to generate CE-boost images. Computed tomography attenuation, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) for the right and left pulmonary arteries as the central and subsegmental arteries as peripheral vessels were assessed. Subjective image quality was rated on a 5-point scale by 2 radiologists. Image quality was assessed using a paired t test. RESULTS: Computed tomography attenuation in the main pulmonary artery was significantly higher for the CE-boost images (311.05 ± 91.94) than for the conventional images (221.25 ± 61.21, P < 0.001). Similarly, the CE-boost images resulted in significantly higher CT attenuation in the subsegmental arteries (right, 305.34 ± 90.13; left, 313.05 ± 97.21) than in the conventional images (right, 218.45 ± 63.16; left, 223.89 ± 74.27). The CE-boost technique demonstrated marked improvement in the visualization of the peripheral pulmonary artery without the administration of a higher iodine delivery rate. The mean SNR and CNR were also significantly higher in the central and peripheral vessels in the CE-boost images than in the conventional images (P < 0.001). In the subjective analysis, the image contrast and vascular contrast edge were significantly higher for the CE-boost images than for conventional images (P < 0.001). CONCLUSIONS: The CE-boost technique increases not only the visualization of peripheral arteries by improving vascular attenuation but also the SNR and CNR.

Body mass index and absolute lymphocyte count predict disease-free survival in Korean breast cancer patients.

BACKGROUND: Our study evaluated the association between body mass index (BMI) and absolute lymphocyte count (ALC) in breast cancer patients and healthy females. Additionally, we determined the prognostic value of these factors in breast cancer. METHODS: We retrospectively identified 1225 primary invasive breast cancer patients and 35,991 healthy females. Factors including BMI and complete blood count associated with disease-free survival (DFS) were assessed using a multi-variable Cox proportional hazard model. RESULTS: BMI and ALC were positively correlated in breast cancer patients and healthy females (both P < 0.001). In multi-variable analysis, overweight or obese participants had worse DFS (hazards ratio [HR], 1.98; 95% confidence interval [CI], 1.34-2.92; P = 0.001) than underweight or normal-weight individuals, but patients with high ALC had better DFS than those with low ALC (HR, 0.43; 95% CI, 0.29-0.65; P < 0.001). After risk stratification according to BMI/ALC, high-risk patients with high BMI/low ALC had worse DFS than others (HR, 2.48; 95% CI, 1.70-3.62; P < 0.001). CONCLUSIONS: BMI and ALC were positive correlated, but their effect on breast cancer prognosis was opposite. Patients with high BMI/low ALC had worse DFS than others. Underlying mechanisms for effect of BMI/ALC on breast cancer prognosis should be studied in the future.

Hierarchic Interfacial Nanocube Assembly for Sensitive, Selective, and Quantitative DNA Detection with Surface-Enhanced Raman Scattering.

Surface-enhanced Raman scattering (SERS)-based sensing is promising in that it has potential to allow for highly sensitive, selective, and multiplexed detection and imaging. However, the controlled assembly and gap formation between plasmonic particles for generating strong SERS signals in a quantitative manner is highly challenging, especially on biodetection platforms, and particle-to-particle variation in the signal enhancement can vary by several orders of magnitude in a single batch, largely limiting the reliable use of SERS for practical sensing applications. Here, a hierarchic-nanocube-assembly based SERS (H-Cube-SERS) bioassay to controllably amplify the electromagnetic field between gold nanocubes (AuNCs) is developed. Based on this strategy, H-Cube-SERS assay allows for detecting target DNA with a wide dynamic range from 100 aM to 10 pM concentrations in a stable and reproducible manner. It is also found that the uniformly formed AuNCs with flat surfaces are much more suitable for highly sensitive, reliable, and quantitative biodetection assays due to faster DNA binding kinetics, sharper DNA melting transition, wider hot spot regions, and less dependence on light polarization direction than spherical Au nanoparticles with curved interfaces. This work paves the pathways to the quantitative and sensitive biodetection on a SERS platform and can be extended to other particle assembly systems.

