BACKGROUND:The prognostic value of cardiac volumetry derived from non-contrast coronary calcium scoring CT (CSCT) remains uncertain. This study evaluated whether artificial intelligence (AI)-enabled cardiac volumetry from CSCT improves prediction of incident atrial fibrillation (AF) and all-cause mortality. METHODS:We analyzed 4402 adults (median age, 55.8 years; 68.6% men) who underwent CSCT at two centers between 2007 and 2014. A deep-learning model automatically quantified four cardiac chamber volumes, left ventricular (LV) mass, and CAC. AI-enabled volumetric measurements were validated against human expert-validated manual measurements using concordance correlation coefficients (CCC) and Spearman correlation. Associations with incident AF and all-cause mortality were evaluated using multivariable Cox regression, and incremental predictive value was assessed using Harrell's C-index, integrated discrimination improvement, and net reclassification improvement. RESULTS:AI-enabled cardiac volumetry showed excellent agreement with manual CSCT measurements (CCC range, 0.80-0.98). During a median follow-up of 14 years, AF occurred in 102 individuals (2.3%), and all-cause mortality occurred in 299 individuals (6.8%). Enlarged left atrial (LA) and right atrial (RA) volumes independently predicted incident AF (hazard ratios [HRs], 7.77 and 9.61; both p ​< ​0.001). Enlarged LA volume and increased LV mass were independently associated with all-cause mortality (HR, 1.61; p ​= ​0.012 and HR, 1.73; p ​= ​0.032, respectively). AI-enabled cardiac volumetry significantly improved discrimination for AF prediction (C-index, 0.74 to 0.83; p ​< ​0.001), whereas its incremental prognostic value for all-cause mortality beyond CAC and clinical variables was modest and not statistically significant. CONCLUSIONS:AI-enabled cardiac volumetry from CSCT significantly enhances prediction of incident AF, while its additional value for mortality prediction beyond CAC remains limited.

OBJECTIVE:To evaluate the impact of computed tomography (CT)-guided planning on surgical myectomy outcomes in patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) and/or midcavity obstruction by comparing these outcomes with those of conventional surgical myectomy. METHODS:This prospective cohort study included patients who underwent surgical septal myectomy for HCM with LVOT and/or mid-cavity obstruction between January 2019 and May 2024 at a single tertiary center. In the CT-planned myectomy group, an expert radiologist simulated the target myectomy site through a series of postprocessing methods to plan the surgical approach, provide a surgeon's view that closely resembles the actual perspective in the operating room, and determine the target myectomy volume. The conventional myectomy group underwent imaging studies, including echocardiography and cardiac CT; however, surgical planning was done using standard methods without CT-based postprocessing. Baseline clinical findings, surgery-related factors, and clinical outcomes were compared between the 2 groups. Multivariable logistic regression was used to evaluate the impact of preoperative CT planning on clinical outcomes. RESULTS:A total of 117 patients (median age, 62.2 years; interquartile range, 50.7-69.0 years; 62 women) were included, with 47 (40.2%) in the CT-planned myectomy group. The operation time was shorter in the CT-planned myectomy group compared to the conventional myectomy group (3.8 hours vs 4.3 hours; P = .01). The incidence of left bundle branch block (LBBB) was significantly lower in the CT-planned group (42.6% vs 67.1%; P = .01). No significant differences between the 2 groups were found in major adverse events, including cardiovascular death, complete atrioventricular block, and iatrogenic ventricular septal defects. Multivariable analysis showed that CT-planned myectomy was associated with lower odds of developing postoperative LBBB (odds ratio, 0.32; 95% confidence interval, 0.14-0.70; P = .005). CONCLUSIONS:CT-planned myectomy in patients with obstructive HCM was associated with shorter operation times and a reduced risk of postoperative LBBB compared with conventional myectomy, without an increase in major complications.

