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Journal of Thoracic Imaging - Current Issue

Journal of Thoracic Imaging - Current Issue
  1. Use of Model-based Iterative Reconstruction to Improve Detection of Congenital Cardiovascular Anomalies in Infants Undergoing Free-breathing Computed Tomographic Angiography
    imagePurpose: The aim of the study was to assess the detection of congenital cardiovascular anomalies (congenital heart disease) in neonates and infants using model-based iterative reconstruction (MBIR) algorithm compared with hybrid iterative reconstruction (HIR) and filtered back projection (FBP) reconstructions on axial computed tomography (CT) performed at minimum scanner dose. Materials and Methods: Over 1 year, all CT angiographies performed in infants below 3 months of age with congenital heart disease were assessed retrospectively. All were scanned on a 256-slice CT (Brilliance iCT) using single axial rotation at minimum allowable scanner dose (80 kV/10 mAs), with patients free-breathing. Intravenous contrast was 1 mL/kg. Scan reconstruction was 0.9 mm/0.45 mm overlap, reconstructed with FBP, HIR (iDose5), and MBIR (IMR2). The 3 reconstructions per study were anonymized and randomized. Four cardiac radiologists (23, 9, 7, and 6 y experience) evaluated each reconstruction on a workstation for presence of an atrial septal defect, a ventricular septal defect, patent ductus arteriosus, and surgical shunt or anomalies of the aorta, pulmonary arteries, and pulmonary veins. Unevaluable structures were classified as nondiagnostic. Gold standard was surgery or both echocardiogram and cardiac catheterization. The sensitivity, specificity, and accuracy were determined for each reconstruction. Results: Fifteen scans in 14 infants met the inclusion criteria, with a total of 48 anomalies. Pooled sensitivity for MBIR of 0.82 (range, 0.75 to 0.9) was significantly better than those for FBP (0.58; range, 0.54 to 0.6; P<0.001) and HIR (0.67; range, 0.60 to 0.79; P<0.001). Pooled accuracy of MBIR, HIR, and FBP was 0.91, 0.84, and 0.81, respectively. Readers deemed 39 and 15 structures nondiagnostic with FBP and HIR, respectively, versus 2 with MBIR (MBIR-FBP, MBIR-HIR, P<0.0001). The CTDIvol, DLP, and estimated dose for all cases was 0.52 mGy, 4.2 mGy×cm, and 0.16 mSv. Conclusions: MBIR significantly improves the detection of congenital anomalies in neonates and infants undergoing CT angiography at minimum allowable dose.

  2. Imaging in Chronic Thromboembolic Pulmonary Hypertension
    imageChronic thromboembolic pulmonary hypertension (CTEPH) is one of the potentially curable causes of pulmonary hypertension and is definitively treated with pulmonary thromboendartectomy. CTEPH can be overlooked, as its symptoms are nonspecific and can be mimicked by a wide range of diseases that can cause pulmonary hypertension. Early diagnosis of CTEPH and prompt evaluation for surgical candidacy are paramount factors in determining future outcomes. Imaging plays a central role in the diagnosis of CTEPH and patient selection for pulmonary thromboendartectomy and balloon pulmonary angioplasty. Currently, various imaging tools are used in concert, with techniques such as computed tomography (CT) and conventional pulmonary angiography providing detailed structural information, tests such as ventilation-perfusion (V/Q) scanning providing functional data, and magnetic resonance imaging providing a combination of morphologic and functional information. Emerging techniques such as dual-energy CT and single photon emission computed tomography-CT V/Q scanning promise to provide both anatomic and functional information in a single test and may change the way we image these patients in the near future. In this review, we discuss the roles of various imaging techniques and discuss their merits, limitations, and relative strengths in depicting the structural and functional changes of CTEPH. We also explore newer imaging techniques and the potential value they may offer.

  3. Managing Incidental Lung Nodules in Patients With a History of Oncologic Disease: A Survey of Thoracic Radiologists
    imagePurpose: The aim of this study was to analyze the impact that a clinical history of an oncologic disease may have on the management decisions for incidentally detected lung nodules on chest computed tomographic (CT) examinations. Materials and Methods: An electronic survey was sent to all 796 members of the Society of Thoracic Radiology regarding criteria for the management of incidentally detected lung nodules in oncologic patients, as well as recommendations for nodule follow-up. Nodule characteristics and clinical parameters used by respondents were analyzed. Differences between variables were examined using the χ2 test. Results: Of the 796 Society of Thoracic Radiology members, 178 (22.36%) replied. Most respondents were subspecialized in cardiothoracic imaging (92.70%) and practiced in an “academic or teaching hospital setting” (75.28%) with a “dedicated oncology center” (94.03%). “History of oncologic disease” was the most important factor (98.87%) for management decisions. In patients with such a history, respondents most commonly used “experience and common sense” (56.74%) and reported “all incidentally found lung nodules” (65.73%, P<0.0001). “Size” and “shape” were the 2 most important nodule characteristics (33.61% and 27.05%, respectively) used to consider a nodule “clinically relevant,” and “size” (44.07%) was also the most important nodule characteristic prompting recommendation for short-term CT follow-up. Follow-up CT examinations in oncologic patients were recommended by 75.84% of respondents. Conclusions: In patients with a history of oncologic disease, radiologists tend to report every detected nodule and to routinely recommend follow-up CT examinations. Although most radiologists rely on “experience and common sense” in managing these nodules, greater standardization of lung nodule management in oncologic patients is needed, ideally through guidelines tailored to this patient population.