Association between aortic valvular calcification and characteristics of the aortic valve in patients with bicuspid aortic valve stenosis.

BACKGROUND: Aortic valve calcification quantification using cardiac computed tomography (CCT) is a reliable marker for aortic stenosis (AS) in patients with bicuspid aortic valve (BAV) disease. PURPOSE: To determine the association of Agatston aortic valve calcium score (AVCS) with morphological and hemodynamic characteristics of BAV and define cut-off AVCS for optimizing the grade of AS in patients with bicuspid AS. MATERIAL AND METHODS: This study included 161 BAV patients with AS regardless of aortic regurgitation who underwent transthoracic echocardiography and CCT. BAVs were classified according to orientation of cusps and presence of raphe. Associations of AVCS with characteristics of BAV morphology and functional variables were determined by linear regression analysis. Area under the receiver operating characteristic curve (AUC) was used to determine the cut-off AVCS greater than which the diagnosis of severe AS was optimized. RESULTS: AVCS was significantly different according to sex ( P < 0.001), AS severity ( P < 0.001), type of valvular dysfunction ( P = 0.011), and orientation of cusps ( P = 0.028). Multiple linear regression showed that AVCS was significantly associated with sex (estimate = -0.583, P < 0.001) and AS severity (estimate = 0.817, P < 0.001). AVCS was a predictor for severe AS with AUC of 0.80 in both women ( P = 0.002) and men ( P < 0.001). Its cut-off value was 1423 Agatston unit (AU) in women and 2573 AU in men. CONCLUSIONS: In patients with bicuspid AS, AVCS was significantly higher in men and those with severe AS. However, AVCS was not significantly associated with morphological characteristics of BAV or the type of valvular dysfunction.

Diagnostic performance of static single-scan stress perfusion cardiac computed tomography in detecting hemodynamically significant coronary artery stenosis: a comparison with combined invasive coronary angiography and cardiovascular magnetic resonance-myocardial perfusion imaging.

Background Non-invasive anatomical and physiological evaluations of coronary artery disease (CAD) may be obtained with static single-scan stress perfusion cardiac computed tomography (SSPCT). Purpose To determine the diagnostic performance of static SSPCT for identifying hemodynamically significant CAD. Material and Methods This prospective study included 29 patients with suspected or known CAD who underwent static SSPCT, cardiovascular magnetic resonance myocardial perfusion imaging (CMR-MPI), and invasive coronary angiography (ICA). CT was performed as follows: (i) coronary calcium scan; (ii) static SSPCT for both coronary artery (coronary CT angiography [CCTA]) and myocardial perfusion (perfusion CT [PCT]) during adenosine infusion; (iii) late-phase scan. The diagnostic performance of CCTA alone, PCT alone, and SSPCT for the detection of a hemodynamically significant CAD (a perfusion defect in a vascular territory subtended by a coronary vessel with ≥ 50% stenosis) was compared with that of combined ICA/CMR-MPI representing the standard of reference. Results Twenty-three (79%) patients and 47 (54%) vascular territories manifested ischemia-causing coronary stenoses by combined ICA/CMR-MPI. The per-vessel sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC) of the SSPCT were 92%, 88%, 90%, 90%, and 0.90, respectively, compared to those of the combined ICA/CMR-MPI. These values for the CCTA alone were 96%, 63%, 75%, 93%, and 0.79, respectively; and the values for the PCT alone were 94%, 83%, 86%, 92%, and 0.88, respectively. The AUC of SSPCT was significantly ( P = 0.013) higher than that of the CCTA alone. Conclusion Static SSPCT may facilitate detection of hemodynamically significant CAD.

Fused aortic valve without an elliptical-shaped systolic orifice in patients with severe aortic stenosis: cardiac computed tomography is useful for differentiation between bicuspid aortic valve with raphe and tricuspid aortic valve with commissural fusion.

