Language：English   Publisher：European Journal of Radiology  

Purpose: To evaluate the utility of synthetic MRI of the shoulder compared with conventional MRI and to optimize the parameters of morphological images through post-processing. Additionally, we aimed to assess the agreement of T2 values between multi-echo spin-echo (MESE) and multi-dynamic multi-echo (MDME) sequences. Methods: Twenty healthy volunteers underwent shoulder MRI. The optimal post-processing parameters for the tendon–muscle contrast were examined using synthetic MRI, and two radiologists analyzed three image sets: conventional images, synthetic images using preset parameters, and optimized images. Qualitative analysis included assessment of the visibility of anatomical structures, overall image quality, and magic angle effect, whereas the quantitative analysis included measurement of the relative signal intensity and relative contrast. The T2 values of the articular cartilage and supraspinatus muscle were measured for each sequence. Results: Images synthesized with short echo times and long repetition times showed high tendon–muscle contrast. For fat-suppressed T2-weighted images, conventional images showed the highest image quality (p < 0.001), whereas the optimized images achieved comparable visibility of the rotator cuff (p = 0.031–1.0). No significant differences were observed among image sets in proton density-weighted images and T1-weighted images (p > 0.05). The T2 values of the MDME sequence were consistent with those of the MESE sequence at the muscle (p = 0.81), but were approximately 8.3 ms longer at the cartilage (p < 0.001). Conclusions: Synthetic MRI provided acceptable image quality using appropriate post-processing parameters. The simultaneous acquisition of multiple morphological images and quantitative maps within five minutes holds promise for shoulder examination.

DOI： 10.1016/j.ejrad.2025.112069

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Language：English   Publisher：Scientific Reports  

This retrospective study developed an automated algorithm for 3D segmentation of adipose tissue and paravertebral muscle on chest CT using artificial intelligence (AI) and assessed its feasibility. The study included patients from the Boston Lung Cancer Study (2000–2011). For adipose tissue quantification, 77 patients were included, while 245 were used for muscle quantification. The data were split into training and test sets, with manual segmentation as the ground truth. Subcutaneous and visceral adipose tissues (SAT and VAT) were segmented separately. Muscle area, mean attenuation value, and intermuscular adipose tissue percentage (IMAT%) were calculated in the paravertebral muscle segmentation. The AI algorithm was trained on the training sets, and its performance was evaluated on the test sets. The AI achieved Dice scores above 0.87 and showed excellent correlations for VAT/SAT ratios, muscle attenuation value, and IMAT% (correlation coefficients > 0.98, p < 0.001). The mean differences between the AI and ground truth were minimal (VAT/SAT ratio: 0.7%; muscle attenuation value: 1 HU; IMAT%: <1%). In conclusion, we developed a feasible AI algorithm for automated 3D segmentation of adipose tissue and paravertebral muscle on chest CT.

DOI： 10.1038/s41598-024-83897-0

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Language：English   Publisher：European Journal of Radiology Open  

Objectives: To investigate the association of lung signal intensity changes during forced breathing using dynamic digital radiography (DDR) with pulmonary function and disease severity in patients with chronic obstructive pulmonary disease (COPD). Methods: This retrospective study included 46 healthy subjects and 33 COPD patients who underwent posteroanterior chest DDR examination. We collected raw signal intensity and gray-scale image data. The lung contour was extracted on the gray-scale images using our previously developed automated lung field tracking system and calculated the average of signal intensity values within the extracted lung contour on gray-scale images. Lung signal intensity changes were quantified as SImax/SImin, representing the maximum ratio of the average signal intensity in the inspiratory phase to that in the expiratory phase. We investigated the correlation between SImax/SImin and pulmonary function parameters, and differences in SImax/SImin by disease severity. Results: SImax/SImin showed the highest correlation with VC (r<inf>s</inf> = 0.54, P < 0.0001), followed by FEV<inf>1</inf> (r<inf>s</inf> = 0.44, P < 0.0001), both of which are key indicators of COPD pathophysiology. In a multivariate linear regression analysis adjusted for confounding factors, SImax/SImin was significantly lower in the severe COPD group compared to the normal group (P = 0.0004) and mild COPD group (P=0.0022), suggesting its potential usefulness in assessing COPD severity. Conclusion: This study suggests that the signal intensity changes of lung fields during forced breathing using DDR reflect the pathophysiology of COPD and can be a useful index in assessing pulmonary function in COPD patients, potentially improving COPD diagnosis and management.

