High-resolution Computed Tomography Research Articles

Deep learning enables the fully automated quantification of high-resolution cardiac CT images: human in loop for model development

Abstract Introduction Cardiac computed tomography (CCT) images provide vast spatial and temporal information. Segmentation of the structure of interest is necessary to provide quantitative information. However, manual segmentation of cardiac substructures is highly time-consuming. Objective This study aims to develop a robust deep-learning segmentation model for cardiac substructure segmentation in 3D CCT images. Method We initially developed a 3D U-Net architecture, incorporating extensive augmentation, for the segmentation of the Left Ventricle Myocardium (LVM), the blood cavities of the Left and Right Ventricles (LV, RV), and the Left and Right Atria (LA, RA). This model utilized CT images from 20 patients who had available manual segmentation. Subsequently, we applied this initial model to datasets from two centers, including different generations of scanners. We then visually inspected the segmentation, selected the highest-quality segmentations, and modify it if necessary, and excluded the low-quality data. We continued fine-tuning the model with the new dataset until we reached a count of 456 patients. As there were multiple images from one patient during this model's development, we generated datasets to develop a new model using the entire new dataset to avoid any data leakage in the reported metrics. The model was developed using data from Center 1 (5-fold cross-validation) and then evaluated on an external test set from Center 2 (126 patients) and also 4D images from Center 1. Various metrics were calculated to assess the model's performance. Results In the internal test set, utilizing 5-fold CV, the model demonstrated high segmentation accuracy, achieving an overall Dice coefficient of 0.98, with individual scores of 0.96 for LVM, 0.98 for LV, 0.98 for RV, 0.99 for RA, and 0.98 for LA. We assessed the automatic quantification capability of the segmentation model from 256 patients, resulting in an R2 value greater than 0.92 for both LV end-diastolic and systolic volumes. In contrast, the model maintained robust performance on the external dataset, achieving an overall Dice coefficient of 0.96, with individual scores of 0.95 for LVM, 0.98 for LV, 0.97 for RV, 0.98 for RA, and 0.94 for LA. Conclusion We provided a large cohort of ground truth segmentations for different cardiac CT substructures using a human-in-the-loop strategy. Subsequently, we developed a deep learning model for highly accurate automated segmentation of these substructures. This model allows for fast and fully automatic segmentation and quantification of 3D and 4D cardiac CT images, from which various quantitative metrics can be extracted from different cardiac substructures.

Sarcoid Nodule or Lung Cancer? A High-Resolution Computed Tomography-Based Retrospective Study of Pulmonary Nodules in Patients with Sarcoidosis

Background: The objective of this retrospective study was to compare the characteristics of sarcoid nodules and neoplastic nodules using high-resolution computed tomography (HRCT) in sarcoidosis patients. Methods: This is a single-center retrospective study. From 2010 to 2023, among 685 patients affected by pulmonary sarcoidosis, 23 patients developed pulmonary nodules of a suspicious malignant nature. The HRCT characteristics of biopsy-proven malignant (Group A) vs. inflammatory (Group B) nodules were analyzed and compared. Results: A significant difference was observed between the groups in terms of age (p = 0.012). With regard to HRCT features, statistical distinctions were observed in the appearance of the nodule, more frequently spiculated in the case of lung cancer (p < 0.01), in the diameter of the nodule (Group A: 23.5 mm; Group B: 12.18 mm, p < 0.02), in the median nodule density (Group A: 60.0 HU, Group B: −126.7 HU, p < 0.01), and in the number of pulmonary nodules, as a single parenchymal nodule was more frequently observed in the neoplastic patient group (p = 0.043). In Group A, the 18-PET-CT demonstrated hilar/mediastinal lymphadenopathy in 100% of cases; histology following surgery did not report any cases of malignant lymph node involvement. Conclusions: An accurate clinical evaluation and HRCT investigation are crucial for diagnosing lung cancer in patients with sarcoidosis in order to determine who requires surgical resection. The spiculated morphology of the nodule, greater size, the number of pulmonary nodules, and density using HRCT appear to correlate with the malignant nature of the lesion.

