Routine Chest CT Research Articles

Visual coronary artery calcium assessment on routine chest CT can readily and cheaply identify liver transplant recipients with a low cardiac risk

Abstract Background Peri- and postoperative cardiac complications play an important role in survival of patients after liver transplantation (LT). However, the optimal approach for cardiac risk prediction in these patients has been debated on. LT recipients routinely receive non-gated computed tomography (CT) of the abdomen and chest to follow-up on their liver diseases. This study analyzed whether performance of coronary artery calcium (CAC) assessment on freely available scans can enhance cardiac risk stratification of LT recipients. Methods Consecutive LT recipients from 2008-2023 were included and analyzed retrospectively. CAC was scored visually on non-gated CT on a semi-quantitative ordinal scale and stratified in two groups according to CAC severity. Peri-operative (≤90 days) and post-operative all-cause mortality and cardiac events were analyzed. Furthermore, all-cause mortality and cardiac events were analyzed and compared between the groups with a Kaplan Meier curve and Cox proportional hazard regression. Results A total of 149 patients were included with a median age of 58 years. The median follow-up time was 5 years. The majority (74%) of patients had no or mild CAC. None of these patients died perioperatively due to cardiac causes, or experienced peri-operative cardiac events. The post-operative 10-year survival of LT recipients with no or mild calcifications was significantly better (p<0.01) than patients with severe CAC. The 10-year cardiac event-free survival was significantly better in patients with no or mild CAC (p<0.01) and the incidence increased >4-fold from only 4% in patients with no-mild CAC to 18% in patients with severe CAC. Of interest, severe CAC was a significant predictor of cardiac events (HR 4.6, p=0.02), while classical cardiovascular risk factors e.g. diabetes were not. Conclusion CAC assessment on routinely available non-gated CT can readily enhance peri- and postoperative cardiac risk stratification of LT recipients, as it identifies a selection of low-risk individuals for having peri- and post-operative cardiac events and all-cause mortality. Thereby, reducing test burden for the patients and saving healthcare expenses.

Indirect-Oscillation Sign Suggesting Infective Endocarditis on the Routine Chest CT.

Routine chest CT is not essential for the diagnostic workup for infective endocarditis (IE), but this type of study may be the initial imaging modality in the evaluation of patients ultimately proven to have IE who present to the emergency department with nonspecific clinical symptoms. Although routine chest CT cannot directly assess valvular oscillating motion due to the lack of cine images, we hypothesized that a combination of elongated nodular valve thickening and abnormal orientation to the normal valve with a blind end on routine CT (indirect-oscillation sign) might suggest movable vegetation indirectly. To evaluate this possibility, we studied 27 patients with IE and 35 controls who underwent both routine chest CT and echocardiography. CT scanning was initiated following a delay of 60-80 s after the administration of the contrast medium. Two cardiothoracic radiologists retrospectively analyzed the CT images to assess the indirect-oscillation sign with consensus. The sensitivity, specificity, positive predictive value, and negative predictive value of the indirect-oscillation sign on routine chest CT were 29.6% (8/27), 100% (35/35), 100% (8/8), and 64.8% (35/54), respectively. Although uncommon, the presence of the indirect-oscillation sign involving the aortic or mitral valve on routine chest CT is a suggestive finding for IE.

A case report on incidentally detected pulmonary sclerosing pneumocytoma: a diagnostic challenge