DOI： 10.1016/j.ejro.2024.100579

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Language：English   Publisher：European Journal of Radiology Open  

Purpose: This study aimed to assess the diagnostic performance of dynamic chest radiography (DCR) and investigate its added value to chest radiography (CR) in detecting pulmonary embolism (PE). Methods: Of 775 patients who underwent CR and DCR in our hospital between June 2020 and August 2022, individuals who also underwent contrast-enhanced CT (CECT) of the chest within 72 h were included in this study. PE or non-PE diagnosis was confirmed by CECT and the subsequent clinical course. The enrolled patients were randomized into two groups. Six observers, including two thoracic radiologists, two cardiologists, and two radiology residents, interpreted each chest radiograph with and without DCR using a crossover design with a washout period. Diagnostic performance was compared between CR with and without DCR in the standing and supine positions. Results: Sixty patients (15 PE, 45 non-PE) were retrospectively enrolled. The addition of DCR to CR significantly improved the sensitivity, specificity, accuracy, and area under the curve (AUC) in the standing (35.6–70.0 % [P < 0.0001], 84.8–93.3 % [P = 0.0010], 72.5–87.5 % [P < 0.0001], and 0.66–0.85 [P < 0.0001], respectively) and supine (33.3–65.6 % [P < 0.0001], 78.5–92.2 % [P < 0.0001], 67.2–85.6 % [P < 0.0001], and 0.62–0.80 [P = 0.0002], respectively) positions for PE detection. No significant differences were found between the AUC values of DCR with CR in the standing and supine positions (P = 0.11) or among radiologists, cardiologists, and radiology residents (P = 0.14–0.68). Conclusions: Incorporating DCR with CR demonstrated moderate sensitivity, high specificity, and high accuracy in detecting PE, all of which were significantly higher than those achieved with CR alone, regardless of scan position, observer expertise, or experience.

DOI： 10.1016/j.ejro.2024.100602

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Language：English   Publisher：Elsevier  

Purpose / This study aimed to assess the diagnostic performance of dynamic chest radiography (DCR) and investigate its added value to chest radiography (CR) in detecting pulmonary embolism (PE). / Methods / Of 775 patients who underwent CR and DCR in our hospital between June 2020 and August 2022, individuals who also underwent contrast-enhanced CT (CECT) of the chest within 72 h were included in this study. PE or non-PE diagnosis was confirmed by CECT and the subsequent clinical course. The enrolled patients were randomized into two groups. Six observers, including two thoracic radiologists, two cardiologists, and two radiology residents, interpreted each chest radiograph with and without DCR using a crossover design with a washout period. Diagnostic performance was compared between CR with and without DCR in the standing and supine positions. / Results / Sixty patients (15 PE, 45 non-PE) were retrospectively enrolled. The addition of DCR to CR significantly improved the sensitivity, specificity, accuracy, and area under the curve (AUC) in the standing (35.6–70.0 % [P < 0.0001], 84.8–93.3 % [P = 0.0010], 72.5–87.5 % [P < 0.0001], and 0.66–0.85 [P < 0.0001], respectively) and supine (33.3–65.6 % [P < 0.0001], 78.5–92.2 % [P < 0.0001], 67.2–85.6 % [P < 0.0001], and 0.62–0.80 [P = 0.0002], respectively) positions for PE detection. No significant differences were found between the AUC values of DCR with CR in the standing and supine positions (P = 0.11) or among radiologists, cardiologists, and radiology residents (P = 0.14–0.68). / Conclusions / Incorporating DCR with CR demonstrated moderate sensitivity, high specificity, and high accuracy in detecting PE, all of which were significantly higher than those achieved with CR alone, regardless of scan position, observer expertise, or experience.

CiNii Research

Language：English  

DOI： 10.1186/s40792-024-02023-4

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Language：English   Publisher：Radiology  

Background: It is increasingly recognized that interstitial lung abnormalities (ILAs) detected at CT have potential clinical implications, but automated identification of ILAs has not yet been fully established. Purpose: To develop and test automated ILA probability prediction models using machine learning techniques on CT images. Materials and Methods: This secondary analysis of a retrospective study included CT scans from patients in the Boston Lung Cancer Study collected between February 2004 and June 2017. Visual assessment of ILAs by two radiologists and a pulmonologist served as the ground truth. Automated ILA probability prediction models were developed that used a stepwise approach involving section inference and case inference models. The section inference model produced an ILA probability for each CT section, and the case inference model integrated these probabilities to generate the case-level ILA probability. For indeterminate sections and cases, both two- and three-label methods were evaluated. For the case inference model, we tested three machine learning classifiers (support vector machine [SVM], random forest [RF], and convolutional neural network [CNN]). Receiver operating characteristic analysis was performed to calculate the area under the receiver operating characteristic curve (AUC). Results: A total of 1382 CT scans (mean patient age, 67 years ± 11 [SD]; 759 women) were included. Of the 1382 CT scans, 104 (8%) were assessed as having ILA, 492 (36%) as indeterminate for ILA, and 786 (57%) as without ILA according to ground-truth labeling. The cohort was divided into a training set (n = 96; ILA, n = 48), a validation set (n = 24; ILA, n = 12), and a test set (n = 1262; ILA, n = 44). Among the models evaluated (two- and three-label section inference models; two- and three-label SVM, RF, and CNN case inference models), the model using the three-label method in the section inference model and the two-label method and RF in the case inference model achieved the highest AUC, at 0.87. Conclusion: The model demonstrated substantial performance in estimating ILA probability, indicating its potential utility in clinical settings.

