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14 pages, 934 KB

Open AccessArticle

Association Between Unenhanced CT Features and Perioperative Outcomes in Bronchogenic Cyst Resection

by Kai-Man U, Pei-Hsing Chen, Min-Shu Hsieh, Yu-Sen Huang, Tzu-Pin Lu, Hsao-Hsun Hsu and Jin-Shing Chen

Diagnostics 2026, 16(18), 3000; https://doi.org/10.3390/diagnostics16183000 - 16 Sep 2026

Abstract

Background: Reliable predictors of perioperative risk beyond symptomatology in bronchogenic cyst (BC) resection are lacking. We aimed to compare perioperative outcomes across different imaging features to identify perioperative risk factors. Methods: We conducted a retrospective cohort study of 57 patients who [...] Read more.

Background: Reliable predictors of perioperative risk beyond symptomatology in bronchogenic cyst (BC) resection are lacking. We aimed to compare perioperative outcomes across different imaging features to identify perioperative risk factors. Methods: We conducted a retrospective cohort study of 57 patients who underwent pathologically confirmed BC resection at a single tertiary center from 2004 to 2023. Preoperative unenhanced CT images were retrospectively reviewed for four prespecified imaging features. Only unenhanced images were used for imaging-feature classification and Hounsfield-unit measurement. Patients were stratified into two groups based on the presence (n = 19) or absence (n = 38) of abnormal features. The prespecified primary perioperative outcomes were peri-cystic adhesion, operative time, estimated intraoperative blood loss, and intensive care unit (ICU) length of stay. Secondary outcomes included chest-tube duration, postoperative hospital length of stay, major intraoperative complications, 30-day postoperative complications, and recurrence. Results: The abnormal image-feature group had a higher prevalence of male patients, symptomatic presentation, and larger cysts. Nineteen patients (33%) had at least one abnormal CT feature. Patients with abnormal CT features had significantly higher peri-cystic adhesion rates (68% vs. 34%; p = 0.015), longer mean operative times (128 ± 60 vs. 87 ± 35 min; p = 0.011), greater blood loss (100 ± 150 vs. 4 ± 24 mL; p = 0.012), and prolonged intensive care unit stays (0.84 ± 1.21 vs. 0.05 ± 0.23 days; p = 0.011) than those with normal imaging. No significant differences were observed in outcomes of chest-tube duration, postoperative hospital length of stay, or recurrence. The presence of abnormal features and cyst size remained significant in multivariate models. Conclusions: Abnormal imaging features on non-contrast CT and cyst size are associated with more challenging perioperative courses in BC resection. Incorporating these imaging features into preoperative assessment may enhance risk stratification and guide surgical approach decisions in the CT screening era. Full article

(This article belongs to the Special Issue Recent Developments and Future Trends in Thoracic Imaging)

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22 pages, 1043 KB

Open AccessArticle

Determinants of Pneumothorax and Alveolar Hemorrhage After CT-Guided Lung Biopsy

by Amalia Constantinescu, Alessia-Stephania Roșian, Radu-Nicolae Căprariu, Ionel-Alin Muntean, Versavia Maria Ancușa, Alin Ciprian Nicola, Cristian Oancea and Diana Manolescu

Diagnostics 2026, 16(12), 1848; https://doi.org/10.3390/diagnostics16121848 - 15 Jun 2026

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Abstract

Background/Objectives: CT-guided transthoracic core needle biopsy (CT-TTNB) is the standard technique for histological characterization of pulmonary lesions, yet it carries a 15–42% rate of pneumothorax and a 5–27% rate of alveolar hemorrhage. Accurate identification of modifiable and non-modifiable procedural determinants is essential for [...] Read more.