To demonstrate the optimized protocol for CT lymphangiography (CTL) and describe its performance in pediatric and adult patients with suspected thoracic duct injury. Patients with suspected thoracic duct injury who underwent either CTL or dynamic contrast-enhanced MR lymphangiography (DCMRL) between August 2017 and July 2024 at a tertiary referral center were retrospectively evaluated. CTL and DCMRL were performed using inguinal lymph node cannulation. Total scan time, the number of enhanced scans, technical success, results of lymphatic interventions, and clinical outcomes were recorded. Radiation dose was recorded for CTL. The acquisition results of CTL were described with reference to the results from a previously performed cohort of DCMRL. A total of 57 CTL (mean age, 48.3 ± 26.4 years; 13 pediatric patients) and 44 DCMRL (mean age, 60.2 ± 16.3 years; 2 pediatric patients) procedures were included. Technical success was achieved in 96.5

OBJECTIVE:This study aimed to evaluate changes in left ventricular and left atrial mechanics in relation to the severity of aortic stenosis (AS) by comparing computed tomography (CT)-derived strain values in patients with mild-to-severe AS. MATERIALS AND METHODS:This single-center retrospective study included 120 patients (median age, 76 years; 45.0% male), comprising 30, 30, and 60 patients with mild, moderate, and severe AS, respectively, all of whom underwent multiphase cardiac CT between 2015 and 2021. Patients were selected from 177 individuals who met the initial eligibility criteria, with matching for age, sex, and hypertension in a 1:1:2 ratio across the mild, moderate, and severe AS groups. Electrocardiography-gated cardiac CT images were analyzed to obtain various quantitative left ventricle (LV) and left atrium (LA) strain parameters. Statistical differences in cardiac CT-derived LV and LA strain parameters among mild, moderate, and severe AS were evaluated using the Kruskal-Wallis test, followed by post-hoc tests. RESULTS:The median LV global longitudinal strain differed significantly across AS severity (GLS: -19.4%, -18.2%, and -16.2% for mild, moderate, and severe AS, respectively; P < 0.001), with the absolute value decreasing as AS severity increased. Additionally, the median values of LV global circumferential strain (GCS: -29.8%, -30.8%, and -27.4%, respectively; P = 0.045), LV global radial strain (GRS: 50.1%, 50.3%, and 39.3%, respectively; P = 0.004), and LA conduit strain (11.5%, 11.2%, and 9.0%, respectively; P = 0.031) differed significantly according to AS severity, with lower absolute values observed in patients with severe AS. CONCLUSION:In patients with AS, CT-derived LV and LA strains revealed changes in myocardial deformation according to AS severity. Specifically, there was a gradual decrease in the absolute value of LV GLS with increasing AS severity and initial preservation until moderate AS, followed by an eventual decrease in the absolute values of LV GCS, LV GRS, and LA conduit strain in severe AS.