DOI： 10.1148/radiol.233435

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Language：English   Publisher：(一社)日本外科学会  

症例は29歳男性で、定期検診時の胸部X線検査で右肺野に異常陰影がみられた。腫瘍マーカーを含む血液検査は正常であったが、CTでは第2肋間内に30mm大の境界明瞭な腫瘤を認め、MRIでもT2強調画像で高信号、T1強調画像で中程度の信号がみられた。神経鞘腫または孤発性線維性腫瘍が疑われたため、診断と治療を目的に胸腔鏡下手術を行った。腫瘍は第2肋軟骨前方の胸壁に認められ、表面は滑らかで胸膜と内側肋間筋に覆われていた。胸膜壁を腫瘍境界に沿って切開し、腫瘍を外側肋間筋および肋骨から剥離した。術後の病理組織学的検査では、毛細血管構造に配列された紡錘形の内皮細胞の増殖が認められ、これに伴って平滑筋線維、脂肪組織、筋肉血管が取り込まれていた。最終的に、切除断端陰性の筋肉内血管腫と診断した。術後経過は良好で、5日後に退院し、術後12ヵ月時点で再発の徴候は認められていない。

Language：English   Publisher：American Journal of Roentgenology  

Pulmonary fibrosis is recognized as occurring in association with a wide and increasing array of conditions, and it presents with a spectrum of chest CT appearances. Idiopathic pulmonary fibrosis (IPF), which corresponds histologically with usual interstitial pneumonia and represents the most common idiopathic interstitial pneumonia, is a chronic progressive fibrotic interstitial lung disease (ILD) of unknown cause. Progressive pulmonary fibrosis (PPF) describes the radiologic development of pulmonary fibrosis in patients with ILD of a known or unknown cause other than IPF. The recognition of PPF impacts management of patients with ILD—for example, in guiding initiation of antifibrotic therapy. Interstitial lung abnormalities are an incidental CT finding in patients without suspected ILD and may represent an early intervenable form of pulmonary fibrosis. Traction bronchiectasis and/ or bronchiolectasis, when detected in the setting of chronic fibrosis, is generally considered evidence of irreversible disease, and progression predicts worsening mortality risk. Awareness of the association between pulmonary fibrosis and connective tissue diseases, particularly rheumatoid arthritis, is increasing. This review provides an update on the imaging of pulmonary fibrosis, with attention given to recent advances in disease understanding with relevance to radiologic practice. The essential role of a multidisciplinary approach to clinical and radiologic data is highlighted.

DOI： 10.2214/AJR.23.29119

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Language：English   Publisher：Medicine United States  

Little information is available regarding incidence and severity of pulmonary embolism (PE) across the periods of ancestral strain, Alpha, Delta, and Omicron variants. The aim of this study is to investigate the incidence and severity of PE over the dominant periods of ancestral strain and Alpha, Delta, and Omicron variants. We hypothesized that the incidence and the severity by proximity of PE in patients with the newer variants and vaccination would be decreased compared with those in ancestral and earlier variants. Patients with COVID-19 diagnosis between March 2020 and February 2022 and computed tomography pulmonary angiogram performed within a 6-week window around the diagnosis (-2 to +4 weeks) were studied retrospectively. The primary endpoints were the associations of the incidence and location of PE with the ancestral strain and each variant. Of the 720 coronavirus disease 2019 patients with computed tomography pulmonary angiogram (58.6 ± 17.2 years; 374 females), PE was diagnosed among 42/358 (12%) during the ancestral strain period, 5/60 (8%) during the Alpha variant period, 16/152 (11%) during the Delta variant period, and 13/150 (9%) during the Omicron variant period. The most proximal PE (ancestral strain vs variants) was located in the main/lobar arteries (31% vs 6%-40%), in the segmental arteries (52% vs 60%-75%), and in the subsegmental arteries (17% vs 0%-19%). There was no significant difference in both the incidence and location of PE across the periods, confirmed by multivariable logistic regression models. In summary, the incidence and severity of PE did not significantly differ across the periods of ancestral strain and Alpha, Delta, and Omicron variants.