Background/Objectives: CT-guided transthoracic core needle biopsy (CT-TTNB) is the standard technique for histological characterization of pulmonary lesions, yet it carries a 15–42% rate of pneumothorax and a 5–27% rate of alveolar hemorrhage. Accurate identification of modifiable and non-modifiable procedural determinants is essential for pre-procedural risk stratification, technique optimization, and post-procedural care. Methods: We conducted a single-centre retrospective cohort study of 240 consecutive CT-TTNB procedures performed between November 2023 and January 2025. The variables were extracted from medical records and PACS and entered into univariate and multivariate analysis models. Model performance was assessed by AUC-ROC, Nagelkerke R², and the Hosmer–Lemeshow test. Results: Pneumothorax occurred in 79 patients (32.9%), with chest tube drainage required in 14 (5.8%). Alveolar hemorrhage was identified in 49 patients (20.4%). Four independent predictors for pneumothorax were identified: needle–pleural angle (OR 0.837/1°; p < 0.001), pleura-to-lesion distance (OR 1.675/10 mm; p < 0.001), fissure traversal (OR 26.718; p = 0.003), and patient age (OR 1.076/year; p = 0.002); AUC-ROC 0.927. The alveolar hemorrhage model identified pleura-to-lesion distance (OR 1.768/10 mm; p < 0.001), RUL apical segment (OR 4.281; p < 0.001), and carcinomatous lymphangitis as protective factors (OR 0.359; p = 0.030); AUC-ROC 0.822. The needle–pleural angle was not independently associated with alveolar hemorrhage, confirming mechanistically distinct complication pathways. Conclusions: Needle–pleural angle is the dominant modifiable determinant of pneumothorax and pneumothorax-related complications. Optimizing the trajectory towards perpendicularity does not increase hemorrhage risk. These findings support the implementation of angle-based trajectory planning protocols and risk-stratified post-procedural monitoring. Full article

(This article belongs to the Special Issue Recent Developments and Future Trends in Thoracic Imaging)

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14 pages, 4697 KB

Open AccessArticle

Correlation Between CT-Derived Bhalla Score and Lung Ultrasound Score in Adult Patients with Cystic Fibrosis

by Roxana Stoicescu, Emil Radu Iacob, Emil Robert Stoicescu, Diana Manolescu, Cristian Oancea, Alexandru Crisan, Adelina Maritescu, Alexandra Magdalena Ioana, Amalia Constantinescu and Camelia Corina Pescaru

Diagnostics 2026, 16(11), 1722; https://doi.org/10.3390/diagnostics16111722 - 3 Jun 2026

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Abstract

Background/Objectives: Cystic fibrosis is a chronic multisystem disease in which pulmonary involvement is the main determinant of morbidity and mortality. Chest computed tomography is the reference standard for assessing structural lung damage, but its repeated use is limited by cumulative radiation exposure. Lung [...] Read more.

Background/Objectives: Cystic fibrosis is a chronic multisystem disease in which pulmonary involvement is the main determinant of morbidity and mortality. Chest computed tomography is the reference standard for assessing structural lung damage, but its repeated use is limited by cumulative radiation exposure. Lung ultrasound has emerged as a radiation-free alternative; however, its role in adult patients remains incompletely defined. This study aimed to evaluate the correlation between CT-derived structural lung damage and ultrasound findings, and to assess the complementary role of these imaging modalities. Methods: A prospective cohort study was conducted including adult patients with cystic fibrosis who underwent both chest computed tomography and lung ultrasound during the same clinical episode. Structural lung involvement was assessed using the Bhalla score, while lung aeration was evaluated using the Lung Ultrasound Score. Correlation analyses, severity stratification, regression modeling, and longitudinal comparisons were performed. Results: Thirteen patients contributed 24 imaging evaluations. A strong positive correlation between Bhalla score and ultrasound findings was observed in the cross-sectional analysis and remained consistent when all examinations were included. Ultrasound scores increased significantly across CT-defined severity groups, and regression analysis confirmed a significant association between the two methods. Exploratory analysis showed stronger associations for peripheral and aeration-related abnormalities, while weaker associations were observed for deeper airway changes. No significant correlation was identified in longitudinal analysis. Conclusions: Lung ultrasound correlates well with CT-derived structural lung damage and may serve as a complementary, radiation-free tool for disease assessment in adult cystic fibrosis. However, its limited sensitivity in detecting temporal changes highlights the continued importance of CT in selected clinical scenarios. Full article