Introduction and importance: Pulmonary sclerosing pneumocytoma (PSP) is a rare non-cancerous lung tumor that is usually asymptomatic, but may cause respiratory distress if it becomes large. PSPs are often detected incidentally because of their slow growth, lack of symptoms, characteristic radiographic features, and increased use of imaging studies. Although it is not a malignant tumor, it can mimic malignancy on imaging and histology, leading to misdiagnosis and unnecessary surgery. Case presentation: A 23-year-old asymptomatic female was incidentally diagnosed with PSP during evaluation for a breast fibroadenoma. A chest CT revealed a 3 cm lobulated mass in the left upper lobe. Cytology showed malignant cells with necrotic debris. Immunohistochemistry was positive for TTF-1 and EMA, negative for p63 and AE1/AE3. Histopathology confirmed a well-circumscribed benign neoplasm, consistent with pulmonary sclerosing pneumocytoma. There was no mediastinal lymph node invasion, and the post-surgery prognosis was good. Clinical discussion: PSP is a slow-growing tumor that is often asymptomatic until it reaches a significant size. Owing to their well-circumscribed margins and the presence of calcifications, they are often detected incidentally during imaging studies, such as routine chest radiography or CT scans for unrelated conditions. Although these tumors are often incidental, it is important to diagnose and treat them appropriately to prevent potential complications and malignant transformation. Conclusion: The findings of this study contribute to the existing literature, increase awareness of this rare tumor, and provide insights into its diagnosis, treatment, and follow-up.

Single-Slice Hounsfield Unit (HU) Value of the Chinese Proximal Humerus on Routine Chest CT: A Study on Opportunistically Screening for Low Bone Density

Single-Slice Hounsfield Unit (HU) Value of the Chinese Proximal Humerus on Routine Chest CT: A Study on Opportunistically Screening for Low Bone Density

A cost-free approach to evaluating vertebral body bone density and height loss in lung transplant recipients using routine chest CT

BackgroundTo assess changes in bone density and vertebral body height of patients undergoing lung transplant surgery using computed tomography (CT). MethodsThis institutional review board (IRB) approved retrospective observational study enrolled patients with a history of lung transplant who had at least two chest CT scans. Vertebral body bone density (superior, middle, and inferior sections) and height (anterior, middle, and posterior sections) were measured at T1-T12 at baseline and follow up CT scans. Changes in the mean bone density, mean vertebral height, vertebral compression ratio (VBCR), percentage of anterior height compression (PAHC), and percentage of middle height compression (PMHC) were calculated and analyzed. ResultsA total of 93 participants with mean age of 58 ± 12.3 years were enrolled. The most common underlying disease that led to lung transplants was interstitial lung diseases (57 %). The inter-scan interval was 34.06 ± 24.8 months. There were significant changes (p-value < 0.05) in bone density at all levels from T3 to T12, with the greatest decline at the T10 level from 163.06 HU to 141.84 HU (p-value < 0.05). The average VBCR decreased from 96.91 to 96.15 (p-value < 0.05). ConclusionRoutine chest CT scans demonstrate a gradual decrease in vertebral body bone density over time in lung transplant recipients, along with evident anatomic changes such as vertebral body bone compression. This study shows that utilizing routine chest CT for lung transplant recipients can be regarded as a cost-free tool for assessing the vertebral body bone changes in these patients and potentially aiding in the prevention of complications related to osteoporosis.

Coronary calcifications as assessed on routine non-gated chest CT; a gatekeeper to tailor downstream additional imaging in patients with stable chest pain

Background and aimsCurrently applied methods for risk-assessment in coronary artery disease (CAD) often overestimate patients’ risk for obstructive CAD. To enhance risk estimation, assessment of coronary artery calcium (CAC) can be applied. In 10 % of patients presenting with stable chest pain a previous non-gated computed tomography (CT) has been performed, suitable for CAC-assessment. This study is the first to investigate the clinical utility of CAC-assessment on non-gated CT for risk-assessment of obstructive CAD in symptomatic patients. MethodsFor this analysis, all patients referred for coronary computed tomography angiography (CCTA), in whom a previous non-gated chest CT was performed were included. The extent of CAC was assessed on chest CT and ordinally scored. CAD was assessed on CCTA and obstructive CAD defined as stenosis of ≥70 %. Patients were stratified according to CAC-severity and percentages of patients with obstructive CAD were compared between the CAC groups. ResultsIn total, 170 patients of 32–88 years were included and 35 % were male. The percentage of obstructive CAD between the CAC groups differed significantly (p < 0.01). A calcium score of 0 ruled out obstructive CAD irrespective of sex, pre-test probability, type of complaints and number of risk factors with a 100 % certainty. Furthermore, a mild CAC score ruled out obstructive CAD in patients with low – intermediate PTP or non-anginal complaints with 100 % certainty. ConclusionWhen available, CAC on non-gated chest CT can accurately rule out obstructive CAD and can therefore function as a radiation-free and cost-free gatekeeper for additional imaging in patients presenting with stable chest pain.