OBJECTIVE: The objective is to determine cardiac computed tomography (CCT) features capable of differentiating between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) in severe aortic stenosis (AS) patients with fused cusp and without elliptical-shaped systolic orifices. METHODS: We retrospectively enrolled 53 patients who had severe AS with fused cusps and without an elliptical-shaped systolic orifice on CCT and who had undergone surgery. CCT features were analyzed using: 1) aortic valve findings including cusp size, cusp area, opening shape, midline calcification, fusion length, calcium volume score, and calcium grade; 2) diameters of ascending and descending aorta, and main pulmonary artery; and 3) rheumatic mitral valve findings. The variables were evaluated using univariate and multivariate logistic regression analyses. RESULTS: At surgery, 19 patients had BAV and 34 had TAV. CCT features including uneven cusp size, uneven cusp area, round-shaped systolic orifice, longer cusp fusion, and dilatation of ascending aorta were significantly associated with BAV (P < 0.05). In particular, fusion length (OR, 1.76; P = 0.001), uneven cusp area (OR, 10.46; P = 0.012), and midline calcification (OR, 0.08; P = 0.013) were strongly associated with BAV. CONCLUSION: CCT provides diagnostic clues that helps differentiate between BAV with raphe and TAV with commissural fusion in patients with severe AS. KEY POINTS: • Accurate morphologic assessment of the aortic valve is important for treatment planning. • It is difficult to differentiate BAV from TAV with a fused cusp. • CCT provides diagnostic clues for the differentiation of BAV and TAV.

Characteristics of aortic valve dysfunction and ascending aorta dimensions according to bicuspid aortic valve morphology.

OBJECTIVE: To characterize aortic valve dysfunction and ascending aorta dimensions according to bicuspid aortic valve (BAV) morphology using computed tomography (CT) and surgical findings. METHODS: We retrospectively enrolled 209 patients with BAVs who underwent transthoracic echocardiography (TTE) and CT. BAVs were classified as anterior-posterior (BAV-AP) or lateral (BAV-LA) orientation of the cusps and divided according to the presence (raphe+) or absence (raphe-) of a raphe. Ascending aortic dimensions were measured by CT at four levels. RESULTS: BAV-AP was present in 129 patients (61.7%) and raphe+ in 120 (57.4%). Sixty-nine patients (33.0%) had aortic regurgitation (AR), 70 (33.5%) had aortic stenosis (AS), and 58 (27.8%) had combined AS and AR. AR was more common in patients with BAV-AP and raphe+; AS was more common with BAV-LA and raphe-.Annulus/body surface area and tubular portion/body surface area diameters in patients with BAV-AP (17.1 ± 2.3 mm/m(2) and 24.2 ± 5.3 mm/m(2), respectively) and raphe+ (17.3 ± 2.2 mm/m(2) and 24.2 ± 5.5 mm/m(2), respectively) were significantly different from those with BAV-LA (15.8 ± 1.9 mm/m(2) and 26.4 ± 5.5 mm/m(2), respectively) and raphe- (15.7 ± 1.9 mm/m(2) and 26.2 ± 5.4 mm/m(2), respectively). CONCLUSION: The morphological characteristics of BAV might be associated with the type of valvular dysfunction, and degree and location of an ascending aorta dilatation. KEY POINTS: • The BAV-AP type had more frequent aortic regurgitation, raphe, and a larger aortic annulus. • BAV without raphe had more frequent aortic stenosis and mid-ascending aorta dilatation. • CT allows assessment of the morphological characteristics of BAV and associated aortopathy.

Diagnostic performance of dual-energy CT stress myocardial perfusion imaging: direct comparison with cardiovascular MRI.