(This article belongs to the Special Issue Recent Developments and Future Trends in Thoracic Imaging)

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13 pages, 13430 KB

Open AccessArticle

CT Features of Granulomatous–Lymphocytic Interstitial Lung Disease (GLILD): The “Kebab Sign” as a Marker to Support Differential Diagnosis

by Federica Ciccarese, Nicolò Piva, Marco Carpano, Ilaria Bassi, Aldo Guerrieri, Gioacchino Schifino, Stefano Nava, Cristina Mosconi and Maurizio Zompatori

Diagnostics 2026, 16(10), 1496; https://doi.org/10.3390/diagnostics16101496 - 14 May 2026

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Abstract

Objective: In this study, we aimed to evaluate high-resolution computed tomography (HRCT) features of granulomatous–lymphocytic interstitial lung disease (GLILD) in patients with Common Variable Immunodeficiency (CVID), and to describe a novel imaging feature—termed the “Kebab sign”—as a potential radiologic marker of GLILD. Materials [...] Read more.

Objective: In this study, we aimed to evaluate high-resolution computed tomography (HRCT) features of granulomatous–lymphocytic interstitial lung disease (GLILD) in patients with Common Variable Immunodeficiency (CVID), and to describe a novel imaging feature—termed the “Kebab sign”—as a potential radiologic marker of GLILD. Materials and Methods: We retrospectively reviewed HRCT scans of 15 patients with GLILD diagnosed between 2005 and 2025 at a single institution (seven biopsy-confirmed, eight probable diagnoses based on multidisciplinary consensus). CT patterns were assessed for predominant morphology (nodular, reticular, alveolar, fibrotic), distribution (axial and cranio-caudal), and presence of extra-parenchymal findings. Nodules were characterized by size, density, morphology, and the presence of air bronchograms. The “Kebab sign” was defined as nodules aligned along bronchial structures with associated peribronchial thickening. Results: All patients demonstrated a diffuse nodular pattern, with non-calcified macronodules in 100% and micronodules in 60% of cases. Air bronchograms were present in 87% of macronodules. A peri-bronchovascular distribution with lower lung predominance was observed in the majority of cases. The “Kebab sign” was identified in 87% of patients. Splenomegaly and hilar/mediastinal lymphadenopathy were observed in 75%. In 20% of patients, fibrosing features were also present, particularly in older individuals. Conclusions: HRCT findings of GLILD typically include peri-bronchovascular nodules with lower lobe predominance, typically associated with splenomegaly and mediastinal lymphadenopathy. The newly described “Kebab sign,” reflecting nodular alignment along thickened bronchial structures, may represent a useful imaging clue to support the diagnosis of GLILD. Full article

(This article belongs to the Special Issue Recent Developments and Future Trends in Thoracic Imaging)

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13 pages, 1350 KB

Open AccessArticle

Imaging Pathways in Pediatric Thoracic Trauma: FAST-First Triage and Selective CT Escalation in Clinical Practice

by Emil Radu Iacob, Emil Robert Stoicescu, Valentina Adriana Marcu, Roxana Stoicescu, Vlad Predescu, Narcis Flavius Tepeneu, Maria Corina Stanciulescu, Mihai Cristian Neagu, Adrian Georgescu and Calin Marius Popoiu

Diagnostics 2026, 16(6), 889; https://doi.org/10.3390/diagnostics16060889 - 17 Mar 2026

Viewed by 658

Abstract

Background/Objectives: Pediatric thoracic trauma requires prompt stabilization and timely imaging; however, actual sequencing and escalation triggers are infrequently delineated at the pathway level. The aim of this study was to analyze imaging pathways observed in routine clinical practice at our institution and [...] Read more.