Cohort study of serological biomarkers for interstitial lung disease in patients with rheumatoid arthritis

Objective Interstitial lung disease (ILD) is an important cause of mortality in patients with rheumatoid arthritis (RA). Early RA-ILD detection is essential to improve prognosis. Here, we investigated eight serological biomarkers that may contribute to RA-ILD detection. Method Fifty-five patients from the Early Rheumatoid Arthritis Program were evaluated for ILD with high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs) using the SCAPIS protocol. Blood samples were obtained for biomarker analysis, and patients’ clinical records were reviewed. We defined ILD using five different models based on the measurements used to confirm ILD: Model A = HRCT; B = PFTs; C = A plus B; D = C plus symptoms; and E = D plus inhalations. Results Among 55 patients, two had an ILD diagnosis before the study, but over one-third fulfilled the ILD criteria. Cancer antigen 15-3 (CA15-3) and matrix metalloproteinase-7 (MMP-7) differentiated between RA with and without ILD (all p < 0.05). Surfactant protein D (SP-D) showed similar trends, as did macrophage inflammatory protein-1β (MIP-1β) and chitinase 3-like protein-1 (YKL-40). Based on Pearson’s correlation coefficients, MIP-1β and YKL-40 were significantly correlated with DAS28 (MIP-1β: 0.3; YKL-40: 0.4), ESR (MIP-1β: 0.3; YKL-40: 0.4), and CRP (only MIP-1β: 0.4) (all p < 0.05). CA15-3 was correlated with rheumatoid factor and anti-citrullinated peptide antibodies (Pearson’s correlation 0.3; both p = 0.03). Conclusions CA15-3 was the most significant biomarker for ILD detection in RA patients with stable low disease activity, closely followed by MMP-7. SP-D, MIP-1β, and YKL-40 may also contribute to RA-ILD diagnosis.

Size-specific dose estimates calculated using patient size measurements from scanned projection radiograph in high-resolution chest computed tomography.

Size-specific dose estimates (SSDE) are used to assess patient-specific radiation exposure in Computed Tomography (CT), complementing the volume CT dose index (CTDIvol). This study compared SSDE calculated using patient's lateral size from scan projection radiograph (SPR) with SSDE calculated using water equivalent diameter (Dw) from tomographic images in adult chest high-resolution CT (HRCT). In a single-centre study, the CTDIvol and dose-length product (DLP) were recorded from HRCT dose reports of adult patients. Lateral width (SLat), at the centre of the scan range, from the SPR was measured and the SSDE (SSDER) was calculated using conversion factors related to SLat. Average CT number, area of the slice, and lateral size of the patient (AxLat) were measured on the middle slice. The Dw and SSDE from Dw (SSDEW) were calculated. SSDER and SSDEW were compared using Wilcoxon signed rank test. Correlation between patient size and dosimetry parameters were investigated using Spearman Correlation test with statistical significance at P < 0.05. Bland-Altman plot was also used to test agreement between the two SSDE values. Median CTDIvol, DLP, SSDER and SSDEW were 11.0 mGy, 372 mGy.cm, 11.6 mGy and 12.9 mGy, respectively. Small but statistically significant differences (P < 0.03) were found between SLat and AxLat as well as between SSDER and SSDEW. Bland-Altman analysis resulted in borderline agreement between SSDE values. Moderate correlations were observed between dosimetry quantities and patient size measurements (ρ > 0.640; P < 0.001). SSDEw showed statistically significant correlation (ρ = 0.587 and P < 0.001) with SSDER. SSDER may be used to assess patients' absorbed radiation dose, before the scan, in adult chest HRCT. The median value of SSDER was about 10% lower than the median value SSDEW. However, the SSDEW should be used after the scan to establish effective dose and radiation risk to the patient.

Radioanatomical evaluation of the subtympanic sinus in children under five years old and its clinical implications - high resolution computed tomography study.

This study aimed to evaluate subtympanic sinus (STS) and its vicinity in high-resolution computed tomography (HRCT) scans of children under five years old with non-diseased temporal bones. We divided the whole group into children under 24 months of age (first stage of pneumatisation development) and between 25 and 60 (second stage). We have determined the width of the entrance to STS, depth of the STS, type in relation to facial nerve according to Anschuetz classification, the pneumatisation of posterior and medial air cell tracts, and jugular bulb position. All the HRCTs (280 temporal bones) were analyzed according to the multiplanar reconstruction protocol with symmetrization. STS's mean width and depth were 2.71 ± 0.60mm and 3.26 ± 1.11mm, respectively. The most common STS type was type A (59.3%), followed by type B (30.7%) and type C (10%). The posterior air cell tract (retrofacial cells) was present in 39.3%. The medial air cell tract (hypotympanic cells) was present in 30.7% The jugular bulb position affected the final shape of STS in 17.5%. The results support the necessity of the classification for the STS. Our study may help with surgical planning regarding endoscopic ear procedures and gives a broader understanding of how pneumatization or jugular bulb might correlate with the final shape of the retrotympanum. The historical remarks track the term's origin for clarity in research and respect for earlier investigators.

