Search Results (25)

Introduction and case report: Angiosarcomas, rare soft tissue malignancies originating from endothelial cells, represent only 1–2% of all soft tissue sarcomas. Primary pleural angiosarcoma (PPA) is exceptionally rare, with only 43 reported cases since 1943. There are many diagnostic and therapeutic challenges due to the rarity of these tumors. We present the case of a 72-year-old man presenting with back pain, dyspnea and anemia. Conventional imaging revealed bilateral pleural effusion and a thickened parietal pleura, while contrast chest MR was able to identify pleural sites of contrast enhancement. Left chest tube placement evidenced a hemothorax, and the cytology result was negative. A thoracoscopic approach was chosen, allowing us to perform different parietal pleural biopsies. Radiological and pathological features led to the diagnosis of epithelioid PPA. Despite pleural drainage and blood transfusions, the patient died only 4 days after diagnosis. Objectives: To present a literature review, evaluating the disease epidemiology and the clinical, diagnostic and therapeutic features of PPA. Methods: We reviewed cases of PPA in the literature (1954–2024) by searching the PubMed database for the terms “pleural angiosarcoma” and “pleura + angiosarcoma”. Results: We found a total of 47 cases that were described between 1987 and 2024 with sufficient data to be included in our review. PPA was found to be a challenging diagnosis, found mostly in older Caucasian males. The cytology is mostly indeterminant, and an endoscopic approach is usually needed. Radical surgery is the most common treatment option, and chemotherapy and radiation therapy are also often used. However, the prognosis is poor. Conclusions: PPA is very rare, and complex cases such as this one showcase the importance of innovative approaches like MRI and emphasize the significance of multidisciplinary collaboration for optimal patient management. Bilateral spontaneous hemothorax, as seen in this case, is uncommon and poses additional challenges in disease management. Further research to advance the diagnostic capabilities and treatment efficacy is needed. Full article

Pediatric congenital lung malformations (CLMs) comprise a spectrum of developmental anomalies of lung parenchyma, airways, and vasculature. CLMs are increasingly diagnosed prenatally but remain best characterized by postnatal cross-sectional imaging. During pregnancy, ultrasound (US) and fetal magnetic resonance imaging (MRI) are commonly used to monitor lung lesions. Management of CLMs, including imaging, in infants and young children depends on associated symptoms and institutional standards. Chest CT angiography (CTA) is usually the most appropriate initial postnatal imaging modality for assessing prenatally diagnosed or clinically suspected CLMs in asymptomatic infants and children. Magnetic resonance (MR) imaging/magnetic resonance angiography (MRA) may be considered as a complementary, problem-solving, imaging modality for evaluation of CLMs during fetal and neonatal periods. This article presents contemporary perspectives on the imaging approach to pediatric patients with suspected CLMs and reviews up-to-date radiologic findings and clinical characteristics of CLMs. Full article

In cardiac magnetic resonance (MR) imaging, an initial set of sequences is acquired to guide the definition of the subsequent cardiac views. These sequences provide a large field of view, enabling the detection of extracardiac findings (ECFs). Although ECFs may have significant clinical relevance, they are typically overlooked since they fall outside the scope of cardiac examinations. The only prior attempt to automatically detect incidental ECFs employed fully supervised methods but faced substantial limitations due to the impracticality of collecting comprehensive samples given the wide range of possible anomalies across various organs. This study investigates the potential of recent anomaly detection (AD) methods to address this challenge. While AD methods have gained popularity, their application has been largely confined to industrial settings or medical imaging tasks such as brain MR or chest X-ray, which exhibit lower anatomical variability and complexity than cardiac MR anatomical sequences. Hereto, twenty state-of-the-art (SOTA) AD methods, including unsupervised, semi-supervised, and open-set supervised learning methodologies, are compared against two fully supervised baselines for detecting ECFs in anatomical planes of cardiac MR. Results from our in-house dataset reveal suboptimal performance of SOTA AD methods, highlighting the need for further research in this domain. Full article