DOI： 10.1097/MD.0000000000036417

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Language：English   Publisher：Journal of Thoracic Disease  

DOI： 10.21037/jtd-23-1403

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Publisher：学研メディカル秀潤社  

DOI： 10.15105/gz.0000005005

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Language：English   Publisher：Rheumatology United Kingdom  

Objective: To investigate the prevalence and mortality impact of interstitial lung abnormalities (ILAs) in RA and non-RA comparators. Methods: We analysed associations between ILAs, RA, and mortality in COPDGene, a multicentre prospective cohort study of current and past smokers, excluding known interstitial lung disease (ILD) or bronchiectasis. All participants had research chest high-resolution CT (HRCT) reviewed by a sequential reading method to classify ILA as present, indeterminate or absent. RA cases were identified by self-report RA and DMARD use; non-RA comparators had neither an RA diagnosis nor used DMARDs. We examined the association and mortality risk of RA and ILA using multivariable logistic regression and Cox regression. Results: We identified 83 RA cases and 8725 non-RA comparators with HRCT performed for research purposes. ILA prevalence was 16.9% in RA cases and 5.0% in non-RA comparators. After adjusting for potential confounders, including genetics, current/past smoking and other lifestyle factors, ILAs were more common among those with RA compared with non-RA [odds ratio 4.76 (95% CI 2.54, 8.92)]. RA with ILAs or indeterminate for ILAs was associated with higher all-cause mortality compared with non-RA without ILAs [hazard ratio (HR) 3.16 (95% CI 2.11, 4.74)] and RA cases without ILA [HR 3.02 (95% CI 1.36, 6.75)]. Conclusions: In this cohort of smokers, RA was associated with ILAs and this persisted after adjustment for current/past smoking and genetic/lifestyle risk factors. RA with ILAs in smokers had a 3-fold increased all-cause mortality, emphasizing the importance of further screening and treatment strategies for preclinical ILD in RA.

DOI： 10.1093/rheumatology/kead277

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Language：English   Publisher：Japan Radiological Society  

Dynamic chest radiography (DCR) is a novel functional radiographic imaging technique that can be used to visualize pulmonary perfusion without using contrast media. Although it has many advantages and clinical utility, most radiologists are unfamiliar with this technique because of its novelty. This review aims to (1) explain the basic principles of lung perfusion assessment using DCR, (2) discuss the advantages of DCR over other imaging modalities, and (3) review multiple specific clinical applications of DCR for pulmonary vascular diseases and compare them with other imaging modalities.

DOI： 10.1007/s11604-023-01483-2

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Language：English   Publisher：(公社)日本医学放射線学会  

乳癌の乳管内播種の術前評価における仮想単色スペクトラルCTイメージング(VMI)の有用性について検討した。病理学的に2cm以上の非浸潤性乳管癌(DCIS)あるいは浸潤性乳管癌(IDC)と診断された女性患者24人(34～74歳)を対象に、従来の120kVp CTと40keVp VMIにおける病変のコントラストノイズ比(CNR)について後方視的に比較した。また、病理学的にDCISあるいは微小浸潤性乳管癌と診断された女性患者22人(37～82歳)を対象に2人の放射線科専門医が120kVp CT、40keV VMI及びMRIにおける病変サイズを測定し、病理組織学的サイズと比較した。40keV VMIにおけるCNRの平均は5.5±1.9で120kVp CTの3.6±1.5よりも有意に大きかった。120kVp CTにおける病変サイズは病理組織学的サイズと比べて有意に過小評価されていたが、40keV VMIにおける病変サイズは病理組織学的サイズと有意差がなかった。MRIとの比較にて、40keV VMIでは誤差範囲が10mm以内の測定値が120kVp CTよりも多く得られた。以上より、VMIは乳癌の乳管内播種に対する術前評価に有用であると考えられた。