Considerations for multidisciplinary management of synchronous primary breast cancer and primary lung cancer - Analysis of thirty-one patients.

The simultaneous (synchronous) presence of primary breast cancer and primary lung cancer diagnosed in a single individual is not an uncommon phenomenon. However, reference data for treatment strategy is scarce and "chaotic". In the present study we discuss the management strategy for this group of patients. We retrospectively reviewed patients in the primary breast cancer database of the Breast Center and the primary lung cancer database of the Thoracic Surgery Department I of Peking University Cancer Hospital. Patients with synchronous primary breast cancer and primary lung cancer who underwent surgery between December 2010 and December 2023 were included in the study. The sequence of outpatient visits, recommendations of multidisciplinary teams, perioperative treatment, and surgical procedures were reviewed. Meanwhile, survival analysis based on propensity score matching with 1:1 ratio was performed between the 31 patients and those with lung cancer only during the same period. A total of 31 patients with synchronous primary breast cancer and primary lung cancer were identified; all of the patients were women. The average age was 61 years. A total of 24 of the patients had visited the breast center first, and routine chest computed tomography (CT) showed evidence of primary lung cancer. The other seven patients had visited the thoracic surgery clinic first, and routine positron emission tomography (PET)-CT revealed the coexistence of primary breast cancer. All the patients had multidisciplinary team consultations, after which 20 patients were recommended to have preoperative treatment for breast cancer, two patients were recommended to have preoperative treatment for lung cancer, and nine patients were recommended to undergo surgery directly. After surgery, 23 patients received postoperative adjuvant treatment for breast cancer, and no patients needed postoperative adjuvant treatment for lung cancer. Survival analysis showed that there was no significant difference between the 31 patients and those with lung cancer only. Routine chest CT is needed for breast cancer patients before surgery, and PET-CT is required for the accurate staging of lung cancer patients. A multidisciplinary expert team should manage synchronous primary breast cancer and primary lung cancer. Emphasis should be placed on patients who need preoperative treatment before surgery. Particularly, for patients who need preoperative chemotherapy, a regimen should be chosen that balances the treatment of lung cancer and breast cancer.

Paediatric cancer risks associated with chest computed tomography (CT) scans: comparison of routine chest and COVID-19 diagnosis CT protocols

The aim of this study is to compare the radiation dose and cancer incidence risk associated with two chest Computed Tomography (CT) protocols: routine chest CT (RC-CT) and COVID-19 Diagnosis CT protocol (CD-CT). The study included 254 pediatric patients divided into three age groups: G1 (&lt;5), G2 (5–&lt;10), and G3 (10–15). The effective diameter, volumetric CT dose index (CTDIvol), dose length product (DLP), size specific dose estimate (SSDE), organ doses, and cancer incidence risk were calculated for the two protocols. Organ doses (mSv) and effective dose (mSv) were estimated using the National Cancer Institute dosimetry system for CT (NCICT) software. Estimation of cancer incidence risks were conducted according to the Biological Effects of Ionizing Radiation (BEIR) VII report. The oldest group (G3) in two protocols exhibited the greatest values for CTDIvol, DLP, effective dose and SSDE. The results showed that CD-CT protocol resulted in statistically significant (p &lt; 0.05) lower organ doses and cancer incidence risk. The cancer incidence risk for both protocols did not exceed the reference levels reported in literature surveys on pediatric CT chest radiation dose for all age groups. It can be concluded that the choice of CT protocol can significantly impact the radiation dose received by pediatric patients during CT imaging, highlighting the importance of carefully selecting the appropriate protocol to minimize radiation exposure.

