Clinical and imaging aspects of pulmonary embolism: a primer for radiologists.

Although many advancements have been made in imaging modalities that can be used to diagnose pulmonary embolism (PE), computed tomography pulmonary angiography (CTPA) is still the preferred gold standard for promptly diagnosing pulmonary embolism by looking for filling defects caused by the embolus lodged within the main pulmonary artery or its respective branches. The diagnosis is made by the radiologists in emergency settings where quick detection of a PE on CTPA helps the Pulmonary Embolism Response Team (PERT) in quick management. Thus, utmost care is needed to follow standard image acquisition protocols and optimal contrast administration techniques to achieve a contrast opacification of at least 210 Hounsfield units for the radiologists to easily pinpoint an embolus within the pulmonary arteries.

Clinical Implementation of an Artificial Intelligence Tool in the Detection and Management of Pneumothoraces in Patients With COVID-19.

In this report, we present a series involving critically ill patients with known coronavirus disease (COVID-19) infection where a portable X-ray machine equipped with artificial intelligence (AI) software aided in the urgent radiographic diagnosis of pneumothorax. These cases demonstrate how real-world clinical employment of AI tools capable of analyzing and prioritizing studies in the radiologist's worklist can potentially lead to earlier detection of emergent findings like pneumothorax. The use of AI tools in this manner has the potential to both improve radiology workflow and add significant clinical value in managing critically ill patient populations, such as those with severe COVID-19 infection.

"Digital Tomosynthesis" As a Technique for the Evaluation of Endobronchial Stents in Lung Transplant Recipients.

Lung transplant patients often suffer from posttransplant airway pathologies that require placement of endobronchial stents. In addition to surveillance bronchoscopy, patients often undergo radiographic stent evaluations. Chest x-rays are extremely limited in their ability to diagnose stent complications, so many patients require chest computed tomography (CT) scans for stent evaluation.

Coronary Artery Calcium Scoring: Current Status and Future Directions.

Coronary artery calcium (CAC) scores obtained from CT scans have been shown to be prognostic in assessment of the risk for development of cardiovascular diseases, facilitating the prediction of outcome in asymptomatic individuals. Currently, several methods to calculate the CAC score exist, and each has its own set of advantages and disadvantages. Agatston CAC scoring is the most extensively used method.

Seamless Integration of Artificial Intelligence Into the Clinical Environment: Our Experience With a Novel Pneumothorax Detection Artificial Intelligence Algorithm.

Although interest in artificial intelligence (AI) has exploded in recent years and led to the development of numerous commercial and noncommercial algorithms, the process of implementing such tools into day-to-day clinical practice is rarely described in the burgeoning AI literature. In this report, we describe our experience with the successful integration of an AI-enabled mobile x-ray scanner with an FDA-approved algorithm for detecting pneumothoraces into an end-to-end solution capable of extracting, delivering, and prioritizing positive studies within our thoracic radiology clinical workflow. We also detail several sample cases from our AI algorithm and associated PACS workflow in action to highlight key insights from our experience.

Distinguishing granulomas from adenocarcinomas by integrating stable and discriminating radiomic features on non-contrast computed tomography scans.

Objective: To identify stable and discriminating radiomic features on non-contrast CT scans to develop more generalisable radiomic classifiers for distinguishing granulomas from adenocarcinomas.

Methods: In total, 412 patients with adenocarcinomas and granulomas from three institutions were retrospectively included. Segmentations of the lung nodules were performed manually by an expert radiologist in a 2D axial view.

Abdominal vessel depiction on virtual triphasic spectral detector CT: initial clinical experience.

Purpose: To evaluate vessel assessment in virtual monoenergetic images (VMI) and virtual-non-contrast images (VNC) derived from venous phase spectral detector computed tomography (SDCT) acquisitions in comparison to arterial phase and true non-contrast (TNC) images.

Methods: Triphasic abdominal SDCT was performed in 25 patients including TNC, arterial and venous phase. VMI and VNC were reconstructed from the venous phase and compared to conventional arterial-phase images (CI), TNC and conventional venous-phase images (CI).

Dual energy imaging in cardiothoracic pathologies: A primer for radiologists and clinicians.

Recent advances in dual-energy imaging techniques, dual-energy subtraction radiography (DESR) and dual-energy CT (DECT), offer new and useful additional information to conventional imaging, thus improving assessment of cardiothoracic abnormalities. DESR facilitates detection and characterization of pulmonary nodules. Other advantages of DESR include better depiction of pleural, lung parenchymal, airway and chest wall abnormalities, detection of foreign bodies and indwelling devices, improved visualization of cardiac and coronary artery calcifications helping in risk stratification of coronary artery disease, and diagnosing conditions like constrictive pericarditis and valvular stenosis.

Application of dual energy CT in the diagnosis of amiodarone lung toxicity as a cause of lung mass.

Background: Diagnosis of amiodarone lung toxicity on computerized tomography (CT) can be challenging especially in the presence of mass-like consolidation. Additional causes of mass-like consolidation including malignancy and pneumonia should be excluded, sometimes requiring tissue sampling.

Case: Here we present a case of amiodarone lung toxicity, with diagnosis suspected based on patient's history of chronic cardiac disease, amiodarone treatment, and imaging characteristics.

Detection of coronary calcifications with dual energy chest X-rays: clinical evaluation.

Our goal is to assess the ability of physicians to detect coronary calcifications in dual energy chest X-rays processed by a previously developed advanced algorithm. Because the chest X-ray is the most common imaging procedure, because the presence of coronary calcium provides proof of coronary artery disease, and because adherence to therapy can improve health, successful detection could positively impact healthcare for a large number of patients. Both dual energy chest and corroborative CT calcium score images were acquired.