Language：English   Publisher：Japanese Journal of Radiology  

Purpose: To investigate the efficacy of virtual monochromatic spectral computed tomography imaging (VMI) in the preoperative evaluation for intraductal spread of breast cancer. Materials and methods: Twenty-four women who underwent spectral CT and were pathologically diagnosed with ductal carcinoma with a ≥ 2-cm noninvasive component were retrospectively enrolled in Group 1. Twenty-two women with 22 lesions pathologically diagnosed with ductal carcinoma in situ or microinvasive carcinoma were enrolled in Group 2. We compared the contrast-to-noise ratios (CNRs) of the lesions on conventional 120-kVp CT images and 40-keV VMIs in Group 1. Two board-certified radiologists measured the maximum diameters of enhancing areas on 120-kVp CT, 40-keV VMI, and MRI in Group 2 and compared with histopathological sizes. Results: The quantitative assessment of Group 1 revealed that the mean ± SD of the CNRs in the 40-keV images were significantly greater than those in the 120-kVp images (5.5 ± 1.9 vs. 3.6 ± 1.5, p < 0.0001). The quantitative assessment of Group 2 demonstrated that the lesion size observed in the conventional 120-kVp CT images by both readers was significantly underestimated as compared to the histopathological size (p = 0.017, 0.048), whereas both readers identified no significant differences between the lesion size measured on 40-keV VMI and the histopathological data. In a comparison with MRI, 40-keV VMI provided measurement within a 10-mm error range in more lesions as compared to the conventional 120-kVp CT. Conclusion: VMI improves the evaluation of intraductal spread and is useful for the preoperative evaluations of breast cancer.

DOI： 10.1007/s11604-023-01392-4

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Language：English   Publisher：American Journal of Respiratory and Critical Care Medicine  

DOI： 10.1164/rccm.202211-2061LE

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Language：English   Publisher：Clinical Imaging  

Purpose: To assess the usefulness of amide proton transfer (APT) imaging to predict the biological status of breast cancers. Method: Sixty-six patients (age range 31–85 years, mean 58.9 years) with histopathologically proven invasive ductal carcinomas of 2 cm or larger in diameter were included in this study. 3D APT weighted imaging was conducted on a 3 T scanner. Mean APT signal intensity (SI) was analyzed in relation to biological subtypes, Ki-67 labeling index, and nuclear grades (NGs). Results: The triple-negative (TN) cancers (n = 10; 2.75 ± 0.42%) showed significantly higher APT SI than the luminal type cancers (n = 48; 1.74 ± 0.83) and HER2 cancers (n = 8; 1.83 ± 0.21) (P = 0.0007, 0.03). APT SI had weakly positive correlation with the Ki-67 labeling index (r = 0.38, P = 0.002). The mean APT SIs were significantly higher for high-Ki-67 (>30%) (n = 31; 2.25 ± 0.70) than low-Ki-67 (≤30%) cancers (n = 35; 1.60 ± 0.79) (P = 0.0007). There was no significant difference in the APT SIs between NG 1–2 (n = 31; 1.71 ± 0.84) and NG 3 (n = 35; 2.08 ± 0.76%) cancers (P = 0.06). Conclusions: TN and high-Ki-67 breast cancers showed high APT SIs. APT imaging can help to predict the biological status of breast cancers.

DOI： 10.1016/j.clinimag.2023.02.002

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Language：English   Publisher：European Journal of Radiology Open  

Purpose: To investigate the association of the maximal severity of pneumonia on CT scans obtained within 6-week of diagnosis with the subsequent development of post-COVID-19 lung abnormalities (Co-LA). Methods: COVID-19 patients diagnosed at our hospital between March 2020 and September 2021 were studied retrospectively. The patients were included if they had (1) at least one chest CT scan available within 6-week of diagnosis; and (2) at least one follow-up chest CT scan available ≥ 6 months after diagnosis, which were evaluated by two independent radiologists. Pneumonia Severity Categories were assigned on CT at diagnosis according to the CT patterns of pneumonia and extent as: 1) no pneumonia (Estimated Extent, 0%); 2) non-extensive pneumonia (GGO and OP, <40%); and 3) extensive pneumonia (extensive OP and DAD, >40%). Co-LA on follow-up CT scans, categorized using a 3-point Co-LA Score (0, No Co-LA; 1, Indeterminate Co-LA; and 2, Co-LA). Results: Out of 132 patients, 42 patients (32%) developed Co-LA on their follow-up CT scans 6–24 months post diagnosis. The severity of COVID-19 pneumonia was associated with Co-LA: In 47 patients with extensive pneumonia, 33 patients (70%) developed Co-LA, of whom 18 (55%) developed fibrotic Co-LA. In 52 with non-extensive pneumonia, 9 (17%) developed Co-LA: In 33 with no pneumonia, none (0%) developed Co-LA. Conclusions: Higher severity of pneumonia at diagnosis was associated with the increased risk of development of Co-LA after 6–24 months of SARS-CoV-2 infection.