Low-Field MRI for Dental Imaging in Pediatric Patients With Supernumerary and Ectopic Teeth: A Comparative Study of 0.55 T and Ultra-Low-Dose CT.

This study sought to elucidate the diagnostic performance of 0.55 T magnetic resonance imaging (MRI) for pediatric dental imaging, specifically in terms of the image quality (IQ) for detecting ectopic and/or supernumerary teeth, compared with routine ultra-low-dose computed tomography (ULD-CT) of the jaw. A total of 16 pediatric patients (mean age: 12.4 ± 2.6 years, range: 9-17 years) with ectopic and/or supernumerary teeth screened from January 2023 to January 2024 were enrolled in this prospective, single-center study. All patients underwent ULD-CT as the clinical reference standard and 0.55 T MRI as the study scan on the same day. A 0.6-mm isotropic 3-dimensional T1w FLASH sequence was developed with a dedicated field of view of the upper and lower jaws. ULD-CT was performed using a new single-source computed tomography (CT) scanner equipped with a tin filter (Sn100, slice thickness: 1 mm, quality reference mAs: 24). The IQ for the tooth axis, the tooth length, the tooth root, root resorptions, cysts, the periodontal ligament space, and the mandibular canal was evaluated twice by 3 senior readers using a 5-point Likert scale (LS) (LS score of 1: insufficient, 3: reduced IQ but sufficient for clinical use, and 5: perfect) and compared between both methods. Subsequently, the results were dichotomized into nonvalid (LS score of ≤2) and valid (LS score of ≥3) for clinical use. A total of 49 ectopic and/or supernumerary teeth in 16 pediatric patients were investigated using ULD-CT (CTDI: 0.43 ± 0.09 mGy) and 0.55 T MRI. The mean MRI acquisition time was 9:45 minutes. Motion artifacts were nonsignificantly different between 0.55 T MRI and ULD-CT (P = 0.126). The IQ for the tooth axis, the tooth root, root resorptions, and cysts was similar between the methods. The IQ for the periodontal ligament space and tooth length favored ULD-CT by 14% (confidence interval [CI]: 4.3%-24%) and 7.5% (CI: 1.8%-13%), respectively, whereas that for the mandibular canal favored 0.55 T MRI by -35% (CI: -54%-16%). Sufficient IQ was found especially for cystic lesions (CT: 100% sufficient, MRI: 95% sufficient), the tooth root (CT: 100%, MRI: 98%), root resorptions (CT: 94%; MRI: 85%), the tooth axis (CT: 100%; MRI: 98%), and the tooth length (CT: 99%; MRI: 91%). The findings indicate that 0.55 T MRI is a feasible, radiation-free technique for delineating ectopic and/or supernumerary teeth in pediatric patients. Nevertheless, to date, 0.55 T MRI has not yet been able to provide an optimal IQ for all anatomical tooth and jaw structures. In cases of advanced clinical indications that require optimal spatial resolution, high-resolution CT or cone-beam CT may still be necessary.

Preoperative Planning of Craniectomy and Reconstruction using 3D Printed Cranioplasty for Treatment of Calvarial Lesion

There is a number of diseases which causes calvarial lesion. Fibrous dysplasia, intraosseous meningioma, osteoma is to name a few. Treatment of these lesions necessitates removal of part of the skull or craniectomy to decompress the brain and neural elements. The ensuing skull defect needs to be repaired to protect the brain. Previously used allograft and alloplastic materials have been replaced with newer PEEK material, which is more resistant, biocompatible and can be 3D printed. In this series we describe 4 cases in which skull lesions are removed and reconstructed in the same sitting using 3D printed PEEK implant designed preoperatively using high resolution CT data. The results are superior and complication rates are low. All the cases were done in different government hospitals. The technical process was developed indigenously, and the methods are the first in our country. Bang. J Neurosurgery 2024; 13(2): 64-69