Background: Mitral annular disjunction (MAD), a mitral annular abnormality involving the whole mitral valve annulus circumference, commonly detected in individuals with mitral valve prolapse (MVP), has been recently recognized as a potential risk factor for malignant ventricular arrhythmias (VAs) and sudden cardiac death. Recent evidence indicates that a multimodality imaging assessment comprehensive of echocardiography, cardiac magnetic resonance (CMR), and cardiac computed tomography angiography (CCTA) may improve MAD detection. To date, no previous author has considered the potential influence of chest wall conformation on MAD presence. Considering the strong association between MVP and anterior chest wall deformities and the increased prevalence of MAD among MVP individuals, we have hypothesized that MAD presence might be more frequently detected among MVP individuals with a narrow anteroposterior (A-P) thoracic diameter and/or concave-shaped chest wall conformation, as noninvasively assessed by the modified Haller index (MHI). Methods: Herein, we present a case of MVP female with relevant MAD distance and moderate mitral regurgitation (MR) who underwent a diagnostic study comprehensive of transthoracic echocardiography, transesophageal echocardiography, CMR, CCTA, and exercise stress echocardiography. Results: The patient was found with a concave-shaped chest wall conformation (MHI > 2.5) and narrow A-P thoracic diameter (<13.5 cm), with a moderate and non-hemodynamically significant MR, without areas of LGE on CMR and with low arrhythmic profile. Conclusions: A preliminary chest shape assessment by the MHI might improve the prognostic risk stratification of MVP patients with MAD, potentially identifying a benign phenotype of MVP individuals, i.e., those with a narrow A-P thoracic diameter. Full article

The operative field and exposure in minimally invasive cardiac surgery (MICS) are limited. Meticulous preoperative planning and intraoperative visualization are crucial. We present our initial experience with HoloLens^® 2 as an intraoperative guide during MICS procedures: aortic valve replacement (AVR) via right anterior small thoracotomy, coronary artery bypass graft surgery (CABG) via left anterior small thoracotomy (LAST), and pulmonary valve replacement (PVR) via LAST. Three-dimensional (3D) segmentations were performed using the patient’s computer tomography (CT) data subsequently rendered into a 3D hologram on the HoloLens^® 2. The holographic image was then superimposed on the patient lying on the operating table, using the xiphoid and the clavicle as landmarks, and was used as a real-time anatomical image guide for the surgery. The incision site marking made using HoloLens^® 2 differed by one intercostal space from the marking made using a conventional surgeon’s mental reconstructed image from the patient’s preoperative imaging and was found to be a more appropriate site of entry into the chest for the structure of interest. The transparent visor of the HoloLens^® 2 provided unobstructed views of the operating field. A mixed reality (MR) device could contribute to preoperative surgical planning and intraoperative real-time image guidance, which facilitates the understanding of anatomical relationships. MR has the potential to improve surgical precision, decrease risk, and enhance patient safety. Full article

Pneumonia remains a global health issue, creating the need for accurate detection methods for effective treatment. Deep learning models like ResNet50 show promise in detecting pneumonia from chest X-rays; however, their black-box nature limits the transparency, which fails to meet that needed for clinical trust. This study aims to improve model interpretability by comparing four interpretability techniques, which are Layer-wise Relevance Propagation (LRP), Adversarial Training, Class Activation Maps (CAMs), and the Spatial Attention Mechanism, and determining which fits best the model, enhancing its transparency with minimal impact on its performance. Each technique was evaluated for its impact on the accuracy, sensitivity, specificity, AUC-ROC, Mean Relevance Score (MRS), and a calculated trade-off score that balances interpretability and performance. The results indicate that LRP was the most effective in enhancing interpretability, achieving high scores across all metrics without sacrificing diagnostic accuracy. The model achieved 0.91 accuracy and 0.85 interpretability (MRS), demonstrating its potential for clinical integration. In contrast, Adversarial Training, CAMs, and the Spatial Attention Mechanism showed trade-offs between interpretability and performance, each highlighting unique image features but with some impact on specificity and accuracy. Full article

Background: To validate the automated quantification of cardiac chamber volumes and myocardial mass on non-contrast chest CT using cardiac MR (CMR) as a reference. Methods: We retrospectively included 53 consecutive patients who received non-contrast chest CT and CMR within three weeks. A deep learning model created cardiac segmentations on axial soft-tissue reconstructions from CT, covering all four cardiac chambers and the left ventricular myocardium. Segmentations on CMR cine short-axis and long-axis images served as a reference. Standard estimates of diagnostic accuracy were calculated for ventricular volumes at end-diastole and end-systole (LVEDV, LVESV, RVEDV, RVESV), left ventricular mass (LVM), and atrial volumes (LA, RA) at ventricular end-diastole. A qualitative assessment noted segmentation issues. Results: The deep learning model generated CT measurements for 52 of the 53 patients (98%). Based on CMR measurements, the average LVEDV was 166 ± 64 mL, RVEDV was 144 ± 51 mL, and LVM was 115 ± 39 g. The CT measurements correlated well with CMR measurements for LVEDV, LVESV, and LVM (ICC = 0.85, ICC = 0.84, and ICC = 0.91; all p < 0.001) and RVEDV and RVESV (ICC = 0.79 and ICC= 0.78; both p < 0.001), and moderately well with LA and RA (ICC = 0.74 and ICC = 0.61; both p < 0.001). Absolute agreements likewise favored LVEDV, LVM, and RVEDV. ECG-gating did not relevantly influence the results. The CT results correctly identified 7/15 LV and 1/1 RV as dilated (one and six false positives, respectively). Major qualitative issues were found in three cases (6%). Conclusions: Automated cardiac chamber volume and myocardial mass quantification on non-contrast chest CT produced viable measurements in this retrospective sample. Relevance Statement: An automated cardiac assessment on non-contrast chest CT provides quantitative morphological data on the heart, enabling a preliminary organ evaluation that aids in incidentally identifying at-risk patients who may benefit from a more targeted diagnostic workup. Full article