DOI： 10.1016/j.ejro.2023.100483

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Language：English   Publisher：European Journal of Radiology  

Objectives: To assess the association of projected lung area (PLA) measured by DXR with demographic data, pulmonary function, and COPD severity, and to generate PLA over time curves using automated tracking. Methods: This retrospective study recruited healthy volunteers and COPD patients. Participants were classified into three groups: normal, COPD mild and COPD severe. PLA was calculated from the manually traced bilateral lung contours. PLA over time curves were produced using automated tracking, which was used to calculate slope and intercept by approximate line during forced expiration. The correlation of PLA, difference of PLA between end-inspiration and end-expiration (ΔPLA), slope, and intercept with demographic data and pulmonary function tests were investigated. The difference of PLA, ΔPLA, intercept, and slope among three groups were also evaluated. Results: This study enrolled 45 healthy volunteers and 32 COPD patients. COPD severe group had larger PLA in both lungs at tidal/forced end-inspiration/expiration, smaller slope, and larger intercept than normal group (p < 0.001). PLA was correlated with % forced expiratory volume in one second (%FEV<inf>1</inf>) (r<inf>s</inf> from −0.42 to −0.31, p ≤ 0.01). ΔPLA in forced breathing showed moderate correlation with vital capacity (VC) (r<inf>s</inf> = 0.58, p < 0.001), while ΔPLA in tidal breathing showed moderate correlation with %FEV<inf>1</inf> (r<inf>s</inf> = -0.52, p < 0.001) as well as mild correlation with tidal volume (r<inf>s</inf> = 0.24, p = 0.032). Intercept was slightly underestimated compared with manually contoured PLA (p < 0.001). Conclusion: COPD patients had larger PLA than healthy volunteers. PLA and ΔPLA in tidal breathing showed mild to moderate correlation with %FEV<inf>1</inf>.

DOI： 10.1016/j.ejrad.2022.110546

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Language：English   Publisher：Radiographics  

Interstitial lung abnormality (ILA) is defined as an interstitial change detected incidentally on CT images. It is seen in 4%–9% of smokers and 2%–7% of nonsmokers. ILA has a tendency to progress with time and is associated with respiratory symptoms, decreased exercise capability, reduced pulmonary function, and increased mortality. ILAs can be classified into three subcategories: nonsubpleural, subpleural nonfibrotic, and subpleural fibrotic. In cases of ILA, clinically significant interstitial lung disease should be identified and requires clinically driven management by a pulmonologist. Risk factors for the progression of ILA include clinical elements (ie, inhalation exposures, medication use, radiation therapy, thoracic surgery, physiologic findings, and gas exchange findings) and radiologic elements (ie, basal and peripheral predominance and fibrotic findings). It is recommended that individuals with one or more clinical or radiologic risk factors for progression of ILA be actively monitored with pulmonary function testing and CT. To avoid overcalling ILA at CT, radiologists must recognize the imaging pitfalls, including centrilobular nodularity, dependent abnormality, suboptimal inspiration, osteophyte-related lesions, apical cap and pleuroparenchymal fibroelastosis–like lesions, aspiration, and infection. There is a close association between ILA and lung cancer, and many studies have reported an increased incidence of lung cancer, worse prognoses, and/or increased pulmonary complications in relation to cancer treatment in patients with ILA. ILA is considered to be an important comorbidity in patients with lung cancer. Accordingly, all radiologists involved with body CT must have sound knowledge of ILAs owing to the high prevalence and potential clinical significance of these anomalies. An overview of ILAs, including a literature review of the associations between ILAs and lung cancer, is presented.

DOI： 10.1148/rg.220073

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Language：English   Publisher：Radiology  

Background: The clinical impact of interstitial lung abnormalities (ILAs) on poor prognosis has been reported in many studies, but risk stratification in ILA will contribute to clinical practice. Purpose: To investigate the association of traction bronchiectasis/bronchiolectasis index (TBI) with mortality and clinical outcomes in individuals with ILA by using the COPDGene cohort. Materials and Methods: This study was a secondary analysis of prospectively collected data. Chest CT scans of participants with ILA for traction bronchiectasis/bronchiolectasis were evaluated and outcomes were compared with participants without ILA from the COPDGene study (January 2008 to June 2011). TBI was classified as follows: TBI-0, ILA without traction bronchiectasis/bronchiolectasis; TBI-1, ILA with bronchiolectasis but without bronchiectasis or architectural distortion; TBI-2, ILA with mild to moderate traction bronchiectasis; and TBI-3, ILA with severe traction bronchiectasis and/or honeycombing. Clinical outcomes and overall survival were compared among the TBI groups and the non-ILA group by using multivariable linear regression model and Cox proportional hazards model, respectively. Results: Overall, 5295 participants (median age, 59 years; IQR, 52–66 years; 2779 men) were included, and 582 participants with ILA and 4713 participants without ILA were identified. TBI groups were associated with poorer clinical outcomes such as quality of life scores in the multivariable linear regression model (TBI-0: coefficient, 3.2 [95% CI: 0.6, 5.7; P = .01]; TBI-1: coefficient, 3.3 [95% CI: 1.1, 5.6; P = .003]; TBI-2: coefficient, 7.6 [95% CI: 4.0, 11; P , .001]; TBI-3: coefficient, 32 [95% CI: 17, 48; P , .001]). The multivariable Cox model demonstrated that ILA without traction bronchiectasis (TBI-0–1) and with traction bronchiectasis (TBI-2–3) were associated with shorter overall survival (TBI-0–1: hazard ratio [HR], 1.4 [95% CI: 1.0, 1.9; P = .049]; TBI-2–3: HR, 3.8 [95% CI: 2.6, 5.6; P , .001]). Conclusion: Traction bronchiectasis/bronchiolectasis was associated with poorer clinical outcomes compared with the group without interstitial lung abnormalities; TBI-2 and 3 were associated with shorter survival.