OBJECTIVE: The purpose of this study was to assess the diagnostic performance of stress perfusion dual-energy CT (DECT) and its incremental value when used with coronary CT angiography (CTA) for identifying hemodynamically significant coronary artery disease. SUBJECTS AND METHODS: One hundred patients with suspected or known coronary artery disease without chronic myocardial infarction detected with coronary CTA underwent stress perfusion DECT, stress cardiovascular perfusion MRI, and invasive coronary angiography (ICA). Stress perfusion DECT and cardiovascular stress perfusion MR images were used for detecting perfusion defects. Coronary CTA and ICA were evaluated in the detection of ≥50% coronary stenosis. The diagnostic performance of coronary CTA for detecting hemo-dynamically significant stenosis was assessed before and after stress perfusion DECT on a per-vessel basis with ICA and cardiovascular stress perfusion MRI as the reference standard. RESULTS: The performance of stress perfusion DECT compared with cardiovascular stress perfusion MRI on a per-vessel basis in the detection of perfusion defects was sensitivity, 89%; specificity, 74%; positive predictive value, 73%; negative predictive value, 90%. Per segment, these values were sensitivity, 76%; specificity, 80%; positive predictive value, 63%; and negative predictive value, 88%. Compared with ICA and cardiovascular stress perfusion MRI per vessel territory the sensitivity, specificity, positive predictive value, and negative predictive value of coronary CTA were 95%, 61%, 61%, and 95%. The values for stress perfusion DECT were 92%, 72%, 68%, and 94%. The values for coronary CTA and stress perfusion DECT were 88%, 79%, 73%, and 91%. The ROC AUC increased from 0.78 to 0.84 (p=0.02) with the use of coronary CTA and stress perfusion DECT compared with coronary CTA alone. CONCLUSION: Stress perfusion DECT plays a complementary role in enhancing the accuracy of coronary CTA for identifying hemodynamically significant coronary stenosis.

Relationship between bicuspid aortic valve phenotype, valvular function, and ascending aortic dimensions.

BACKGROUND AND AIM OF THE STUDY: Bicuspid aortic valve (BAV) is known to be associated with aortic valve dysfunction and ascending aorta (AA) dilatation. However, the relationship between BAV morphology and AA dimensions remains unclear. Thus, the study aim was to characterize the aortic valve function and AA dimensions according to the presence of raphe and BAV phenotype. METHODS: A total of 164 patients with BAV who underwent aortic valve surgery between October 2007 and November 2012 was investigated. BAV was classified as either type I (anterior-posterior orientation) or type II (right-left orientation), and subdivided as raphe+ (presence of raphe) and raphe-(no raphe). RESULTS: Type I BAV was present in 103 patients (62.8%), and raphe+ in 100 (61.0%). Patients with raphe+ were typically younger than those with raphe-, and male gender was more predominant (88.0% and 53.1%, respectively, p < 0.05). Aortic regurgitation was more common in patients with type I and raphe+ BAV, and aortic stenosis in patients with type II and raphe- BAV. In patients with raphe+, the diameters of aortic annulus related to the body surface area (BSA) were larger, and the diameters of the tubular portion of AA indexed to BSA were smaller than in patients with raphe- (p < 0.05). CONCLUSION: BAV morphology is helpful for predicting the type of aortic valve dysfunction and the location of AA dilatation.

Pre-navigation balloon technique: Distal emboli protection during stent retriever thrombectomy.