Background/Objectives: Pediatric thoracic trauma requires prompt stabilization and timely imaging; however, actual sequencing and escalation triggers are infrequently delineated at the pathway level. The aim of this study was to analyze imaging pathways observed in routine clinical practice at our institution and to outline a preliminary escalation framework integrating injury mechanism, clinical severity, and initial ultrasound findings. Methods: A retrospective cohort study was conducted at the “Louis Țurcanu” Clinical Emergency Hospital for Children, Timișoara, Romania, including 66 children admitted with primary thoracic trauma between January 2022 and December 2024. Clinical trajectory markers (transfer-in, ICU admission, length of stay) and imaging utilization/sequencing (FAST, CXR, CT, MRI/CTA) were extracted. We divided injuries into two groups: bony (like fractures of the clavicle or scapula) and non-bony. CT escalation was characterized as a chest CT conducted upon admission. Fisher’s exact and Mann–Whitney U tests were used for comparative analyses. Results: FAST was done on all patients but was infrequently positive. Imaging followed heterogeneous but structured patterns, most commonly FAST with CXR, with or without CT. A large group of them had CT scans without first having any X-rays. CT escalation was associated with fracture-pattern injuries and higher-acuity trajectories (transfer-in and ICU admission), as well as prolonged hospital stays. Pathway-level assessment demonstrated that CT escalation effectively captured bony injury patterns, whereas FAST proficiently sorted ICU-level trajectories. Conclusions: Pediatric thoracic trauma imaging functioned as a selective escalation system: FAST served as a universal bedside entry step, and CT operated as an injury pattern- and acuity-linked severity gate. Making this escalation logic clear may help with standardization while still protecting against radiation. Full article

(This article belongs to the Special Issue Recent Developments and Future Trends in Thoracic Imaging)

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11 pages, 2309 KB

Open AccessArticle

Radiomics Feature Stability in True and Virtual Non-Contrast Reconstructions from Cardiac Photon-Counting Detector CT Datasets

by Luca Canalini, Elif G. Becker, Franka Risch, Stefanie Bette, Simon Hellbrueck, Judith Becker, Katharina Rippel, Christian Scheurig-Muenkler, Thomas Kroencke and Josua A. Decker

Diagnostics 2024, 14(22), 2483; https://doi.org/10.3390/diagnostics14222483 - 7 Nov 2024

Cited by 1 | Viewed by 1972

Abstract

Objectives: Virtual non-contrast (VNC) series reconstructed from contrast-enhanced cardiac scans acquired with photon counting detector CT (PCD-CT) systems have the potential to replace true non-contrast (TNC) series. However, a quantitative comparison of the image characteristics of TNC and VNC data is necessary [...] Read more.

Objectives: Virtual non-contrast (VNC) series reconstructed from contrast-enhanced cardiac scans acquired with photon counting detector CT (PCD-CT) systems have the potential to replace true non-contrast (TNC) series. However, a quantitative comparison of the image characteristics of TNC and VNC data is necessary to determine to what extent they are interchangeable. This work quantitatively evaluates the image similarity between VNC and TNC reconstructions by measuring the stability of multi-class radiomics features extracted in intra-patient TNC and VNC reconstructions. Methods: TNC and VNC series of 84 patients were retrospectively collected. For each patient, the myocardium and epicardial adipose tissue (EAT) were semi-automatically segmented in both VNC and TNC reconstructions, and 105 radiomics features were extracted in each mask. Intra-feature correlation scores were computed using the intraclass correlation coefficient (ICC). Stable features were defined with an ICC higher than 0.75. Results: In the myocardium, 41 stable features were identified, and the three with the highest ICC were glrlm_GrayLevelVariance with ICC3 of 0.98 [0.97, 0.99], ngtdm_Strength with ICC3 of 0.97 [0.95, 0.98], firstorder_Variance with ICC3 of 0.96 [0.94, 0.98]. For the epicardial fat, 40 stable features were found, and the three highest ranked are firstorder_Median with ICC3 of 0.96 [0.93, 0.97], firstorder_RootMeanSquared with ICC3 of 0.95 [0.92, 0.97], firstorder_Mean with ICC3 of 0.95 [0.92, 0.97]. A total of 24 features (22.8%; 24/105) showed stability in both anatomical structures. Conclusions: The significant differences in the correlation of radiomics features in VNC and TNC volumes of the myocardium and epicardial fat suggested that the two reconstructions may differ more than initially assumed. This indicates that they may not be interchangeable, and such differences could have clinical implications. Therefore, care should be given when selecting VNC as a substitute for TNC in radiomics research to ensure accurate and reliable analysis. Moreover, the observed variations may impact clinical workflows, where precise tissue characterization is critical for diagnosis and treatment planning. Full article