Purpose: The current guidelines for initial cross-sectional imaging in pediatric lymphomas involve computed tomography (CT) of the chest, abdomen, and pelvis. However, whole-body magnetic resonance imaging (MRI) can be favored over CT for diagnosing and staging the disease, given its lack of ionizing radiation and its higher tissue contrast. Imaging characteristics of lymphoid tissue on MRI include a high T2/short tau inversion recovery (STIR) signal. A low or intermediate signal of lymphadenopathy on T2 and STIR images is an unexpected finding, noted anecdotally in nodular sclerosing Hodgkin lymphoma. This signal may be characteristic of a histological subtype of the disease and, if confirmed, could potentially be used to avoid biopsy. In this study, we aimed to review signal characteristics of lymphadenopathy in patients with biopsy-confirmed nodular sclerosing Hodgkin lymphoma. Methods: We undertook a retrospective review of relevant MR studies of patients with nodular sclerosing Hodgkin lymphoma. Studies were reviewed by an experienced pediatric radiologist regarding lymph node signal, especially on T2/STIR. Results: Eleven children with nodular sclerosing Hodgkin lymphoma were included. Median age at the time of MRI was 14.3 (IQR: 13.9–16.1) years, and nine were boys. Five patients showed some lymphadenopathy with a low T2/STIR signal, and six showed an intermediate T2/STIR signal. Central gadolinium non-enhancement was observed in four patients. Conclusions: All eleven patients (100%) with a diagnosis of nodular sclerosing Hodgkin lymphoma showed some lymphadenopathy with a low or intermediate T2/STIR signal, and five children (45.5%) showed a frank low signal of some lymphadenopathy, a feature which may prove to be a biomarker for this histology. Full article

Pain manifestation following coronary artery disease (CAD) disease differs between men and women. Here, we aimed to provide evidence favoring possible differences in pain manifestation between men and women following CAD using Mendelian randomization (MR). We used summary-level data from sex-stratified genome-wide association studies on CAD and self-reported and clinically diagnosed chest, neck and shoulder, back, and facial pain using data from the UK Biobank cohort (N > 450,000) followed by two-sample MR (sensitivity) analyses. We identified 32 and 19 independent genetic variants associated with CAD for men and women, respectively, as instrumental variables. Genetically influenced CAD was associated with a higher risk of self-reported chest pain in both men (OR: 1.27, CI: 1.2–1.33) and women (OR: 1.44, CI: 1.20–1.73), with similar results for clinically diagnosed chest pain (men OR: 1.22, CI: 1.17–1.26; women OR: 1.31, CI: 1.18–1.46). In addition, in women only, genetically influenced CAD was associated with a higher risk of back pain (OR: 1.35, CI: 1.03–1.66) and neck and shoulder pain (OR: 1.22, CI: 0.91–1.63) (p-values for interaction with men: 0.030 and 0.041, respectively). Sensitivity analysis did not indicate the results were biased by directional pleiotropy. We found evidence, based on genetic predisposition for CAD, for different pain manifestations of CAD in men and women. While CAD was associated with chest pain in both sexes, we only found evidence for a higher risk of back pain and neck and shoulder pain in women, supporting common notions that women may present more often with uncharacteristic anginal symptoms. Full article