OBJECTIVE: During stent retriever thrombectomy, a balloon guide catheter reduces distal emboli and consequently improves clinical outcomes. Because balloons are usually used before stent retrieval, these can affect the thrombus including the distal emboli while performing microcatheter navigation. This study aimed to evaluate the usefulness and safety of the pre-navigation balloon technique during microcatheter and microwire navigation. METHODS: Patients who underwent stent retriever thrombectomy secondary to an anterior circulation large-artery occlusion were retrospectively evaluated. The pre-navigation balloon technique was used, and the number of retrievals, procedure time, final recanalization, presence of distal emboli, first-pass effect (FPE), symptomatic intracranial hemorrhage including procedure-related complications, and clinical outcomes at 3 months were evaluated. RESULTS: In total 123 patients were analyzed, and occurrence of distal emboli was lesser in the pre-navigation balloon than in the non-preballoon group (4.4% vs. 11.5%, p = 0.02). No statistical difference was found in successful recanalization, mortality, and procedure-related complications. Moreover, the pre-navigation balloon group had a higher FPE than the non-balloon group (37.8% vs. 20.5%, p = 0.004). Although no statistical difference was found in the pre-navigation balloon group, a trend toward a higher rate of good clinical outcomes was observed (mRS 0-2 at 3 months, 55.6% vs. 48.7%, p = 0.09). For ICA occlusion(n = 35), significant effects were seen in decreasing distal embolism (0(0%) vs 3(16%), p = 0.01), increasing FPE (8(50%) vs 6(32%), p = 0.003), and improving clinical outcomes (mRS 0-2 at 3 months, 9(56%) vs 7(37%), p = 0.03) in the pre-navigation balloon group. In the multivariate analysis, lesser distal embolism (0.91 [0.80-1.00], p = 0.02), higher successful recanalization (3.52 [1.11-7.03], p = 0.016), and higher FPE (3.17 [1.83-7.37], p = 0.001) secondary to the procedure was a predictor of favorable clinical outcomes. CONCLUSIONS: The pre-navigation balloon technique significantly reduced occurrence of distal embolism and increased the FPE.

Practical Recommendations for the Evaluation and Management of Cardiac Injury Due to Carbon Monoxide Poisoning.

Carbon monoxide (CO) is a relatively frequent cause of poisoning evaluated in emergency departments. The risk of neurologic injuries, such as cognitive, psychological, vestibular, and motor deficits, is 25% to 50%. However, the risk of cardiac injuries should also be considered. Among patients with CO poisoning, the mortality in patients with myocardial injury is approximately 3 times greater than that in patients without myocardial injury. In large-scale studies, up to 69.2% of patients with acute CO poisoning exhibiting elevated troponin I levels and no underlying cardiovascular illnesses had late gadolinium enhancement on cardiac magnetic resonance, suggesting covert CO-induced myocardial fibrosis. Myocardial damage can be evaluated using electrocardiography, echocardiography, computed tomography, and cardiac magnetic resonance. This paper offers recommendations for cardiac evaluations based on our collective experience of managing >2,000 cases of acute CO poisoning with supporting information taken from peer-reviewed published reports on CO poisoning.

Super-resolution deep learning image reconstruction: image quality and myocardial homogeneity in coronary computed tomography angiography.

BACKGROUND: The recently introduced super-resolution (SR) deep learning image reconstruction (DLR) is potentially effective in reducing noise level and enhancing the spatial resolution. We aimed to investigate whether SR-DLR has advantages in the overall image quality and intensity homogeneity on coronary computed tomography (CT) angiography with four different approaches: filtered-back projection (FBP), hybrid iterative reconstruction (IR), DLR, and SR-DLR. METHODS: Sixty-three patients (mean age, 61 ± 11 years; range, 18-81 years; 40 men) who had undergone coronary CT angiography between June and October 2022 were retrospectively included. Image noise, signal to noise ratio, and contrast to noise ratio were quantified in both proximal and distal segments of the major coronary arteries. The left ventricle myocardium contrast homogeneity was analyzed. Two independent reviewers scored overall image quality, image noise, image sharpness, and myocardial homogeneity. RESULTS: Image noise in Hounsfield units (HU) was significantly lower (P < 0.001) for the SR-DLR (11.2 ± 2.0 HU) compared to those associated with other image reconstruction methods including FBP (30.5 ± 10.5 HU), hybrid IR (20.0 ± 5.4 HU), and DLR (14.2 ± 2.5 HU) in both proximal and distal segments. SR-DLR significantly improved signal to noise ratio and contrast to noise ratio in both the proximal and distal segments of the major coronary arteries. No significant difference was observed in the myocardial CT attenuation with SR-DLR among different segments of the left ventricle myocardium (P = 0.345). Conversely, FBP and hybrid IR resulted in inhomogeneous myocardial CT attenuation (P < 0.001). Two reviewers graded subjective image quality with SR-DLR higher than other image reconstruction techniques (P < 0.001). CONCLUSIONS: SR-DLR improved image quality, demonstrated clearer delineation of distal segments of coronary arteries, and was seemingly accurate for quantifying CT attenuation in the myocardium.