Occult Pneumomediastinum - An Atypical Presentation of Chest Discomfort in a Patient with Depression

Pneumomediastinum (mediastinal emphysema) is an uncommon condition characterized by the accumulation of air or gas in the mediastinum. Here is a case of a 16-year-old female known to have depression who presented to the emergency department with complaints of shortness of breath, restlessness, chest discomfort, and hoarseness of voice for 2 days. She was initially diagnosed with panic attack, and later on clinical examination, surgical emphysema over the right supraclavicular area was noticed. Chest X-ray was found to be normal, and further imaging with high-resolution computed tomography (HRCT) of the thorax showed pneumomediastinum. In this report, the clinical presentations, radiological features, and management of pneumomediastinum will be discussed.

High resolution computed tomography in systemic sclerosis: From diagnosis to follow-up.

Early diagnosis of interstitial lung disease (ILD) and pulmonary hypertension (PH) is crucial in systemic sclerosis (SSc) for both management and treatment. However, diagnosing SSc-ILD can be challenging because symptoms of lung involvement are often non-specific at the early stages of disease. High-resolution computed tomography (HRCT) of the chest is recognized as the most accurate imaging modality for baseline and follow-up evaluation of SSc-ILD. Key features of SSc-ILD on HRCT include a non-specific interstitial pneumonia (NSIP) pattern, with peripheral ground-glass opacities and extensive traction bronchiectasis. Less common HRCT manifestations include usual interstitial pneumonia (UIP) pattern, followed by diffuse alveolar damage (DAD), diffuse alveolar hemorrhage (DAH) and organizing pneumonia (OP). The extent of disease on HRCT is known to relate with prognosis and serial assessments can be helpful in monitoring disease progression or treatment response. We discuss the main chest computed tomography (CT) manifestations of SSc, highlighting the role of imaging at both baseline and follow-up evaluations.

Systemic sclerosis-associated interstitial lung disease: How to manage in 2024?

Systemic sclerosis (SSc) or scleroderma is an autoimmune disease characterized by immune dysregulation which leads to progressive fibrosis of the skin and internal organs. Interstitial lung disease (ILD) is present in approximately 65% of patients with SSc and it accounts for approximately 40% of all SSc deaths. Risk factors associated with the development of systemic sclerosis related interstitial lung disease (SSc-ILD) include male sex, African heritage, high modified Rodnan skin score (mRSS), presence of anti-Scl-70/Topoisomerase I antibodies, and nucleolar pattern on antinuclear antibody (ANA). The primary tool to diagnose ILD in patients with SSc is high-resolution computed tomography (HRCT). Full pulmonary function tests (PFTs) with diffusing capacity of the lungs for carbon monoxide (DLco) and ambulatory desaturation testing should be obtained following the diagnosis of SSc-ILD for disease monitoring. The purpose of this review is to provide an updated guide for the management of SSc-ILD. Our proposed first line treatment for SSc-ILD is immunosuppressive therapy such as mycophenolate mofetil, tocilizumab, and rituximab which are discussed in depth, and we present the evidence-based data that has justified the use of these pharmacotherapies. Other immunosuppressive treatments are also reviewed, and we discuss the role of antifibrotic therapy. Finally, we dive into other avenues of treatments such as chimeric antigen receptor (CAR)-T cell therapy and hematopoietic stem cell transplant.

Providing Insight for Pediatric Ear Surgery: Analysis of Middle Ear Development via HRCT.

Providing insight for pediatric ear surgery via investigations on the development patterns of ossicles, mastoid, and external auditory canal (EAC). This retrospective study analyzed high-resolution computed tomography (HRCT) scans of 191 healthy temporal bones ranging from infants to adults. Subjects were grouped by 1-year intervals for developmental regression models and 3-year intervals for stage comparisons using t-tests or Mann-Whitney U tests. The size of auditory ossicles and tympanic cavity (TC) remained stable during development, while the minimum diameter of the tympanic sinus (TS) entrance was reduced. Regarding mastoid pneumatization, the air cells can be observed at birth, became pronounced at 2 years old, and were fully developed around the age of 5, with subsequent growth primarily involving radial expansion. Furthermore, the EAC demonstrated significant growth with age: the width of EAC increased linearly ( = 0.12x + 4.01, R2 = 0.85), while the length of EAC followed a polynomial growth pattern ( = -0.03x2 + 1.15x + 6.25, R2 = 0.96). Ossicles and TC remain stable during development. Furthermore, mastoid air cells may have developed in the early stages of life, while their diameter increases synchronously with EAC. All in all, ossicular chain reconstruction surgery and endoscopic ear surgery can be performed in babies. NA Laryngoscope, 2024.