We aimed to compare artificial intelligence (AI)-based coronary stenosis evaluation of coronary computed tomography angiography (CCTA) with its quantitative counterpart of invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR). This single-center retrospective study included 195 symptomatic patients (mean age 61 10 years, 149 men, 585 coronary arteries) with 215 intermediate coronary lesions, with quantitative coronary angiography (QCA) diameter stenosis ranging from 20% to 80%. An AI-driven research prototype (AI-CCTA) was used to quantify stenosis on CCTA images. The diagnostic accuracy of AICCTA was assessed on a per-vessel basis using ICA stenosis grading (with >= 50% stenosis) or invasive FFR (<= 0.80) as reference standards. AI-driven diameter stenosis was correlated with the QCA results and expert manual measurements subsequently. The disease prevalence in the 585 coronary arteries, as determined by invasive angiography (>= 50%), was 46.5%. AI-CCTA exhibited sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC) of 71.7%, 89.8%, 85.9%, 78.5%, and 0.81, respectively. The diagnostic performance of AI-CCTA was moderate for the 215 intermediate lesions assessed using QCA and FFR, with an AUC of 0.63 for QCA and FFR. AI-CCTA demonstrated a moderate correlation with QCA (r = 0.42, p <0.001) for measuring the degree of stenosis, which was notably better than the results from manual quantification versus QCA (r = 0.26, p = 0.001). In conclusion, AI-driven CCTA analysis exhibited promising results. AI-CCTA demonstrated a moderate relation with QCA in intermediate coronary stenosis lesions; however, its results surpassed those of manual evaluations. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Objective: Segmenting the aorta into zones based on anatomical landmarks is a current trend to better understand interventions for aortic dissection or aneurysm. However, comprehensive reference values for aortic zones are lacking. The aim of this study was to establish reference values for aortic size using a fully automated deep learning based segmentation method. Methods: This retrospective study included 704 healthy adults (mean age 50.6 +/- 7.5 years; 407;57.8%] males) who underwent contrast enhanced chest computed tomography (CT) for health screening. A convolutional neural network (CNN) was trained and applied on 3D CT images for automatic segmentation of the aorta based on the Society for Vascular Surgery and Society of Thoracic Surgeons classification. The CNN generated masks were reviewed and corrected by expert cardiac radiologists. Results: Aortic size was significantly larger in males than in females across all zones (zones 0- 8, all p < .001). The aortic size in each zone increased with age, by approximately 1 mm per 10 years of age, e.g., 25.4, 26.7, 27.5, 28.8, and 29.8 mm at zone 2 in men in the age ranges of 30- 39, 40- 49, 50- 59, 60- 69, and >= 70 years, respectively (all p < .001). Conclusion: The deep learning algorithm provided reliable values for aortic size in each zone, with automatic masks comparable to manually corrected ones. Aortic size was larger in males and increased with age. These fi ndings have clinical implications for the detection of aortic aneurysms and other aortic diseases.

BACKGROUND:The analysis of cardiovascular borders (CVBs) in chest x-rays (CXRs) traditionally relied on subjective assessment and does not have established normal ranges. OBJECTIVES:The authors aimed to develop a deep learning-based method for quantifying CVBs on CXRs and to explore its clinical utility. METHODS:This study used a prevalidated deep learning to analyze CVBs. A total of 96,129 normal CXRs from 4 sites were used to establish age- and sex-specific normal ranges of CVBs. The quantified CVBs were standardized into z-scores for newly inputted CXRs. The clinical utility of the z-score analysis was tested using 44,567 diseased CXRs from 3 sites (9,964 valve disease; 32,900 coronary artery disease; 1,299 congenital heart disease; 294 aortic aneurysm; 110 mediastinal mass). RESULTS:For distinguishing valve disease from normal controls, the area under the receiver operating characteristic curve for the cardiothoracic ratio was 0.80 (95% CI: 0.80-0.80), while the combination of right atrium and left ventricle borders had an area under the receiver operating characteristic curve of 0.83 (95% CI: 0.83-0.83). Between mitral and aortic stenosis, z-scores of CVBs were significantly different in the left atrial appendage (1.54 vs 0.33, P < 0.001), carinal angle (1.10 vs 0.67, P < 0.001), and ascending aorta (0.63 vs 1.02, P < 0.001), reflecting disease pathophysiology. Cardiothoracic ratio was independently associated with a 5-year risk of death or myocardial infarction in the coronary artery disease (z-score ≥2, adjusted HR: 3.73 [95% CI: 2.09-6.64], reference z-score <-1). CONCLUSIONS:Deep learning-derived z-score analysis of CXR showed potential in classifying and stratifying the risk of cardiovascular abnormalities.