Artificial Intelligence-Based Emphysema Quantification in Routine Chest Computed Tomography: Correlation With Spirometry and Visual Emphysema Grading.

The aim of the study is to assess the correlation between artificial intelligence (AI)-based low attenuation volume percentage (LAV%) with forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) and visual emphysema grades in routine chest computed tomography (CT). Furthermore, optimal LAV% cutoff values for predicting a FEV1/FVC < 70% or moderate to more extensive visual emphysema grades were calculated. In a retrospective study of 298 consecutive patients who underwent routine chest CT and spirometry examinations, LAV% was quantified using an AI-based software with a threshold < -950 HU. The FEV1/FVC was derived from spirometry, with FEV1/FVC < 70% indicating airway obstruction. The mean time interval of CT from spirometry was 3.87 ± 4.78 days. Severity of emphysema was visually graded by an experienced chest radiologist using an established 5-grade ordinal scale (Fleischner Society classification system). Spearman correlation coefficient between LAV% and FEV1/FVC was calculated. Receiver operating characteristic determined the optimal LAV% cutoff values for predicting a FEV1/FVC < 70% or a visual emphysema grade of moderate or higher (Fleischner grade 3-5). Significant correlation between LAV% and FEV1/FVC was found (ϱ = -0.477, P < 0.001). Increasing LAV% corresponded to higher visual emphysema grades. For patients with absent visual emphysema, mean LAV% was 2.98 ± 3.30, for patients with trace emphysema 3.22 ± 2.75, for patients with mild emphysema 3.90 ± 3.33, for patients with moderate emphysema 6.41 ± 3.46, for patients with confluent emphysema 9.02 ± 5.45, and for patients with destructive emphysema 16.90 ± 8.19. Optimal LAV% cutoff value for predicting a FEV1/FVC < 70 was 6.1 (area under the curve = 0.764, sensitivity = 0.773, specificity = 0.665), while for predicting a visual emphysema grade of moderate or higher, it was 4.7 (area under the curve = 0.802, sensitivity = 0.766, specificity = 0.742). Furthermore, correlation between visual emphysema grading and FEV1/FVC was found. In patients with FEV1/FVC < 70% a high proportion of subjects had emphysema grade 3 (moderate) or higher, whereas in patients with FEV1/FVC ≥ 70%, a larger proportion had emphysema grade 3 (moderate) or lower. The sensitivity for visual emphysema grading predicting a FEV1/FVC < 70% was 56.3% with an optimal cutoff point at a visual grade of 4 (confluent), demonstrating a lower sensitivity compared with LAV% (77.3%). A significant correlation between AI-based LAV% and FEV1/FVC as well as visual CT emphysema grades can be found in routine chest CT suggesting that AI-based LAV% measurement might be integrated as an add-on functional parameter in the evaluation of chest CT in the future.

Feasibility of using chest computed tomography (CT) imaging at the first lumbar vertebra (L1) level to assess skeletal muscle mass: a retrospective study