Failed Thrombus Aspiration and Reduced Myocardial Perfusion in Patients With STEMI and Large Thrombus Burden.

BACKGROUND: Thrombus aspiration (TA) is used to decrease large thrombus burden (LTB), but it can cause distal embolization. OBJECTIVES: The aim of this study was to investigate the impact of TA failure on defective myocardial perfusion in patients with ST-segment elevation myocardial infarction (STEMI) and LTB. METHODS: In total, 812 consecutive patients with STEMI and LTB (thrombus grade ≥3) were enrolled, who underwent manual TA during the primary percutaneous coronary intervention. TA failure was defined as the absence of thrombus retrieval, presence of prestenting thrombus residue, or distal embolization. The final TIMI flow grades and other myocardial perfusion parameters of the failed TA group were matched with those of the successful TA group. RESULTS: The proportion of final TIMI flow grade 3 was lower (74.6% vs 82.2%; P = 0.011) in the failed TA group (n = 279 [34.4%]) than in the successful TA group (n = 533 [65.6%]). The failed TA group also had lower myocardial blush grade, lower ST-segment resolution, and a higher incidence of microvascular obstruction than the successful TA group. TA failure was independently associated with low final TIMI flow grade (risk ratio: 1.525; 95% CI: 1.048-2.218; P = 0.027). Old age, Killip class ≥III, vessel tortuosity, calcification, and a culprit vessel other than the left anterior descending coronary artery were associated with TA failure. CONCLUSIONS: TA failure is associated with reduced myocardial perfusion in patients with STEMI and LTB. Advanced age, hemodynamic instability, hostile coronary anatomy such as tortuosity or calcification, and non-left anterior descending coronary artery status might attenuate TA performance. (Gangwon PCI Prospective Registry [GWPCI]; NCT02038127).

A preliminary study of super-resolution deep learning reconstruction with cardiac option for evaluation of endovascular-treated intracranial aneurysms.

OBJECTIVES: To investigate the usefulness of super-resolution deep learning reconstruction (SR-DLR) with cardiac option in the assessment of image quality in patients with stent-assisted coil embolization, coil embolization, and flow-diverting stent placement compared with other image reconstructions. METHODS: This single-centre retrospective study included 50 patients (mean age, 59 years; range, 44-81 years; 13 men) who were treated with stent-assisted coil embolization, coil embolization, and flow-diverting stent placement between January and July 2023. The images were reconstructed using filtered back projection (FBP), hybrid iterative reconstruction (IR), and SR-DLR. The objective image analysis included image noise in the Hounsfield unit (HU), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and full width at half maximum (FWHM). Subjectively, two radiologists evaluated the overall image quality for the visualization of the flow-diverting stent, coil, and stent. RESULTS: The image noise in HU in SR-DLR was 6.99 ± 1.49, which was significantly lower than that in images reconstructed with FBP (12.32 ± 3.01) and hybrid IR (8.63 ± 2.12) (P < .001). Both the mean SNR and CNR were significantly higher in SR-DLR than in FBP and hybrid IR (P < .001 and P < .001). The FWHMs for the stent (P < .004), flow-diverting stent (P < .001), and coil (P < .001) were significantly lower in SR-DLR than in FBP and hybrid IR. The subjective visual scores were significantly higher in SR-DLR than in other image reconstructions (P < .001). CONCLUSIONS: SR-DLR with cardiac option is useful for follow-up imaging in stent-assisted coil embolization and flow-diverting stent placement in terms of lower image noise, higher SNR and CNR, superior subjective image analysis, and less blooming artifact than other image reconstructions. ADVANCES IN KNOWLEDGE: SR-DLR with cardiac option allows better visualization of the peripheral and smaller cerebral arteries. SR-DLR with cardiac option can be beneficial for CT imaging of stent-assisted coil embolization and flow-diverting stent.