DOI： 10.1148/radiol.212584

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PubMed

Language：English   Publisher：American Journal of Respiratory and Critical Care Medicine  

Rationale: Knowledge on biomarkers of interstitial lung disease is incomplete. Interstitial lung abnormalities (ILAs) are radiologic changes that may present in its early stages. Objectives: To uncover blood proteins associated with ILAs using large-scale proteomics methods. Methods: Data from two prospective cohort studies, the AGES-Reykjavik (Age, Gene/Environment Susceptibility–Reykjavik) study (N = 5,259) for biomarker discovery and the COPDGene (Genetic Epidemiology of COPD) study (N = 4,899) for replication, were used. Blood proteins were measured using DNA aptamers, targeting more than 4,700 protein analytes. The association of proteins with ILAs and ILA progression was assessed with regression modeling, as were associations with genetic risk factors. Adaptive Least Absolute Shrinkage and Selection Operator models were applied to bootstrap data samples to discover sets of proteins predictive of ILAs and their progression. Measurements and Main Results: Of 287 associations, SFTPB (surfactant protein B) (odds ratio [OR], 3.71 [95% confidence interval (CI), 3.20–4.30]; P = 4.28 3 10²⁶⁷), SCGB3A1 (Secretoglobin family 3A member 1) (OR, 2.43 [95% CI, 2.13–2.77]; P = 8.01 3 10²⁴⁰), and WFDC2 (WAP four-disulfide core domain protein 2) (OR, 2.42 [95% CI, 2.11–2.78]; P = 4.01 3 10²³⁶) were most significantly associated with ILA in AGES-Reykjavik and were replicated in COPDGene. In AGES-Reykjavik, concentrations of SFTPB were associated with the rs35705950 MUC5B (mucin 5B) promoter polymorphism, and SFTPB and WFDC2 had the strongest associations with ILA progression. Multivariate models of ILAs in AGES-Reykjavik, ILAs in COPDGene, and ILA progression in AGES-Reykjavik had validated areas under the receiver operating characteristic curve of 0.880, 0.826, and 0.824, respectively. Conclusions: Novel, replicated associations of ILA, its progression, and genetic risk factors with numerous blood proteins are demonstrated as well as machine-learning–based models with favorable predictive potential. Several proteins are revealed as potential markers of early fibrotic lung disease.

DOI： 10.1164/rccm.202110-2296OC

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Scopus

PubMed

Language：English   Publisher：European Radiology Experimental  

Background: We assessed the difference in lung motion during inspiration/expiration between chronic obstructive pulmonary disease (COPD) patients and healthy volunteers using vector-field dynamic x-ray (VF-DXR) with optical flow method (OFM). Methods: We enrolled 36 COPD patients and 47 healthy volunteers, classified according to pulmonary function into: normal, COPD mild, and COPD severe. Contrast gradient was obtained from sequential dynamic x-ray (DXR) and converted to motion vector using OFM. VF-DXR images were created by projection of the vertical component of lung motion vectors onto DXR images. The maximum magnitude of lung motion vectors in tidal inspiration/expiration, forced inspiration/expiration were selected and defined as lung motion velocity (LMV). Correlations between LMV with demographics and pulmonary function and differences in LMV between COPD patients and healthy volunteers were investigated. Results: Negative correlations were confirmed between LMV and % forced expiratory volume in one second (%FEV<inf>1</inf>) in the tidal inspiration in the right lung (Spearman’s rank correlation coefficient, r<inf>s</inf> = -0.47, p < 0.001) and the left lung (r<inf>s</inf> = -0.32, p = 0.033). A positive correlation between LMV and %FEV<inf>1</inf> in the tidal expiration was observed only in the right lung (r<inf>s</inf> = 0.25, p = 0.024). LMVs among normal, COPD mild and COPD severe groups were different in the tidal respiration. COPD mild group showed a significantly larger magnitude of LMV compared with the normal group. Conclusions: In the tidal inspiration, the lung parenchyma moved faster in COPD patients compared with healthy volunteers. VF-DXR was feasible for the assessment of lung parenchyma using LMV.