Background Skeletal muscle mass is an essential parameter for diagnosing sarcopenia. The gold standard for assessing skeletal muscle mass is using computed tomography (CT) to measure skeletal muscle area at the third lumbar vertebra (L3) level. This study aims to investigate whether skeletal muscle mass could be evaluated at the first lumbar vertebra (L1) level using images obtained from routine chest CT scans. Methods Skeletal muscle index (SMI, cm2/m2) and skeletal muscle density (SMD, HU) are commonly used to measure relative muscle mass and the degree of fat infiltration. This study used CT images at the L1 level to measure the skeletal muscle area (SMA, cm2) in 815 subjects from the health examination center. Linear regression analysis was used to explore the association between L1 and L3 measurements. The receiver operating characteristic (ROC) analysis was used to assess the predictive performance of L1 SMI for sarcopenia. The sex-specific cut-off values for low skeletal muscle mass in patients under the age of 60 were determined using the following formula: “mean − 1.28 × standard deviation.” A multivariate linear regression model was established. Results A significantly higher SMI at the L1 level was found in males than in females (43.88 ± 6.33 cm2/m2 vs 33.68 ± 5.03 cm2/m2; P &lt; 0.001). There were strong correlations between measures at the L1 and L3 levels in both the total subject and sex-specific analyses. A negative association was found between age and L3 SMI in males (r = −0.231, P = 0.038). Both body mass index (BMI) and body surface area (BSA) were positively associated with L1 SMI in both males and females. A multivariate analysis was used to establish a prediction rule to predict SMI at the L3 level. The assessment of consistency and interchangeability between predicted and actual SMI at the L3 level yielded moderately good results. Considering the significant differences observed between male and female participants, the sex-specific cut-off values of the L1 SMI for defining low skeletal muscle mass were 36.52 cm2/m2 in males and 27.29 cm2/m2 in females. Conclusions Based on a population from central China, the correlated indicators obtained at the L1 level from routine chest CT scans may serve as effective surrogate markers for those at the L3 level in assessing overall skeletal muscle mass.

COVID-19 Vaccination Effectively Reduces Pneumonia Severity as Assessed by Routine Chest Computed Tomography

Background: In China, the COVID-19 outbreak infected more than 80% of the population. Few trials have been conducted to assess the effectiveness of the China-manufactured vaccine against COVID-19. Purpose: The purpose of this study was to evaluate the severity of pneumonia in individuals with COVID-19 who were fully vaccinated, partially vaccinated, and unvaccinated, using routine chest computed tomography. Materials and Methods: We analyzed data from patients (aged &gt;18 years) who were hospitalized due to COVID-19 pneumonia between December 2022 and January 2023. Patients who underwent routine chest CT scans were divided into three groups based on their vaccination status. The lobar involvement grading system (0-25) was used to assess the extent of lung injury. The primary outcome was either survival or death. The Pearson chi-square test, Fisher's exact test, and one-way ANOVA were used to compare clinical and imaging features. The receiver operating characteristic (ROC) curve analysis was used to calculate the area under the curve (AUC), sensitivity, and specificity of the CT severity score (CT-SS) in relation to the outcome. Results: Of the 94 patients with COVID-19 pneumonia, 39 patients (41%) were fully vaccinated, 14 (15%) were partially vaccinated, and 41 (44%) were unvaccinated. Among patients with COVID-19 pneumonia, the mean CT severity scores (CT-SS) were 5.9 ± 4.0, 6.5 ± 4.9, and 8.9 ± 4.5 for fully vaccinated individuals, partially vaccinated individuals, and unvaccinated individuals, respectively. The difference was statistically significant (p&lt;0.05). CT-SS of 10.5 or higher was associated with severe pneumonia (100% sensitivity, 81.1% specificity, and an area under the curve of 0.92). Conclusion: COVID-19 vaccination leads to less severe pneumonia based on CT. Fully and partially vaccinated patients with COVID-19 pneumonia have less lung involvement compared to unvaccinated patients. Visual observation by CT imaging provides additional evidence to support the clinical effectiveness of vaccination.

Coronary artery calcium assessment on routine non-gated chest CT as a gatekeeper for additional imaging in patients with stable chest pain