Lymphatic leakage, manifesting as chylothorax or chylous ascites, arises from traumatic or non- traumatic causes and poses severe risks such as malnutrition and increased infection susceptibility. Accurate diagnosis and an effective treatment strategy necessitate comprehensive lymphatic imaging. Conventional lymphangiography and dynamic contrast-enhanced MR lymphangiography (DCMRL) have been widely used and studied as effective lymphatic imaging methods. Recently, CT lymphangiography (CTL) has been successfully implemented in animal studies and some patients, and the authors' institution now prioritizes CTL over DCMRL. Contrast-enhanced CTL offers a promising alternative, with advantages such as better accessibility and faster imaging. These advantages of CTL over traditional methods highlight its superior accessibility and fast acquisition time. Moreover, to reduce and optimize radiation dose, the stepwise propagation scanning method in CTL could be used, which is especially beneficial in pediatric patients. In this review, the authors suggest the protocol for CTL and interpretation methods for evaluation and therapeutic planning of central lymphatic disorders, focusing on the condition of lymphatic leakage. (c) RSNA, 2024 center dot radiographics.rsna.org

The complex hemodynamic environment within the aortic lumen plays a crucial role in the progression of aortic diseases such as aneurysms and dissections. Traditional imaging modalities often fail to provide comprehensive flow dynamics that are essential for precise risk assessment and timely intervention. The advent of time-resolved, three-dimensional (3D) phase-contrast magnetic resonance imaging (4D flow MRI) has revolutionized the evaluation of aortic diseases by allowing a detailed visualizations of flow patterns and quantification of hemodynamic parameters. This review explores the utility of 4D flow MRI in the assessment of thoracic aortic diseases, highlighting the key hemodynamic parameters, including flow velocity, wall shear stress, oscillatory shear index, relative residence time, vortex, turbulent kinetic energy, flow displacement, pulse wave velocity, aortic distensibility, energy loss, and stasis. We elucidate the significant findings of studies utilizing 4D flow MRI in the context of aortic aneurysms and dissections, highlighting its role in enhancing our understanding of disease mechanisms and improving clinical outcomes. This review underscores the potential of 4D flow MRI to refine risk stratification and guide therapeutic decisions, ultimately contributing to better management of aortic diseases.

Research on cardiovascular diseases using CT-derived strain is gaining momentum, yet there is a paucity of information regarding reference standard values beyond echocardiography, particularly in cardiac chambers other than the left ventricle (LV). We aimed to compile CT-derived strain values from the four cardiac chambers in healthy adults and assess the impact of age and sex on myocardial strains. This study included 101 (mean age: 55.2 ± 9.0 years, 55.4% men) consecutive healthy individuals who underwent multiphase cardiac CT. CT-derived cardiac strains, including LV global and segmental longitudinal, circumferential, and transverse strains, left atrial (LA), right atrial (RA), and right ventricle (RV) strains were measured by the commercially available software. Strain values were classified and compared by their age and sex. The normal range of CT-derived LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were −20.2 ± 2.7%, −27.9 ± 4.1%, and 49.4 ± 12.1%, respectively. For LA, reservoir strain, pump strain, and conduit strain were 28.6 ± 8.5%, 13.2 ± 6.4%, and 15.5 ± 8.6%, respectively. The GLS of RA and RV were 27.9 ± 10.9% and −22.0 ± 5.7%, respectively. The absolute values of GLS of RA and RV of women were higher than that in men (32.4 ± 11.4 vs. 24.3 ± 9.1 and −25.2 ± 4.7 vs. −19.4 ± 5.0, respectively; p<0.001, both). Measurement of CT-derived strain in four cardiac chambers is feasible. The reference ranges of CT strains in four cardiac chambers can be used for future studies of various cardiac diseases using the cardiac strains.