Pulmonary Emphysema Disease Classification Model Using Deep Structured Techniques

Emphysema is normally employed in the sense of morphology, and thus, imaging the modalities has a significant part in detecting the disorder. Most importantly, the High-Resolution Computed Tomography (HRCT) is a trustworthy component for illustrating the emphysema pathology. Hence, the pulmonary emphysema diagnosis at the starting stage is very important and can secure the life of a human. When there is a failure in the technique, there is a possibility of the death that displays the importance of effective diagnosis. The endotracheal intubation’s delay is prevented by implementing distinct mechanisms that result in various requirements. The presented work develops a deep learning-aided pulmonary emphysema disease classification model that is implemented to defeat the above difficulties. At first, the images are accumulated from a standard dataset. Then, the collected images are provided to the phase of segmentation. Here, the newly developed Adaptive Trans-Residual Dense UNet (ATRDUNet) is employed to perform the segmentation process. Also, the recommended ATRDUNet model helps to locate the disease in the appropriate location. Moreover, the performance of the segmentation process is enriched to fine-tune the parameter using the Fitness Revised Position of Wild Horse Optimizer (FRP-WHO). While optimizing the parameters effectively, it tends to handle the complex issues to strengthen the model accurately. The segmented results from the ATRDUNet are passed to Vision Transformer-based Residual DenseNet with LSTM layer (ViTrans-RDLSTM) for getting the final classified outcome. To this end, the analysis of the suggested model is correlated to find the effectiveness of the recommended model. However, these results are examined with the help of standard performance measures. Also, the experimentation is carried out using the standard “Automatic emphysema detection using weakly labeled HRCT lung images” dataset to attain better outcomes in the developed model. The findings of the recommended approach show 95% in terms of accuracy. Also, the statistical analysis of the developed model shows 23.9%, 12.3%, 15.2%, and 13.0% better performance than BWO, CO, HBA, and WHO in terms of mean analysis to show enriched performance.

FAM13A polymorphism is associated with a usual interstitial pneumonia pattern in patients with systemic sclerosis-associated interstitial lung disease.

The MUC5B promoter single nucleotide polymorphism (SNP) rs35705950 has been associated with idiopathic pulmonary fibrosis (IPF) and rheumatoid arthritis (RA)-related interstitial lung disease (ILD), but not with systemic sclerosis (SSc)-ILD. We hypothesized that the MUC5B promoter polymorphism or other IPF susceptibility loci are associated with an increased risk for the uncommon SSc-usual interstitial pneumonia (UIP) endophenotype, rather than SSc-ILD in general. We performed a cross-sectional study of SSc-ILD patients from 4 US Scleroderma Programs to investigate the frequency of MUC5B rs35705950 and 12 additional IPF susceptibility loci. SSc-ILD patients were stratified by high resolution chest CT (HRCT) imaging findings into UIP and non-UIP groups. Analysis of HRCTs performed by a thoracic radiologist blinded to participants' characteristics classified each scan as definite UIP, probable UIP, indeterminate, or alternative diagnosis, according to American Thoracic Society criteria. Four-hundred eighty-nine SSc-ILD patients were included; 80% were female and 75% were White. Twenty-three (4.7%) patients had a definite UIP pattern. The MUC5B SNP rs35705950 was not associated with a definite UIP pattern in SSc-ILD. In contrast, patients carrying 2 copies of the IPF risk gene FAM13A minor allele rs2609255 had significantly higher odds of a definite UIP pattern compared with the other patterns (OR 3.40, 95% CI 1.19-9.70), and compared with an alternative diagnosis (OR 3.65, 95% CI 1.25-10.65). We demonstrated a novel association between FAM13A and SSc-UIP. Contrary to IPF and RA-ILD, the MUC5B promoter polymorphism was not associated with a definite UIP pattern in SSc-ILD.