Abstract Aims In Coronary Artery Disease (CAD), currently applied risk assessment methods often overestimate patients’ risk of obstructive CAD. To enhance and patient-tailor risk estimation, assessment of Coronary Artery Calcium (CAC) can be applied. In ∼10% of patients presenting with stable chest pain a non-gated chest computed tomography (CT) has been previously performed, suitable for CAC assessment. This study is the first to investigate the clinical value of CAC assessment on non-gated chest CT for risk assessment of obstructive CAD. Purpose This study aims to point out the clinical utility of visual CAC assessment for enhancing risk assessment and avoid unnecessary additional imaging in patients presenting with stable chest pain. Methods For this study, all patients referred for coronary CT angiography (CCTA), in whom a prior non-gated chest CT was performed, were included. To assess the extent of patients’ CAC, an ordinal score was applied. CAD was assessed on CCTA and obstructive CAD was defined as stenosis of ≥70%. Patients were stratified in to groups according to CAC severity, pre-test probability and number of risk factors. Percentages of patients with obstructive CAD were compared between the groups. Results A total of 181 patients of 30-88 years old were included. The percentage of obstructive CAD was significantly different between de CAC groups (p&amp;lt;0.01). The absence of CAC ruled out obstructive CAD with 100% certainty, irrespective of sex, pre-test probability, type of complaint and number of risk factors. Additionally, a mild CAC score ruled out obstructive CAD in patients with low – intermediate PTP or non-anginal complaints, with 100% certainty. Conclusion CAC assessment on non-gated chest CT can safely rule out obstructive CAD in patients presenting with stable chest pain and can therefore function as a radiation-free and cost-free gatekeeper for additional imaging.CCTA results for CAC severityDecisiontree patients with chest pain

Added value of an artificial intelligence algorithm in reducing the number of missed incidental acute pulmonary embolism in routine portal venous phase chest CT.

The purpose of this study was to evaluate the incremental value of artificial intelligence (AI) compared to the diagnostic accuracy of radiologists alone in detecting incidental acute pulmonary embolism (PE) on routine portal venous contrast-enhanced chest computed tomography (CT). CTs of 3089 consecutive patients referred to the radiology department for a routine contrast-enhanced chest CT between 27-5-2020 and 31-12-2020, were retrospectively analysed by a CE-certified and FDA-approved AI algorithm. The diagnostic performance of the AI was compared to the initial report. To determine the reference standard, discordant findings were independently evaluated by two readers. In case of disagreement, another experienced cardiothoracic radiologist with knowledge of the initial report and the AI output adjudicated. The prevalence of acute incidental PE in the reference standard was 2.2% (67 of 3089 patients). In 25 cases, AI detected initially unreported PE. This included three cases concerning central/lobar PE. Sensitivity of the AI algorithm was significantly higher than the outcome of the initial report (respectively 95.5% vs. 62.7%, p < 0.001), whereas specificity was very high for both (respectively 99.6% vs 99.9%, p = 0.012). The AI algorithm only showed a slightly higher amount of false-positive findings (11 vs. 2), resulting in a significantly lower PPV (85.3% vs. 95.5%, p = 0.047). The AI algorithm showed high diagnostic accuracy in diagnosing incidental PE, detecting an additional 25 cases of initially unreported PE, accounting for 37.3% of all positive cases. Radiologist support from AI algorithms in daily practice can prevent missed incidental acute PE on routine chest CT, without a high burden of false-positive cases. • Incidental pulmonary embolism is often missed by radiologists in non-diagnostic scans with suboptimal contrast opacification within the pulmonary trunk. • An artificial intelligence algorithm showed higher sensitivity detecting incidental pulmonary embolism on routine portal venous chest CT compared to the initial report. • Implementation of artificial intelligence support in routine daily practice will reduce the number of missed incidental pulmonary embolism.

Opportunistic screening at chest computed tomography: literature review of cardiovascular significance of incidental findings.

Several incidental cardiovascular findings are present in a routine chest computed tomography (CT) scan, many of which do not make it to the final radiology report. However, these findings have important clinical implications, particularly providing prognosis and risk-stratification for future cardiovascular events. The purpose of this article is to review the literature on these incidental cardiovascular findings in a routine chest CT and inform the radiologist on their clinical relevance. A time unlimited review of PubMed and Web of Science was performed by using relevant keywords. Articles in English that involved adults were included. Coronary artery calcification (CAC) is the most common incidental cardiac finding detected in a routine chest CT and is a significant predictor of cardiovascular events. Noncoronary vascular calcifications in chest CT include aortic valve, mitral annulus, and thoracic aortic calcifications (TAC). Among these, aortic valve calcification (AVC) has the strongest association with coronary artery disease and cardiovascular events. Additional cardiac findings such as myocardial scar and left ventricular size and noncardiac findings such as thoracic fat, bone density, hepatic steatosis, and breast artery calcifications can also help in risk stratification and patient management. The radiologist interpreting a routine chest CT should be cognizant of the incidental cardiovascular findings, which helps in the diagnosis and risk-stratification of cardiovascular disease. This will guide appropriate referral and management.