Hypertrophic cardiomyopathy (HCM) is a genetic myocardial disease characterized by abnormal thickening of the myocardium caused by myocardial disarray and interstitial fibrosis. HCM is associated with sudden cardiac-related events, such as ventricular fibrillation, tachycardia, and syncope. Moreover, left ventricular or midcavity obstruction due to the thickened myocardium can result in severe heart failure and mortality in patients with HCM. Surgical myectomy is a standard treatment option for patients with symptomatic obstructive HCM; however, it is a complex procedure that requires careful planning and execution to avoid complications, such as residual flow obstruction, persistent obliteration of the left ventricular cavity in systole, or iatrogenic ventricular septal defects. Therefore, a thorough understanding of the mechanics of HCM and precise evaluation of the location and extent of the hypertrophic myocardium to be removed are crucial for preoperative planning. Multiphase cardiac CT postprocessing is important for preoperative evaluation and planning of surgical myectomy in patients with HCM. In this review, the authors highlight use of multiphase cardiac CT with step-by-step postprocessing methods to simulate successful surgical myectomy. The transaortic surgeon's view on end-diastolic phase images accurately represents the surgical field. Moreover, myocardial segmentation can be used to generate volume-rendered images and three-dimensional printing. CT evaluation can also assist in identifying concurrent abnormalities, such as mitral valve or papillary muscle abnormalities. In addition to CT, other imaging modalities for preoperative evaluation of HCM and postmyectomy evaluation methods are presented. ©RSNA, 2023 Test Your Knowledge questions in the supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.

In 2023, the Korean Core Data for Interoperability (KR-CDI), comprising 77 elements, was established as a compliance item for healthcare data exchange in Korea to promote patient-centered medical information exchange and reestablish national interoperability in healthcare standardization. Radiologic examinations are in the core classification of diagnostic imaging tests, and the examination name, results, and image data must be exchanged based on standard codes of terminology and transfer. Accordingly, the Korean Society of Radiology has formed a standardization committee that maps radiologic examination names to international standard codes, such as LOINC and SNOMED CT. Additionally, we propose a pilot project for the standardization and exchange of DICOM images and plan a project to map the terms of the Conclusion sections of diagnostic reports to standard codes. The Korean Society of Radiology is actively participating in these efforts.

BACKGROUND:We aimed to compare computed tomography (CT)-derived myocardial strain between patients with constrictive pericarditis (CP) and a matched healthy control group and to identify factors associated with clinical outcomes after pericardiectomy. METHODS:This retrospective study included 65 patients with CP (mean age: 58.9 ​± ​8.0 years) and 65 healthy individuals (mean age: 58.0 ​± ​6.5 years) who underwent multiphase cardiac CT. The type of CP was classified as calcified CP or fibrotic CP. CT-derived strains from four cardiac chambers were compared between the CP and control groups, as well as between different types of CP. Clinical and CT-derived factors associated with adverse outcomes were identified using Cox regression analysis. RESULTS:Compared with the control group, the CP group showed significantly lower values of left atrium (LA) reservoir strain (15.7 ​% vs. 27.4 ​%), right atrium (RA) reservoir strain (15.1 ​% vs. 27.0 ​%), left ventricle (LV) global longitudinal strain (GLS) (-17.0 ​% vs. -19.5 ​%), and right ventricle free wall longitudinal strain (-21.1 ​% vs. -25.9 ​%) (all p ​< ​0.001). Biatrial reservoir strains and LV GLS were significantly lower in those with calcified CP compared to those with fibrotic CP. LA reservoir strain (hazard ratio, 0.91-95 ​% confidence interval, 0.86-0.96- p ​= ​0.001) was an independent prognostic factor for adverse events in patients with CP. CONCLUSION:Cardiac strain differences in CP were predominantly observed in the LA and RA compared to the healthy control group. Biatrial reservoir strains were specifically impaired in those with calcified CP than in those with fibrotic CP. LA reservoir strain was associated with prognosis in patients with CP following pericardiectomy.