(This article belongs to the Special Issue Recent Developments and Future Trends in Thoracic Imaging)

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Review

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16 pages, 21964 KB

Open AccessReview

Osteosarcoma Metastasis to the Thorax: A Pictorial Review of Chest Computed Tomography Findings

by Khalid Abdulaziz Alduraibi, Jawaher Ali Towhari, Hatim Abdullah Alebdi, Bader Zaid Alfadhel, Ghazi S. Alotaibi, Subha Ghosh and Mnahi Bin Saeedan

Diagnostics 2024, 14(18), 2085; https://doi.org/10.3390/diagnostics14182085 - 20 Sep 2024

Cited by 7 | Viewed by 7769

Abstract

Background: Osteosarcoma, a primary bone malignancy in children and adolescents, frequently metastasizes to the lungs, contributing significantly to morbidity and mortality. Lung Metastases: At diagnosis, 15–20% of patients present with detectable lung metastases. Chest computed tomography (CT) is vital for the early detection [...] Read more.

Background: Osteosarcoma, a primary bone malignancy in children and adolescents, frequently metastasizes to the lungs, contributing significantly to morbidity and mortality. Lung Metastases: At diagnosis, 15–20% of patients present with detectable lung metastases. Chest computed tomography (CT) is vital for the early detection and monitoring of these metastases. Lung involvement typically presents as multiple nodules of varying sizes and can include atypical features such as cavitation, cystic lesions, ground-glass halos, intravascular tumor thrombi, and endobronchial disease. Additional Findings: Pleural metastasis often occurs alongside pulmonary disease, and complications like spontaneous pneumothorax may arise. Additional findings may include thoracic lymphadenopathy, cardiac tumor thrombus, and chest wall deposits. Conclusion: Familiarity with these imaging patterns is essential for radiologists to ensure timely diagnosis and effective management. This review highlights the critical role of chest CT in detecting and characterizing osteosarcoma metastasis. Full article

(This article belongs to the Special Issue Recent Developments and Future Trends in Thoracic Imaging)

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Other

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18 pages, 1104 KB

Open AccessSystematic Review

Artificial Intelligence-Based 18F-FDG PET/CT Radiomics for Mediastinal Lymph Node Staging in Non-Small Cell Lung Cancer: A Systematic Review

by Alessia-Stephania Rosian, Agneta-Maria Pusztai, Amalia Constantinescu, Gabriel-Aurel Rus, Cristian Oancea and Diana Manolescu

Diagnostics 2026, 16(13), 2014; https://doi.org/10.3390/diagnostics16132014 - 27 Jun 2026

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Abstract

Background/Objectives: Accurate staging of mediastinal lymph nodes is essential for therapeutic decisions and prognostic assessment in non-small cell lung cancer (NSCLC). This systematic review evaluates diagnostic performance, validation strategies, and clinical significance of artificial intelligence (AI)-based 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET/CT) radiomics [...] Read more.