  4. Recent Advances in Computed Tomographic Technology: Cardiopulmonary Imaging Applications
    imageCardiothoracic diseases result in substantial morbidity and mortality. Chest computed tomography (CT) has been an imaging modality of choice for assessing a host of chest diseases, and technologic advances have enabled the emergence of coronary CT angiography as a robust noninvasive test for cardiac imaging. Technologic developments in CT have also enabled the application of dual-energy CT scanning for assessing pulmonary vascular and neoplastic processes. Concerns over increasing radiation dose from CT scanning are being addressed with introduction of more dose-efficient wide-area detector arrays and iterative reconstruction techniques. This review article discusses the technologic innovations in CT and their effect on cardiothoracic applications.

  5. Reviewer Awards and Acknowledgements Editors’ Recognition Awards for Distinction in Reviewing in 2016
    No abstract available

  6. Comparison of Total Lung Capacity Determined by Plethysmography With Computed Tomographic Segmentation Using CALIPER
    imagePurpose: Traditionally, determination of total lung capacity (TLC) by plethysmography (TLCpleth) has been important in the diagnosis of lung diseases. Alternatively, data acquired from computerized tomography (CT) can be utilized to calculate a measure of TLC (TLCCT). The clinical utility of TLCCT is not certain. We sought to determine, in a clinical setting, whether TLCCT correlates with TLCpleth across a range of lung diseases and scanning techniques. In addition, we determined whether TLCCT affects the interpretation of pulmonary function tests. Subjects and Methods: Records of 118 of 148 consecutive lung transplant recipients were reviewed and determined to have coinciding pulmonary function tests, including plethysmography as well as volumetric chest CT performed supine during full inspiration. CT images acquired with a wide range of scanning protocols were analyzed using CALIPER, a software program for lung and trachea extraction from a CT volume and volumetric tissue characterization of the lung. Segmentation of the lung was achieved by using completely automated dynamic thresholding and region-growing techniques developed to extract the relatively low-density lung and tracheal anatomy from the CT data set without user intervention. Results: TLCpleth and TLCCT were strongly related with a correlation coefficient of 0.88 (P<0.001). The efficacy of the CT-derived measure was not influenced by specific lung diagnoses, age, height, body mass index, or spirometric parameters. TLCCT did not misidentify any diagnosis of restrictive lung disease, nor hyperinflation. Conclusions: In a clinical setting, CT segmentation analysis provides a favorable determination of TLC compared with traditional plethysmography. The technique has general applicability across varying CT data acquisition protocols, lung diseases, and patient characteristics. TLCCT may substitute for TLCpleth in pulmonary function interpretation and may be preferable for some patients in whom plethysmography is difficult to perform, such as transplant subjects with severe pulmonary fibrosis.

  7. Left Atrium Maximal Axial Cross-Sectional Area is a Specific Computed Tomographic Imaging Biomarker of World Health Organization Group 2 Pulmonary Hypertension
    imagePurpose: Left heart disease is associated with left atrial enlargement and is a common cause of pulmonary hypertension (PH). We investigated the relationship between left atrium maximal axial cross-sectional area (LA-MACSA), as measured on chest computed tomography (CT), and PH due to left heart disease (World Health Organization group 2) in patients with right heart catheterization–proven PH. Materials and Methods: A total of 165 patients with PH who had undergone right heart catheterization with pulmonary artery pressure and pulmonary capillary wedge pressure (PCWP) measurements and nongated chest CTs were included. LA-MACSA, LA anterior-posterior, and LA transverse measurements were independently obtained using the hand-drawn region-of-interest and distance measurement tools on standard PACS by 2 blinded cardiothoracic radiologists. Nonparametric statistical analyses and receiver operating characteristic curve were performed. Results: Forty-three patients had group 2 PH (PCWP>15 mm Hg), and 122 had nongroup 2 PH (PCWP≤15 mm Hg). Median LA-MACSA was significantly different between the group 2 PH and nongroup 2 PH patients (2312 vs. 1762 mm2, P<0.001). Interobserver concordance correlation for LA-MACSA was high at 0.91 (P<0.001). At a threshold of 2400 mm2, LA-MACSA demonstrated 93% specificity for classifying group 2 PH (area under the curve, 0.73; P<0.001). Conclusions: LA-MACSA is a readily obtainable and reproducible measurement of left atrial enlargement on CT and can distinguish between group 2 and nongroup 2 PH with high specificity.

  8. Imaging of the Lungs in Organ Donors and its Clinical Relevance: A Retrospective Analysis
    imagePurpose: The aim of the study was to retrospectively evaluate the diagnostic imaging that potential lung donors undergo, the reader variability of image interpretation and its relevance for donation, and the potential information gained from imaging studies not primarily intended for lung evaluation but partially including them. Materials and Methods: Bedside chest radiography and computed tomography (CT), completely or incompletely including the lungs, of 110 brain-dead potential organ donors in a single institution during 2007 to 2014 were reviewed from a donation perspective. Two chest radiologists in consensus analyzed catheters and cardiovascular, parenchymal, and pleural findings. Clinical reports and study review were compared for substantial differences in findings that could have led to a treatment change, triggered additional examinations such as bronchoscopy, or were considered important for donation. Results: Among 136 bedside chest radiographs, no differences between clinical reports and study reviews were found in 37 (27%), minor differences were found in 28 (21%), and substantial differences were found in 71 (52%) examinations (P<0.0001). In 31 of 42 (74%) complete or incomplete CT examinations, 50 of 74 findings with relevance for lung donation were not primarily reported (P<0.0001). Conclusions: The majority of donor patients undergo only chest radiography. A targeted imaging review of abnormalities affecting the decision to use donor lungs may be useful in the preoperative stage. With a targeted list, substantial changes were made from initial clinical interpretations. CT can provide valuable information on donor lung pathology, even if the lungs are only partially imaged.

  9. The Double Artery Sign
    imageNo abstract available

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