Bronchial washing fluid sequencing is useful in the diagnosis of lung cancer with necrotic tumor.

BACKGROUND: Early-stage lung cancers detected by low-dose computed tomography (CT) often require confirmation through invasive procedures due to the absence of endobronchial lesions. This study assesses the diagnostic utility of bronchial washing fluid (BW) sequencing, a less invasive alternative, aiming to identify patient characteristics most suited for this approach. METHODS: From June 2017 to March 2018, we conducted a prospective cohort study by enrolling patients with incidental lung lesions suspected of early-stage lung cancer at two independent hospitals, and 114 were diagnosed with lung cancer while 50 were diagnosed with benign lesions. BW sequencing was performed using a targeted gene panel, and the clinical characteristics of patients detected with cancer through sequencing were identified. RESULTS: Malignant cells were detected in 33 patients (28.9 %) through BW cytology. By applying specificity-focused mutation criteria, BW sequencing classified 42 patients (36.8 %) as having cancer. Among the cancer patients who were BW sequencing positive and BW cytology negative, 15 patients (75.0 %) showed necrosis on CT. The sensitivity of BW sequencing was particularly enhanced in patients with necrotic tumors, reaching 75 %. CONCLUSIONS: BW sequencing presents a viable, non-invasive diagnostic option for early-stage lung cancer, especially valuable in patients with necrotic lesions. By potentially reducing the reliance on more invasive diagnostic procedures, this method could streamline clinical workflows, decrease patient burden, and improve overall diagnostic efficiency.

2024 Consensus Statement on Coronary Stenosis and Plaque Evaluation in CT Angiography From the Asian Society of Cardiovascular Imaging-Practical Tutorial (ASCI-PT).

The Asian Society of Cardiovascular Imaging-Practical Tutorial (ASCI-PT) is an instructional initiative of the ASCI School designed to enhance educational standards. In 2021, the ASCI-PT was convened with the goal of formulating a consensus statement on the assessment of coronary stenosis and coronary plaque using coronary CT angiography (CCTA). Nineteen experts from four countries conducted thorough reviews of current guidelines and deliberated on eight key issues to refine the process and improve the clarity of reporting CCTA findings. The experts engaged in both online and on-site sessions to establish a unified agreement. This document presents a summary of the ASCI-PT 2021 deliberations and offers a comprehensive consensus statement on the evaluation of coronary stenosis and coronary plaque in CCTA.

Detection of left atrial thrombus in patients with mitral stenosis and atrial fibrillation: retrospective comparison of two-phase computed tomography, transoesophageal echocardiography and surgical findings.