MUC5B rs35705950 Promoter Variant Is Associated with Usual Interstitial Pneumonia in Patients with Antisynthetase Syndrome

Background: The presence of the rs35705950 variant in the MUC5B gene promoter is a critical genetic risk factor in idiopathic pulmonary fibrosis (IPF). It has been associated with usual interstitial pneumonia (UIP) in several interstitial lung diseases (ILDs). In antisynthetase syndrome (ASSD), most high-resolution computed tomography (HRCT) patterns are inflammatory, but up to 13% have UIP, leading to a worse prognosis. Methods: This single-center study included 60 patients with ASSD-ILD. We investigated whether carrying the MUC5B rs35705950 promoter variant was associated with UIP. To estimate the strength of the association between the genotype of the MUC5B rs35705950 promoter variant and the fibrotic pattern we used the odds ratio (cOR), and to assess the effect of confounding variables (age, evolution time, and sex), we performed a logistic regression to obtained the adjusted odds ratio (aOR). Results: The GT genotype of the MUC5B rs35705950 promoter variant is associated with up to a 4-fold increased risk of UIP (cOR 5.0, 95% CI 1.13–22.10), and the effect was even maintained after adjusting for potentially confounding variables such as sex, age, and time to progression (aOR 5.2, 95% CI 1.04–25.89). Conclusions: our study supports the role of MUC5B rs35705950 in ASSD-ILD with UIP. It reinforces that this polymorphism in our population could have a similar genetic basis to that already described in other ILDs that present predominantly fibrotic patterns.

Pulmonary fibrosis in pulmonary alveolar proteinosis evaluated by transbronchial lung cryobiopsy: A single-center retrospective study

BackgroundApproximately 20% of patients with pulmonary alveolar proteinosis (PAP) present with pulmonary fibrosis on high-resolution computed tomography (HRCT). Although transbronchial lung cryobiopsy (TBLC) has recently been used to diagnose fibrotic interstitial lung disease, no studies have investigated whether TBLC is useful for the histopathological detection of pulmonary fibrosis coexisting with PAP. Therefore, the present study aimed to investigate the utility of TBLC for evaluating pulmonary fibrosis in patients with PAP. MethodsWe retrospectively reviewed patients diagnosed with PAP who underwent TBLC at our hospital between May 2021 and March 2023. We collected data including patient background, HRCT findings, and histopathological findings of the TBLC samples. ResultsSeven patients met the inclusion criteria, with a median age was 69 years; 5 patients were male. Six patients were diagnosed with autoimmune PAP, and one was diagnosed with unclassified PAP. Periodic acid-Schiff staining-positive materials in the alveoli were observed in six out of seven patients. Pulmonary fibrosis, defined as fibrosis with architectural distortion, was found in two patients. Fibroblastic foci and airway-centered fibrosis were presented in two and one patient, respectively. As a result of a multidisciplinary discussion, we diagnosed one each with fibrotic HP coexisting with PAP and PAP-associated fibrosis. ConclusionTwo of the seven patients with PAP presented histopathologically with pulmonary fibrosis in samples obtained through TBLC. Thus, TBLC should be considered when the coexistence of pulmonary fibrosis is suspected.

Myositis-Associated Interstitial Lung Disease: The Experience of a Tertiary Center.

Background: Interstitial lung disease (ILD) is a common extra-muscular manifestation of idiopathic inflammatory myopathies (IIMs), often associated with a poorer prognosis and increased mortality risk. Methods: This retrospective study aimed to characterize lung involvement and treatment response in an IIM cohort at a Portuguese tertiary center, followed between June 2016 and March 2024. We analyzed data from high-resolution computed tomography (HRCT) scans and pulmonary function tests (PFTs) to assess associations with autoantibody profiles and treatment regimens. Results: A total of 198 patients were included, with 69 (34.8%) exhibiting ILD. Antisynthetase syndrome (ASyS) and dermatomyositis were the most common diagnoses among IIM-ILD patients, with ASyS being significantly more frequent in this group than in non-ILD patients (p < 0.001). Anti-Jo1 and anti-MDA-5 antibodies were more frequent in ILD patients (p < 0.001 and p = 0.021), while anti-Mi2 antibodies were less common (p = 0.002). Non-specific interstitial pneumonia (NSIP) was the most common radiological pattern (69.5%). IIM-ILD patients presented with significantly lower forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO) compared to non-ILD patients (p < 0.001 for all values). Longitudinal analysis showed improved DLCO (p = 0.022) and stable or improved FVC (p = 0.097), especially with intravenous immunoglobulin (IVIg) and azathioprine (AZA). Combination therapies including IVIg with mycophenolate mofetil (MMF) or rituximab (RTX) also improved DLCO and FVC. Most ILD patients (89.6%) had stable HRCT patterns over time. Conclusions: Our findings highlight the potential for stabilizing or even improving lung function in IIM-ILD with appropriate immunosuppressive therapy, particularly with regimens incorporating IVIg and AZA, and combination therapies.