Objective: Residual aortic dissection (AD) following DeBakey type I AD repair is associated with a high rate of adverse events that need additional intervention or surgery. This study aimed to identify clinical and early post-operative computed tomography angiography (CTA) imaging factors associated with adverse events in patients with type I AD after ascending aorta replacement. Methods: This single centre, retrospective cohort study included consecutive patients with type I AD who underwent ascending aorta replacement from January 2011 to December 2017 and post-operative CTA within three months. The primary outcome was AD related adverse events, defined fi ned as AD related death and re- operation due to aortic aneurysm or impending rupture. The location and size of the primary intimal tears, aortic diameter, and false lumen status were evaluated. Regression analyses were performed to identify factors associated with AD related adverse events. A decision tree model was used to classify patients as high or low risk. Results: Of 103 participants (55.43 +/- 13.94 years; 49.5% male), 24 (23.3%) experienced AD related adverse events. In multivariable Cox regression analysis, connective tissue disease (hazard ratio [HR] 15.33; p < .001), maximum aortic diameter > 40 mm (HR 4.90; p < .001), and multiple (three or more) intimal tears (HR 7.12; p < .001) were associated with AD related adverse events. The three year cumulative survival free from AD related events was lower in the high risk group with aortic diameter > 40 mm and multiple intimal tears (41.7% vs. 90.9%; p < .001). Conclusion: Early post-operative CTA fi ndings indicating a maximum aortic diameter > 40 mm and multiple intimal tears may predict a higher risk of adverse events. These fi ndings suggest the need for careful monitoring and more vigilant management approaches in these cases.

Background This study aimed to investigate the hemodynamic and anatomic factors associated with sinus thrombosis following transcatheter aortic valve replacement (TAVR), integrating in vivo patient data analysis and in vitro experiments. Methods and Results Postprocedural, 4‐dimensional, multiphase computed tomography data from 211 patients enrolled in the ADAPT‐TAVR (Anticoagulation Versus Dual Antiplatelet Therapy for Prevention of Leaflet Thrombosis and Cerebral Embolization After Transcatheter Aortic Valve Replacement) study were analyzed. The prevalence of native sinus thrombosis was examined in relation to valve type, implant depth, and anatomic features. In vitro experiments used particle image velocimetry to observe changes in sinus flow based on the transcatheter heart valves (23‐mm SAPIEN3, Edwards Lifesciences; and 29‐mm CoreValve, Medtronic) height and coronary artery flow. Native sinus thrombosis was more common in self‐expanding valves (39.1% versus 14.9%, P =0.004). In per‐cusp analysis of in vivo patient data, adjusted transcatheter heart valve implant depth (odds ratio, 1.2 [95% CI, 1.1–1.3]; P <0.001), noncoronary sinus of Valsalva (odds ratio, 4.0 [95% CI, 2.0–7.8]; P <0.001), sinus inflow diameter (odds ratio, 0.8 [95% CI, 0.6–0.9]; P =0.008), and implanted valve size (odds ratio, 0.8 [95% CI, 0.7–1.0]; P =0.025) were significant factors associated with native sinus thrombosis. In the in vitro experiments, CoreValve showed noticeable flow stasis compared with SAPIEN3. High‐positioned SAPIEN3 was linked to reduced velocity within the native sinus of Valsalva. Coronary artery flow led to higher sinus velocity and improved particle washout, reducing sinus thrombosis risk. Conclusions This study provides insights into the relationship between transcatheter heart valve deployment and native sinus thrombosis, emphasizing the role of anatomic factors in relation to the risk of sinus thrombosis.