OBJECTIVE: This retrospective study aims to assess the accuracy of two-phase computed tomography (CT) and transoesophageal echocardiography (TEE) for the detection of left atrial (LA) thrombus in patients with mitral stenosis (MS) and atrial fibrillation (AF), by using intraoperative findings as the reference standard. METHODS: Preoperative two-phase CT and intraoperative TEE were performed in 106 patients with MS and AF. The ratio (LAA/AAL) of Hounsfield units (HU) in the LA appendage (LAA) to the ascending aorta (AA) was calculated on the late-phase CT image. RESULTS: LA echodense masses on TEE and LA filling defects on two-phase CT were observed in 29 and 39 patients, respectively. Thirty-five LA thrombi were identified at surgery in 27 patients. Compared with the intraoperative findings, per-patient sensitivity, specificity, positive and negative predictive values of two-phase CT were 100 %, 85 %, 69 % and 100 %, and those by using TEE were 93 %, 95 %, 86 % and 97 % in detecting LAA thrombus. After adopting the cut-off value of 0.5 for the LAA/AAL HU ratio, the specificity and positive predictive value of two-phase CT were increased to 96 % and 90 %, respectively. CONCLUSION: Two-phase CT with a cut-off value of LAA/AAL HU ratio of 0.5 provides high performance for the detection of LAA thrombus. KEY POINTS: • Accurate detection of left atrial appendage (LAA) thrombus is extremely important. • However artefacts from flow effects influence both CT and ultrasound findings. • Two-phase ECG-gated CT offers new insight into thrombus detection. • Analysis of aortic/atrial opacification helps differentiate LAA thrombus from artefact at CT.

Multidirectional instability of the shoulder: rotator interval dimension and capsular laxity evaluation using MR arthrography.

OBJECTIVES: To compare the rotator interval and capsular dimension as measured on MR arthrography between patients with clinically diagnosed multidirectional instability (MDI) and control subjects with no instability. MATERIALS AND METHODS: We retrospectively reviewed a consecutive series of 658 shoulders that had undergone MR arthrography between 2006 and 2010. Of these, 97 shoulders were included in the present study. These shoulders were divided into two groups according to the clinically established diagnoses. The MDI group comprised 47 shoulders with atraumatic multidirectional shoulder instability, and the control group comprised 50 shoulders with no instability. Two independent observers measured the width and depth of the rotator interval, and the capsular dimensions at the anterior, anteroinferior, inferior, posteroinferior, and posterior regions in the two groups using MR arthrography. RESULTS: The rotator interval width and depth were significantly greater in the MDI group (width, observer 1, 17.7 mm, observer 2, 17.9 mm; depth, observer 1, 8.9 mm, observer 2, 8.8 mm) than in the control group (width, observer 1, 14.3 mm, observer 2, 14.5 mm; depth, observer 1, 5.9 mm, observer 2, 6.2 mm) (p < .001). The capsular dimensions at the inferior and posteroinferior regions were significantly larger in the MDI group (inferior, observer 1, 27.9 mm, observer 2, 27.8 mm; posteroinferior, observer 1, 27.0 mm, observer 2, 27.1 mm) than in the control group (inferior, observer 1, 25.7 mm, observer 2, 25.3 mm; posteroinferior, observer 1, 23.3 mm, observer 2, 23.6 mm) (p < .05). A width greater than 15.2 mm or a depth greater than 6.4 mm of the rotator interval, suggesting MDI, had sensitivities of 81 and 92 % for observer 1, and 79 and 94 % for observer 2, and specificities of 66 and 72 % for observer 1, and 62 and 66 % for observer 2, respectively. CONCLUSIONS: Measurements of the rotator interval and the size of the distended inferior and posteroinferior joint capsule on MR arthrography are greater in shoulders with clinical MDI than in stable shoulders.

Computed Tomography and Magnetic Resonance Imaging Findings of Bicuspid Aortic Valve and Related Abnormalities of the Heart and Thoracic Aorta.

The bicuspid aortic valve (BAV) is the most common congenital cardiovascular malformation. Patients with BAV are at higher risk of other congenital cardiovascular malformations and valvular dysfunction, including aortic stenosis/regurgitation and infective endocarditis. BAV may also be related to aortic wall abnormalities such as aortic dilatation, aneurysm, and dissection. The morphology of the BAV varies with the presence and position of the raphe and is associated with the type of valvular dysfunction and aortopathy. Therefore, accurate diagnosis and effective treatment at an early stage are essential to prevent complications in patients with BAV. This pictorial essay highlights the characteristics of BAV and its related congenital cardiovascular malformations, valvular dysfunction, aortopathy, and other rare cardiac complications using multimodal imaging.