DOI： 10.1186/s41747-021-00254-w

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Scopus

PubMed

Language：English   Publisher：European Journal of Radiology Open  

Purpose: To investigate the effect of vaccinations and boosters on the severity of COVID-19 pneumonia on CT scans during the period of Delta and Omicron variants. Methods: Retrospectively studied were 303 patients diagnosed with COVID-19 between July 2021 and February 2022, who had obtained at least one CT scan within 6 weeks around the COVID-19 diagnosis (−2 to +4 weeks). The severity of pneumonia was evaluated with a 6-point scale Pneumonia Score. The association between demographic and clinical data and vaccination status (booster/additional vaccination, complete vaccination and un-vaccination) and the difference between Pneumonia Scores by vaccination status were investigated. Results: Of 303 patients (59.4 ± 16.3 years; 178 females), 62 (20 %) were in the booster/additional vaccination group, 117 (39 %) in the complete vaccination group, and 124 (41 %) in the unvaccinated group. Interobserver agreement of the Pneumonia Score was high (weighted kappa score = 0.875). Patients in the booster/additionally vaccinated group tended to be older (P = 0.0085) and have more underlying comorbidities (P < 0.0001), and the Pneumonia Scores were lower in the booster/additionally vaccinated [median 2 (IQR 0–4)] and completely vaccinated groups [median 3 (IQR 1–4)] than those in the unvaccinated group [median 4 (IQR 2–4)], respectively (P < 0.0001 and P < 0.0001, respectively). A multivariable linear analysis adjusted for confounding factors confirmed the difference. Conclusion: Vaccinated patients, with or without booster/additional vaccination, had milder COVID-19 pneumonia on CT scans than unvaccinated patients during the period of Delta and Omicron variants. This study supports the efficacy of the vaccine against COVID-19 from a radiological perspective.

DOI： 10.1016/j.ejro.2022.100456

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Scopus

PubMed

Language：English   Publisher：European Journal of Radiology Open  

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editor-in-Chief. The article reuses without permission six images (Figs. 5A, B, 6A, B and 7A, B) that were previously published in an article in the American Journal of Roentgenology (AJR) doi.org/10.2214/AJR.17.18384. The article also contains alterations to the details in the legends of these same figures relative to their details in the earlier article. The authors have been provided the option to submit a version of the manuscript with new images in place of the previously listed images; such a submission would be required to undergo peer review as a new submission.

DOI： 10.1016/j.ejro.2022.100402

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Scopus

PubMed

Language：English   Publisher：European Journal of Radiology Open  

Connective tissue diseases (CTDs) demonstrating features of interstitial lung disease (ILD) include systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis (SSc), dermatomyositis (DM) and polymyositis (PM), ankylosing spondylitis (AS), Sjogren syndrome (SS), and mixed connective tissue disease (MCTD). On histopathology of lung biopsy in CTD-related ILDs (CTD-ILDs), multi-compartment involvement is an important clue, and when present, should bring CTD to the top of the list of etiologic differential diagnoses. Diverse histologic patterns including nonspecific interstitial pneumonia (NSIP), usual interstitial pneumonia (UIP), organizing pneumonia, apical fibrosis, diffuse alveolar damage, and lymphoid interstitial pneumonia can be seen on histology in patients with CTD-ILDs. Although proportions of ILDs vary, the NSIP pattern accounts for a large proportion, especially in SSc, DM and/or PM and MCTD, followed by the UIP pattern. In RA patients, interstitial lung abnormality (ILA) is reported to occur in approximately 20–60% of individuals of which 35–45% will have progression of the CT abnormality. Subpleural distribution and greater baseline ILA involvement are risk factors associated with disease progression. Asymptomatic CTD-ILDs or ILA patients with normal lung function and without evidence of disease progression can be followed without treatment. Immunosuppressive or antifibrotic agents for symptomatic and/or fibrosing CTD-ILDs can be used in patients who require treatment.

DOI： 10.1016/j.ejro.2022.100419

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Scopus

PubMed

Language：Japanese  

Language：Japanese  

Language：Japanese   Publisher：大道学館出版部