Exploring the Potential Value of [68Ga]Ga-FAPI-46 PET/CT for Molecular Assessment of Fibroblast Activation in Interstitial Lung Disease: A Single-Center Pilot Study.

The aim of the study was to evaluate the association of high-resolution computed tomography (HRCT) findings with pulmonary fibrotic activity in the corresponding regions using [68Ga]Ga-fibroblast activation fibroblast inhibitor (FAPI) PET/CT in patients with interstitial lung disease (ILD). Additionally, the potential of [68Ga]Ga-FAPI-46 PET/CT for evaluating the active fibrosis process and 99mTc-MIBI scintigraphy for assessing the inflammatory process in ILD patients was also assessed. In this pilot study, 20 ILD patients underwent [68Ga]Ga-FAPI-46 PET/CT and 99mTc-MIBI SPECT/CT. Additionally, 10 patients without lung or thoracic involvement who were undergoing [68Ga]Ga-FAPI PET/CT for cancer detection were enrolled in the control group. The images were evaluated both visually and semiquantitatively and also compared with HRCT and pulmonary function tests. Multiple quantitative parameters were derived from the lung segments in the PET scan, including SUVmax, SUVmean, maximum target-to-liver ratio, mean target-to-liver ratio (TLRmean), and total lesion FAPI expression for the entire lung, as well as its lobes and zones. Additionally, the maximum Hounsfield unit (HU) and mean HU in HRCT were calculated for the whole lung as well as its lobes and zones. Furthermore, an HRCT fibrosis score (HFS) was defined according to the HRCT findings. Twenty ILD patients with a mean age of 58.70 (SD, 11.09) years were enrolled. Additionally, 10 control patients were enrolled with a mean age of 57.70 (SD, 15.19) years. Based on visual assessment, the FAPI scan was positive in 12 (60%) patients. Similarly, the MIBI scan was positive in 12 (60%) patients. In the 20 ILD cases, both scans were positive in 6 cases, and both were negative in 2 cases. Six cases showed FAPI-negative and MIBI-positive results, whereas another 6 cases showed FAPI-positive and MIBI-negative results. Comparing the control and ILD patients, there was a significant difference in SUVmax, SUVmean, total lesion FAPI expression, TLRmean, maximum HU, and mean HU (P < 0.05). When comparing HFS with PET-derived parameters in zones, a significant positive correlation was found between HFS and SUVmean, SUVmax, maximum target-to-liver ratio, and TLRmean (P < 0.05). Additionally, a significant difference was noted between FAPI results and HFS (P = 0.003). An ancillary finding, 9 of 20 (45%) ILD patients showed intense FAPI uptakes in gallbladder, whereas none of the 10 in the control group showed such uptake. The present study may suggest that combining [68Ga]Ga-FAPI PET/CT and 99mTc-MIBI SPECT/CT yields an additive effect for evaluating ILD-related fibrosis and inflammatory processes over using either modality alone. Furthermore, it appears that [68Ga]Ga-FAPI PET/CT has the potential to ascertain levels of fibrotic activity from population of resident fibroblasts, active fibroblasts, and scar maturation among ILD patients based on their HRCT patterns.