CT Coronary Angiography Fractional Flow Reserve: New Advances in the Diagnosis and Treatment of Coronary Artery Disease.

Coronary artery disease (CAD) remains the most common cardiovascular disease, accounting for 6% of all Emergency Department visits and 27% of all Emergency Department hospitalizations. Invasive coronary angiography with fractional flow reserve (FFR) remains the gold standard to assess for hemodynamically stenosis in CAD patients. However, for low- and intermediate-risk patients, noninvasive modalities have started to gain favor as patients with stable CAD who received optimal medical therapy did as well as patients who underwent percutaneous coronary intervention.

Multimodality imaging of IgG4 related coronary artery aneurysm.

Involvement of the coronary arteries by immunoglobulin G4-related disease is rare. It can cause coronary artery aneurysm and arterial wall thickening. Imaging plays a key role in the assessment of the coronary arteries and multimodality approach imaging is helpful to make the diagnosis and provide functional and prognostic information.

Multimodality approach to the diagnosis and management of constrictive pericarditis.

Despite advances in cardiovascular imaging, the diagnosis of constrictive pericarditis remains challenging. A multimodality approach to the diagnosis of CP is essential to (a) fully assess the extent of pericardial thickening and calcification, (b) detect the functional and hemodynamic consequences of the constricting pericardium, and (c) implement the optimal management strategy in these often complex cases. This case-based review highlights the role and diagnostic ambiguities of multimodality imaging.

Stable and discriminating radiomic predictor of recurrence in early stage non-small cell lung cancer: Multi-site study.

Objectives: To evaluate whether combining stability and discriminability criteria in building radiomic classifiers will improve the prognosis of cancer recurrence in early stage non-small cell lung cancer on non-contrast computer tomography (CT).

Materials And Methods: CT scans of 610 patients with early stage (IA, IB, IIA) NSCLC from four independent cohorts were evaluated. A total of 350 patients from Cleveland Clinic Foundation and University of Pennsylvania were divided into two equal sets for training (D) and validation set (D).

Multimodality imaging of tumefactive lipomatous hypertrophy of the right ventricle extending to the right ventricular outflow tract.

Lipomatous hypertrophy of the right ventricle is a rare entity that is usually asymptomatic and diagnosed incidentally in an otherwise healthy individual. Accurate diagnosis and assessment of possible hemodynamic consequences of this pathology is, however, necessary to secure an appropriate treatment. Multimodality imaging with echocardiography, CT, and cardiac MR can provide useful functional and anatomic information that can help to reach this goal.

Utility of Iodine Density Perfusion Maps From Dual-Energy Spectral Detector CT in Evaluating Cardiothoracic Conditions: A Primer for the Radiologist.

The purpose of this article is to outline the utility of iodine density maps for evaluating cardiothoracic disease and abnormalities. Multiple studies have shown that the variety of images generated from dual-energy spectral detector CT (SDCT) improve identification of cardiothoracic conditions. Understanding the technique of SDCT and being familiar with the features of different cardiothoracic conditions on iodine density map images help the radiologist make a better diagnosis.

Dual-energy Subtraction Chest Radiography: Application in Cardiovascular Imaging.

The chest radiograph is the most frequently performed imaging in radiology and by including the heart and central vessels can suggest the presence of cardiovascular disease. Dual-energy subtraction radiography of the chest provides improved detection of a wide variety of cardiovascular pathologies including coronary artery disease, valvular pathologies, and pericardial disease given the presence of calcification in many subtypes of these diseases. We review the principles of dual-energy subtraction radiography and demonstrate its added value in the assessment of cardiovascular disease.

Multimodality imaging of quadricuspid pulmonary valve associated with pulmonary artery aneurysm.

Quadricuspid pulmonary valve is a rare entity that can be associated with pulmonary artery aneurysm. It is usually asymptomatic and diagnosed incidentally. Association with other congenital or acquired heart diseases has been reported.

Multimodality Imaging of Right Ventricular Pseudoaneurysm Caused by Blunt Chest Trauma.

Right ventricular pseudoaneurysm is a rare but fatal complication of blunt chest trauma. Different imaging modalities including transthoracic echocardiogram, gated-CT angiography and cardiac MR can provide useful anatomic and functional information that can make the diagnosis and guide management. Surgical treatment is needed to avoid fatal outcome.

Virtual Monoenergetic Images for Diagnostic Assessment of Hypodense Lesions Within the Liver: Semiautomatic Estimation of Window Settings Using Linear Models.

Objective: The aim of the study was to establish the reference window settings for display of virtual monoenergetic images (VMIs) from spectral detector computed tomography when assessing hypodense liver lesions.

Methods: In patients with cysts (n = 24) or metastases (n = 26), objective (HU, signal-to-noise ratio [SNR]) and subjective (overall image quality, lesion conspicuity and noise) were assessed. Furthermore, 2 readers determined optimal window center/width (C/W) for conventional images (CIs) and VMIs of 40 to 120 keV.

Increased FDG Uptake and Chronic Lung Changes in a Case of Persistent Lipoid Pneumonia.

Lipoid pneumonia is uncommon disease caused by presence of macroscopic fat in the lung parenchyma commonly originating from exogenous source secondary to aspiration or inhalation of animal fats or mineral or vegetable oils. Alternatively, it can be due to endogenous fat accumulated in the alveoli in the setting of chronic bronchial obstruction or inflammation. The imaging findings include ground-glass opacities, consolidation, nodules, and masses.