The axial and sagittal CT values of the 7th thoracic vertebrae in screening for osteoporosis and osteopenia

To evaluate the difference in computed tomography (CT) attenuation value of different planes of the 7th thoracic vertebra and investigate the efficacy of axial and sagittal vertebral CT measurements in predicting osteoporosis. Patients who underwent routine chest CT and dual-energy X-ray absorptiometry (DXA) within 1 month were included in this retrospective study. The CT attenuation values of different planes were compared. Logistic regression and receiver operating characteristic (ROC) were used to analyse the difference of each plane in the diagnosis of osteoporosis. The study included 1,338 patients (mean age of 61.9±11.9; 54% female). The CT attenuation values decreased successively in the normal group, osteopenia group, and osteoporosis group. The paired t-test results showed that the mid-axial measurements were greater than mid-sagittal measurements, with a mean difference of 9 HU, the difference was statistically significant (p<0.001, 95% confidence interval [CI]=7.8-10.1). For each one-unit reduction in mid-sagittal CT attenuation value, the risk of osteopenia or osteoporosis increased by 3.6%. To distinguish osteoporosis from non-osteoporosis (osteopenia+normal), the sensitivity was 90% and the specificity was 52.4% at the mid-sagittal threshold of 113.7 HU. The CT attenuation values of mid-sagittal plane have higher diagnostic efficacy than axial planes in predicting osteoporosis. For patients with a sagittal CT attenuation value of <113.7 HU in the T7, further DXA examination is warranted.

Assessing the role of an artificial intelligence assessment tool for thoracic aorta diameter on routine chest CT.

To assess the diagnostic accuracy and clinical impact of automated artificial intelligence (AI) measurement of thoracic aorta diameter on routine chest CT. A single-centre retrospective study involving three cohorts. 210 consecutive ECG-gated CT aorta scans (mean age 75 ± 13) underwent automated analysis (AI-Rad Companion Chest CT, Siemens) and were compared to a reference standard of specialist cardiothoracic radiologists for accuracy measuring aortic diameter. A repeated measures analysis tested reporting consistency in a second cohort (29 patients, mean age 61 ± 17) of immediate sequential pre-contrast and contrast CT aorta acquisitions. Potential clinical impact was assessed in a third cohort of 197 routine CT chests (mean age 66 ± 15) to document potential clinical impact. AI analysis produced a full report in 387/436 (89%) and a partial report in 421/436 (97%). Manual vs AI agreement was good to excellent (ICC 0.76-0.92). Repeated measures analysis of expert and AI reports for the ascending aorta were moderate to good (ICC 0.57-0.88). AI diagnostic performance crossed the threshold for maximally accepted limits of agreement (>5 mm) at the aortic root on ECG-gated CTs. AI newly identified aortic dilatation in 27% of patients on routine thoracic imaging with a specificity of 99% and sensitivity of 77%. AI has good agreement with expert readers at the mid-ascending aorta and has high specificity, but low sensitivity, at detecting dilated aortas on non-dedicated chest CTs. An AI tool may improve the detection of previously unknown thoracic aorta dilatation on chest CTs vs current routine reporting.