Biologic Correlates of Radiologic Features of Systemic Sclerosis Interstitial Lung Disease

Background and objectivesThe extent and pattern of radiological features (e.g., fibrosis, ground glass) can influence treatment approaches for systemic sclerosis-related interstitial lung disease (SSc-ILD). However, the pathobiology underlying these radiologic features is poorly understood and warrants further investigation.MethodsSixty-eight proteins were measured in bronchoalveolar lavage (BAL) fluid from 103 SSc-ILD participants in Scleroderma Lung Study I. Quantitative image analysis calculated the extent of fibrosis (QLF) and ground glass opacity (QGG) from concurrent high-resolution computerized tomography (HRCT) scans. The relationship between BAL proteins and quantitative HRCT scores was assessed by univariate and multivariate analyses.ResultsQLF scores correlated weakly with the extent of QGG, suggesting two distinct processes. In a univariate analysis, 25 proteins from several biologic pathways correlated with QLF scores, including pro-fibrotic factors, tissue remodeling proteins, proteins involved in monocyte/macrophage migration and activation, and proteins linked to inflammation and immune regulation. In contrast, QGG scores correlated with only 6 proteins of which four were unique and related to granulocyte activation, mobilization of bone marrow mesenchymal stem cells, and activation of T cells, B cells, macrophages and eosinophils. In the multivariate models, IL-4, CCL7, receptor activator of NF-κB, and tumor necrosis factor alpha were independently associated with QLF, whereas, IFN-γ was independently associated with QGG.InterpretationQLF and QGG represent distinct radiologic features of SSc-ILD, a conclusion reinforced by the presence of different biologic pathways present within BAL fluid that associate with each. The identified proteins and related biologic pathways may represent important therapeutic targets.

An exploratory study of the impact of CT slice thickness and inter-rater variability on anatomical accuracy of malunited distal radius models and surgical guides for corrective osteotomy.

High-resolution CT images are essential in clinical practice to accurately replicate patient anatomy for 3D virtual surgical planning and designing patient-specific surgical guides. These technologies are commonly used in corrective osteotomy of the distal radius. This study evaluated how the virtual radius models and the surgical guides' surface that is in contact with the bone vary between experienced raters. Further, the discrepancies from the reference radius of surgical guides and radius models created from CT images with slice thicknesses larger than the reference standard of 0.625mm were assessed. Maximum overlap with radius model was measured for guides, and absolute average distance error was measured for radius models. The agreement between the lower-resolution guides surface and the raters' guide surface was evaluated. The average inter-rater guide surface overlap was -0.11mm [95% CI: -0.13-0.09]. The surface of surgical guides designed on CT images with a 1mm slice thickness deviated from the reference radius within the inter-rater range (0.03mm). For slice thicknesses of 1.25mm and 1.5mm, the average guide surface overlap was 0.12mm and 0.15mm, respectively. The average inter-rater radius surface variability was 0.03mm [95% CI: 0.025-0.035]. The discrepancy from the reference of all radius models created from CT images with a slice thickness larger than the reference slice thickness was notably larger than the inter-rater variability but, excluding one case, did not exceed 0.2mm. The results suggest that 1mm CT images are suitable for surgical guide design. While 1.25mm slices are commonly used for virtual planning in hand and forearm surgery, slices larger than 1mm may approach the limit of clinical acceptability. Discrepancies in radius models were below 1mm, likely below clinical relevance.

Diagnosis of pulmonary sarcoidosis comorbid with non-specific interstitial pneumonia: a case report

BackgroundAlthough the imaging manifestations of pulmonary sarcoidosis have been described in detail in previous studies, a consensus has not been reached on the imaging presentation of non-specific interstitial pneumonia (NSIP) lookalike pattern as a distinct pattern in the diagnosis of pulmonary sarcoidosis in high-resolution computed tomography (HRCT). No cases of pulmonary sarcoidosis comorbid with NSIP have been reported.Case presentationA 53-year-old male presented to the hospital with a five-year history of recurrent coughing up sputum and a four-year history of shortness of breath. In addition to the typical features of pulmonary sarcoidosis, the patient’s HRCT also showed unexpected interstitial changes in the lower lobes of both lungs, suggesting an NSIP pattern. Histopathology of the lung tissue in this region confirmed well-formed noncaseating epithelioid granulomas and pathological modifications of NSIP. After a rigorous exclusion diagnosis combining the patient’s clinical features, radiological and pathological findings, we diagnosed this patient with pulmonary sarcoidosis comorbid with NSIP.ConclusionsThis suggests that NSIP may act as a rare comorbidity of pulmonary sarcoidosis thereby resulting in the patient’s HRCT presenting differently from routine sarcoidosis imaging.