Hybrid positron emission tomography/magnetic resonance imaging (PET/MR) opens new possibilities in multimodal multiparametric (m2p) image analyses. But even the simultaneous acquisition of positron emission tomography (PET) and magnetic resonance imaging (MRI) does not guarantee perfect voxel-by-voxel co-registration due to organs and distortions, especially in diffusion-weighted imaging (DWI), which would be, however, crucial to derive biologically meaningful information. Thus, our aim was to optimize fusion and voxel-wise analyses of DWI and standardized uptake values (SUVs) using a novel software for m2p analyses. Using research software, we evaluated the precision of image co-registration and voxel-wise analyses including the rigid and elastic 3D registration of DWI and [18F]-Fluorodeoxyglucose (FDG)-PET from an integrated PET/MR system. We analyzed DWI distortions with a volume-preserving constraint in three different 3D-printed phantom models. A total of 12 PET/MR-DWI clinical datasets (bronchial carcinoma patients) were referenced to the T1 weighted-DIXON sequence. Back mapping of scatterplots and voxel-wise registration was performed and compared to the non-optimized datasets. Fusion was rated using a 5-point Likert scale. Using the 3D-elastic co-registration algorithm, geometric shapes were restored in phantom measurements; the measured ADC values did not change significantly (F = 1.12, p = 0.34). Reader assessment showed a significant improvement in fusion precision for DWI and morphological landmarks in the 3D-registered datasets (4.3 ± 0.2 vs. 4.6 ± 0.2, p = 0.009). Most pronounced differences were noted for the chest wall (p = 0.006), tumor (p = 0.007), and skin contour (p = 0.014). Co-registration increased the number of plausible ADC and SUV combinations by 25%. The volume-preserving elastic 3D registration of DWI significantly improved the precision of fusion with anatomical sequences in phantom and clinical datasets. The research software allowed for a voxel-wise analysis and visualization of [18F]FDG-PET/MR data as a “combined diffusivity–metabolic index” (cDMI). The clinical value of the optimized PET/MR biomarker can thus be tested in future PET/MR studies. Full article

Compared with computed tomography (CT), magnetic resonance imaging (MRI) traditionally plays a very limited role in lung cancer management, although there is plenty of room for improvement in the current CT-based workflow, for example, in structures such as the brachial plexus and chest wall invasion, which are difficult to visualize with CT alone. Furthermore, in the treatment of high-risk tumors such as ultracentral lung cancer, treatment-associated toxicity currently still outweighs its benefits. The advent of MR-Linac, an MRI-guided radiotherapy (RT) that combines MRI with a linear accelerator, could potentially address these limitations. Compared with CT-based technologies, MR-Linac could offer superior soft tissue visualization, daily adaptive capability, real-time target tracking, and an early assessment of treatment response. Clinically, it could be especially advantageous in the treatment of central/ultracentral lung cancer, early-stage lung cancer, and locally advanced lung cancer. Increasing demands for stereotactic body radiotherapy (SBRT) for lung cancer have led to MR-Linac adoption in some cancer centers. In this review, a broad overview of the latest research on imaging-guided radiotherapy (IGRT) with MR-Linac for lung cancer management is provided, and development pertaining to artificial intelligence is also highlighted. New avenues of research are also discussed. Full article

Background and Objectives: Chest radiography remains the most frequently used examination in emergency departments (ED) for the diagnosis of community-acquired pneumonia (CAP), despite its poor diagnostic accuracy compared with ultra-low-dose (ULD) chest computed tomography (CT). However, although ULD CT appears to be an attractive alternative to radiography, its organizational impact in ED remains unknown. Our objective was to compare the relevant timepoints in ED management of CT and chest radiography. Materials and Methods: We conducted a retrospective study in two ED of a University Hospital including consecutive patients consulting for a CAP between 1 March 2019 and 29 February 2020 to assess the organizational benefits of ULD chest CT and chest radiography (length of stay (LOS) in the ED, time of clinical decision after imaging). Overlap weights (OW) were used to reduce covariate imbalance between groups. Results: Chest radiography was performed for 1476 patients (mean age: 76 years [63; 86]; 55% men) and ULD chest CT for 133 patients (mean age: 71 [57; 83]; 53% men). In the weighted population with OW, ULD chest CT did not significantly alter the ED LOS compared with chest radiography (11.7 to 12.2; MR 0.96 [0.85; 1.09]), although it did significantly reduce clinical decision time (6.9 and 9.5 h; MR 0.73 [0.59; 0.89]). Conclusion: There is real-life evidence that a strategy with ULD chest CT can be considered to be a relevant approach to replace chest radiography as part of the diagnostic workup for CAP in the ED without increasing ED LOS. Full article