Background/Objectives: Accurate staging of mediastinal lymph nodes is essential for therapeutic decisions and prognostic assessment in non-small cell lung cancer (NSCLC). This systematic review evaluates diagnostic performance, validation strategies, and clinical significance of artificial intelligence (AI)-based 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET/CT) radiomics models for mediastinal nodal staging in NSCLC. Methods: Systematic literature searching was conducted in PubMed, ScienceDirect, and Scopus according to the PRISMA 2020 guidelines. Eligible studies used radiomic or AI-based approaches for mediastinal lymph node (LN) evaluation in NSCLC, with histopathology as a reference standard. Extracted data included study design, cohort characteristics, imaging method, validation strategy, and diagnostic performance metrics. Methodological quality was assessed by the QUADAS-2 tool. Results: Thirteen studies were included which are mainly retrospective in their designs with cohort sizes varying between 87 and 3265 patients. Models evaluated on external or prospective validation cohorts generally showed lower performance compared with training or internal datasets. However, clinically significant discriminative ability has been preserved across heterogeneous populations. In studies that directly compared methods, composite models integrating radiomic features with clinical factors and conventional PET metrics, sometimes including deep learning-derived features, consistently outperformed radiomics-only models. Additionally, selected approaches addressing FDG-related false-positive uptake improved distinction between benign and metastatic mediastinal lymph nodes; this is reflected by reduced false-positive classifications plus higher specificity compared with conventional PET/CT interpretation. Conclusions: AI-based 18F-FDG PET/CT radiomics show a promising discriminative capacity for mediastinal nodal staging in NSCLC, especially when it is integrated with clinical and conventional imaging variables. Although the model performance remains clinically significant within independent validation cohorts, attenuation compared with training datasets is commonly observed. Methodological heterogeneity, predominantly retrospective study designs, and the scarcity of prospective multicenter validation currently limit routine clinical implementation. Full article

(This article belongs to the Special Issue Recent Developments and Future Trends in Thoracic Imaging)

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13 pages, 1323 KB

Open AccessProtocol

Lung Elastance and Microvascularization as Quantitative Non-Invasive Biomarkers for the Aetiological Diagnosis of Lung Consolidations in Children (ELASMIC Study)

by Sergi Huerta-Calpe, Carmina Guitart, Josep Lluis Carrasco, Bárbara Salas, Francisco José Cambra, Iolanda Jordan and Mònica Balaguer

Diagnostics 2025, 15(7), 910; https://doi.org/10.3390/diagnostics15070910 - 2 Apr 2025

Cited by 1 | Viewed by 1352

Abstract

Background: Acute lower respiratory tract conditions are highly prevalent in paediatrics. Many of these conditions present as consolidations on imaging studies. One of the most common causes is bacterial pneumonia (BP), which requires an accurate diagnosis to implement the best treatment plan. Despite [...] Read more.

Background: Acute lower respiratory tract conditions are highly prevalent in paediatrics. Many of these conditions present as consolidations on imaging studies. One of the most common causes is bacterial pneumonia (BP), which requires an accurate diagnosis to implement the best treatment plan. Despite the fact that major guidelines constrain the use of invasive tests, chest X-ray (CXR) or blood tests are still routinely used for the diagnosis. In this regard, the introduction of lung ultrasound (LUS) signified an advancement in reducing the invasiveness of diagnosis. However, there are still situations where distinguishing between different aetiologies remains challenging, especially in the case of atelectasis. Methods: This is a prospective cohort study to assess the diagnostic accuracy of new non-invasive, quantifiable, and reproducible imaging biomarkers (lung elastance and microvascularization ratio) for differentiating BP from another major entity that causes the appearance of consolidation in imaging tests, atelectasis. It will be conducted at Sant Joan de Déu Hospital in Spain from June 2025 to June 2027. Firstly, imaging biomarkers will be measured in well-aerated lung tissue without consolidation to establish their values in healthy lung tissue, according to a predefined imaging acquisition protocol. Subsequently, the imaging biomarkers will be assessed in patients with confirmed lung consolidation by LUS (Group 1: BP; Group 2: atelectasis). Results: The study aims to determine whether there are statistically significant differences in the biomarker values in relation to the normal values and between the different etiological groups. Conclusions: The demonstration of the reliable diagnostic accuracy of these biomarkers could significantly reduce the need for invasive techniques and improve the therapeutic management of many patients with BP and other pulmonary conditions presenting with consolidation in imaging tests. Full article

(This article belongs to the Special Issue Recent Developments and Future Trends in Thoracic Imaging)

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