Rare cavitary lymphoepithelioma-like carcinoma of lung: clinical experience and literature review

BackgroundLymphoepithelioma-like carcinoma of the lung is a rare primary malignancy of the lung, accounting for only 0.9% of primary malignancies of the lung. Those associated with cavities are even rarer, with fewer than five cases reported in the English literature. Concurrently, the imaging findings of tumors are usually non-specific, resulting in insufficient understanding of the disease by clinicians, thus leading to misdiagnosis and delayed treatment.Case presentationA 42-year-old female presented with a right lower lung mass with cavities. First identified on chest computed tomography (CT) in 2021, the mass persisted for 1 year and subsequently enlarged on chemotherapy and routine follow-up CT. Right lower lobectomy was then performed. Postoperative pathology confirmed primary pulmonary lymphoepithelioma-like carcinoma. After 10 months of follow-up, the patient was still alive and no recurrence was observed.ConclusionsThis article aims to describe a rare case of cavitary lymphoepithelioma-like carcinoma of the lung and review it clinical and imaging characteristics reported in previous cases, which will be helpful for clinicians and imaging physicians in diagnosing this disease.

Coronary Artery Calcium Assessment On Routine Non-gated Chest Ct As A Gatekeeper For Additional Imaging In Patients With Stable Chest Pain

Coronary Artery Calcium Assessment On Routine Non-gated Chest Ct As A Gatekeeper For Additional Imaging In Patients With Stable Chest Pain

Delayed iatrogenic diaphragmatic hernia after thoracoscopic resection of diaphragm lipoma

BackgroundIatrogenic diaphragmatic hernias have been reported as a rare complication of thoracic and abdominal surgery. We herein report a case of delayed iatrogenic left diaphragmatic hernia after diaphragm pedunculated lipoma resection with minimally invasive surgery.Case presentationA 72-year-old Japanese man was found to have an abnormal shadow by medical checkup X-ray and was admitted to our hospital. Chest computed tomography (CT) showed a 5 × 2-cm solid tumor at the left diaphragm. He was diagnosed with a left diaphragm tumor. We performed three-port video-assisted thoracic surgery. This tumor was pedunculated at the left central tendon of the diaphragm. We therefore dissected this tumor using an electric scalpel. Although there was about 5 × 4 mm in diameter slight heat damage to the diaphragm, it was not reinforced because it was very minor injury. He was diagnosed with a left diaphragmatic hernia without any symptoms by routine CT examination which scheduled 1 year after surgery. One day after hospitalization, on the morning of the operation, he suddenly complained of left back pain with acute exacerbation of the left diaphragmatic hernia. We therefore immediately performed emergency surgery and rescued this patient. No adverse events or complications were seen, and he was discharged on postoperative day 11. Three months after this surgery, this patient is doing very well.ConclusionsCaution should be exercised when using energy devices on the diaphragmatic surface, especially the left side, to avoid causing delayed diaphragmatic hernia. In cases of surgery involving the left-side diaphragm, it seems that careful follow-up after surgery is necessary.

Chest CT Findings after Mild COVID-19 Do Not Explain Persisting Respiratory Symptoms: An Explanatory Study.

(1) Background: Lung tissue involvement is frequently observed in acute COVID-19. However, it is unclear whether CT findings at follow-up are associated with persisting respiratory symptoms after initial mild or moderate infection. (2) Methods: Chest CTs of patients with persisting respiratory symptoms referred to the post-COVID-19 outpatient clinic were reassessed for parenchymal changes, and their potential association was evaluated. (3) Results: A total of 53 patients (31 female) with a mean (SD) age of 46 (13) years were included, of whom 89% had mild COVID-19. Median (quartiles) time from infection to CT was 139 (86, 189) days. Respiratory symptoms were dyspnea (79%), cough (42%), and thoracic pain (64%). Furthermore, 30 of 53 CTs showed very discrete and two CTs showed medium parenchymal abnormalities. No severe findings were observed. Mosaic attenuation (40%), ground glass opacity (2%), and fibrotic-like changes (25%) were recorded. No evidence for an association between persisting respiratory symptoms and chest CT findings was found. (4) Conclusions: More than half of the patients with initially mild or moderate infection showed findings on chest CT at follow-up. Respiratory symptoms, however, were not related to any chest CT finding. We, therefore, do not suggest routine chest CT follow-up in this patient group if no other indications are given.