The present study was designed to identify the preoperative clinical and imaging findings influencing adverse clinical outcomes in patients with chronic constrictive pericarditis after pericardiectomy. Patients with constrictive pericarditis who underwent pericardiectomy between January 2009 and September 2023 were retrospectively analyzed. Preoperative evaluations included assessments of clinical symptoms, comorbidities, laboratory tests, cardiac computed tomography (CT), and transthoracic echocardiography. The volume of pericardial calcifications was quantified on calcium scoring CT. Adverse clinical events were defined as cardiovascular death or hospitalization due to cardiac causes, and all-cause mortality was assessed. Univariable and multivariable Cox proportional hazard model analysis were performed to find factors associated with adverse clinical events. Among the 91 patients with available preoperative CT scans, 26 (28.6%) experienced adverse clinical events after pericardiectomy, with 19 (20.9%) experiencing cardiovascular deaths. On multivariable Cox analysis, larger pericardial calcium volume hazard ratio [HR], 1.004 (95% confidence interval [CI], 1.001-1.006) per 1cm3 increase; p = 0.005), higher E/E' ratio (HR, 1.059, 95% CI, 1.015-1.105, p = 0.008), and lower albumin level (HR, 0.476, 95% CI, 0.229-0.986, p = 0.046) were significant factors associated with the adverse clinical events after pericardiectomy. The amount of pericardial calcification could be associated with the efficacy of pericardiectomy and potentially have implications for postoperative outcomes. Additionally, a high E/E ratio on echocardiography is indicative of unfavorable postoperative prognosis.

BACKGROUND:The pragmatic role of dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) needs to be evaluated and compared across distinct lymphatic disorders. We aimed to evaluate the performance of DCMRL for identifying the underlying causes of lymphatic disorders and to define the potential benefit of DCMRL for planning lymphatic interventions. METHODS:Patients who underwent DCMRL between August 2017 and July 2022 were included in this retrospective analysis. DCMRL was performed with intranodal injection of a gadolinium-based contrast medium through inguinal lymph nodes under local anesthesia. Technical success of DCMRL and feasibility of percutaneous embolization were assessed based on the lymphatic anatomy visualized by DCMRL. Based on the underlying causes, clinical outcomes were evaluated and compared. RESULTS:Seventy consecutive patients were included. The indications were traumatic chylothorax (n = 42), traumatic chylous ascites (n = 11), and nontraumatic lymphatic leak (n = 17). The technical success rate of DCMRL was the highest in association with nontraumatic lymphatic disorders (94.1% [16/17]), followed by traumatic chylothorax (92.9% [39/42]) and traumatic chylous ascites (81.8% [9/11]). Thirty-one (47.7%) patients among 65 patients who underwent technically successful DCMRL had feasible anatomy for intervention. Clinical success was achieved in 90.3% (28/31) of patients with feasible anatomy for radiologic intervention, while 62.5% (10/16) of patients with anatomical challenges showed improvement. Most patients with traumatic chylothorax showed improvement (92.9% [39/42]), whereas only 23.5% (4/17) of patients with nontraumatic lymphatic disorders showed clinical improvement. CONCLUSION:DCMRL can help identify the underlying causes of lymphatic disorders. The performance of DCMRL and clinical outcomes vary based on the underlying cause. The feasibility of lymphatic intervention can be determined using DCMRL, which can help in predicting clinical outcomes.

Introduction: Idiopathic pulmonary arterial hypertension (IPAH) is a severe condition characterized by a poor prognosis, rapid deterioration, and high mortality in the absence of lung transplantation. However, non-invasive prognostic markers in assessing IPAH remain uncertain. We aimed to investigate the prognostic significance of chest CT and alterations in heart contours on chest radiography (CXR) in predicting adverse outcomes in IPAH patients. Methods: A retrospective study analyzed medical records of IPAH patients who underwent right heart catheterization and chest CT at a tertiary center between 2001 and 2023. Clinical, hemodynamic, and CT findings, and changes (Delta) in heart contours on CXR were assessed. Adverse events were defined as IPAH-related death or lung transplantation. Cox regression models evaluated the predictive power of these parameters. Results: In 80 patients with IPAH (mean age 42.6 years; 75 % females), the 3- and 5-year survival rates were 65.8 % and 55.1 %, respectively. Adverse events were associated with a history of cardiac arrest (Hazard ratio [HR], 11.67, p = 0.02), mean pulmonary artery pressure (HR, 1.04, p = 0.001), creatinine (HR, 4.12, p < 0.001), 6-min walk distance (HR, 0.997, p = 0.03), CT-derived right atrial (RA) volume index (HR, 1.01, p = 0.02), and Delta RA contour on CXR (HR, 1.27, p < 0.001). Combined clinical, CT, and CXR findings showed a 3-year event-free survival predictive accuracy of 82.2 % (95 % CI, 69.8-94.7), outperforming clinical factors alone. Conclusion: Rapid increases in RA contour on CXR and CT-derived RA volume index were associated with adverse outcomes in IPAH. Assessing these parameters may be helpful in identifying patients who require proactive treatments.