We aimed to overview the most recent data on sternal metastases from a multidisciplinary approach (diagnosis strategies, outcome, and histological reports). This narrative review based on a PubMed search (between January 2020 and 22 July 2023) using key words such as “sternal”, “manubrium”, and “metastasis” within the title and/or abstract only included original papers that specifically addressed secondary sternal spreading of cancer in adults, for a total of 48 original articles (14 studies and 34 single case reports). A prior unpublished case in point is also introduced (percutaneous incisional biopsy was used to address a 10 cm sternal tumour upon first admission on an apparently healthy male). The studies (n = 14) may be classified into one of three groups: studies addressing the incidence of bone metastases (including sternum) amid different primary cancers, such as prostate cancer (N = 122 with bone metastases, 83% of them with chest wall metastases), head and neck cancers (N = 3620, 0.8% with bone metastases, and 10.34% of this subgroup with sternum involvement); and glioblastoma (N = 92 with bone metastases, 37% of them with non-vertebral metastases, including the sternum); assessment cohorts, including breast cancer (N = 410; accuracy and sensitivity of PET/CT vs. bone scintigraphy is superior with concern to sternum spreading) and bone metastases of unknown origin (N = 83, including a subgroup with sternum metastases; some features of PET/CT help the differentiation with multiple myeloma); and cohorts with various therapeutic approaches, such as palliative arterial embolization (N = 10), thymic neuroendocrine neoplasia (1/5 detected with sternum metastases), survival rates for sternum metastases vs. non-sternum chest wall involvement (N = 87), oligo-metastatic (sternal) breast cancer (3 studies, N = 16 for all of them), oligo-metastatic head and neck cancer (N = 81), conformal radiotherapy (N = 24,215, including an analysis on sternum spreading), and EBRT followed by MR-HIFU (N = 6). Core data coming from the isolated case reports (N = 34) showed a female to male ratio of 1.6; the females’ ages were between 34 and 80 (mean of 57.28) and the males’ ages varied between 33 and 79 (average of 58.78) years. The originating tumour profile revealed that the most frequent types were mammary (N = 8, all females) and thyroid (N = 9, both women and men), followed by bladder (N = 3), lung (N = 2), and kidney (N = 2). There was also one case for each of the following: adenoid cystic carcinoma of the jaw, malignant melanoma, caecum MiNEN, a brain and an extracranial meningioma, tongue carcinoma, cholangiocarcinoma, osteosarcoma, and hepatocellular carcinoma. To our knowledge, this is the most complex and the largest analysis of prior published data within the time frame of our methods. These data open up new perspectives of this intricate, dynamic, and challenging domain of sternum metastases. Awareness is a mandatory factor since the patients may have a complex multidisciplinary medical and/or surgical background or they are admitted for the first time with this condition; thus, the convolute puzzle will start from this newly detected sternal lump. Abbreviations: N = number of patients; n = number of studies; PET/CT = positron emission tomography/computed tomography; EVRT = external beam radiotherapy; MR-HIFU = magnetic resonance-guided high-intensity focused ultrasound; MiNEN = mixed neuroendocrine-non-neuroendocrine tumour. Full article

Cervical kyphosis is a rare entity with challenging management due to the limitations of pediatric age, along with a growing spine. The pathogenesis is made up of a large group of congenital, syndromic and acquired deformities after posterior element deterioration or as a result of previous trauma or surgery. In rare progressive cases, kyphotic deformities may result in severe “chin-on-chest” deformities with severe limitations. The pathogenesis of progression to severe kyphotic deformity after minor hyperflexion trauma is not clear without an obvious MR pathology; it is most likely multifactorial. The authors present the case of a six-month progression of a pediatric cervical kyphotic deformity caused by a cervical spine hyperflexion injury, and an MR evaluation without the pathology of disc or major ligaments. Surgical therapy with a posterior fixation and fusion, together with the preservation of the anterior growing zones of the cervical spine, are potentially beneficial strategies to achieve an excellent curve correction and an optimal long-term clinical outcome in this age group. Full article

Breast MR is the most sensitive imaging modality, but there are cases of malignant tumors that are not detected in MR. This study evaluated the frequency and main causes of malignant breast lesions not detected in dynamic contrast-enhanced (DCE) MR. A total of 1707 cases of preoperative breast MR performed between 2020 and 2021 were included. Three radiologists individually reviewed the DCE MRs and found not-detected malignancy cases in the MRs. The final cases were decided through consensus. For the selected cases, images other than DCE MRIs, such as mammography, ultrasounds, diffusion-weighted MRs, and, if possible, contrast-enhanced chest CTs, were analyzed. In the final sample, 12 cases were not detected in DCE MR, and the frequency was 0.7% (12/1707). Six cases were not detected due to known non-enhancing histologic features. In four cases, tumors were located in the breast periphery and showed no enhancement in MR. In the remaining two cases, malignant lesions were not identified due to underlying marked levels of BPE. The frequency of not-detected malignancy in DCE MR is rare. Knowing the causes of each case and correlating it with other imaging modalities could be helpful in the diagnosis of breast malignancy in DCE MR. Full article