Background: To demonstrate the magnetic resonance lymphangiography (MRL) imaging findings of lymphatic diseases and the clinical outcomes of lymphatic embolization in pediatric patients. Methods and Results: This retrospective study included 10 consecutive pediatric patients who underwent MRL for lymphatic diseases between June 2017 and June 2021. Nine patients underwent dynamic contrast-enhanced MRL with bilateral inguinal lymph node injection of diluted gadolinium, and one patient underwent nonenhanced MRL with a heavily T2-weighted image. The etiology of lymphatic disease was classified into three categories based on the magnetic resonance findings. The resolution of chylous fluid and weight-adjusted amounts of chylous fluid collected from a drainage tube were evaluated as outcomes. Patients were classified as postoperative lymphatic leak (n = 3), pulmonary lymphatic perfusion syndrome (n = 3), central lymphatic flow disorder (CLFD; n = 3), and primary lymphatic dysfunction (Gorham-Stout syndrome; n = 1). Three patients underwent radiological lymphatic intervention, and one CLFD patient underwent surgical intervention. In patients with postoperative lymphatic leak, the median chest tube drainage decreased significantly after the intervention [from 87.9 to 12.4 mL/(kg·d); p = 0.02]. However, in one CLFD patient, the amount of chylous fluid did not decrease until 7 days after intervention. Conclusion: The etiology of lymphatic disease in pediatrics can be recognized on MRL, and lymphatic intervention can be performed for cessation of lymphatic leak, even though the treatment outcomes may differ according to the underlying etiology. MRL can play an important role in classifying lymphatic disease, and in planning treatment on the basis of the lymphatic anatomy and underlying etiology.

BACKGROUND:A certain proportion of patients with severe aortic stenosis (AS) present with discordant grading between different diagnostic modalities, which raises uncertainty about the true severity of AS. The aim of this study was to compare the aortic valve area (AVA) measured on CT and echocardiography and demonstrate the factors affecting AVA discrepancies.METHODS:Between June 2011 and March 2016, 535 consecutive patients (66.83±8.80 years, 297 men) with AS who underwent pre-operative cardiac CT and echocardiography for aortic valve replacement were retrospectively included. AVA was obtained by AVA on echocardiography (AVAecho) and CT (AVACT) using a measurement of the left ventricular outflow tract on each modality and correlations between those measures were evaluated. Logistic regression analysis was performed to identify factors affecting the discordance for grading severe AS.RESULTS:The AVACT and AVAecho showed a high correlation (r: 0.79, P <0.001) but AVACT was larger than the AVAecho (difference 0.26 cm2, P <0.001). By using the cut-off values of AVACT (<1.2 cm2) and AVAecho (<1.0 cm2) for diagnosing severe AS, the BSA (odds ratio [OR]: 68.03, 95% confidence interval [CI]: 5.45-849.99; P = 0.001), AVAecho (OR: 1.19, 95%CI: 1.14-1.24; P <0.001), tricuspid valve morphology (OR: 2.83, 95%CI: 1.23-6.50; P = 0.01), and normalized annulus area (OR: 1.02; 95%CI:1.02-1.03; P <0.001) were significant factors associated with the discordance between the AVAecho and AVACT.CONCLUSION:Patients with larger BSA, AVAecho, and annulus, and tricuspid valve morphology were associated with the AVA discordance between the echocardiography and CT. Complementary use of CT with echocardiography for grading severe AS could be helpful in such conditions.