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Purpose: To address the limited utility of the interferon (IFN)-γ release assay (IGRA) caused by its variability and inconsistency. Methods: This retrospective cohort study was based on data obtained between 2011 and 2019. QuantiFERON-TB Gold-In-Tube was used to measure IFN-γ levels in nil, tuberculosis (TB) antigen, and mitogen tubes. Results: Of 9,378 cases, 431 had active TB. The non-TB group comprised 1,513 IGRA-positive, 7,202 IGRA-negative, and 232 IGRA-indeterminate cases. Nil-tube IFN-γ levels were significantly higher in the active TB group (median = 0.18 IU/mL; interquartile range: 0.09–0.45 IU/mL) than in the IGRA-positive non-TB (0.11 IU/mL; 0.06–0.23 IU/mL) and IGRA-negative non-TB (0.09 IU/mL; 0.05–0.15 IU/mL) groups (P < 0.0001). From receiver operating characteristic analysis, TB antigen tube IFN-γ levels had higher diagnostic utility for active TB than TB antigen minus nil values. In a logistic regression analysis, active TB was the main driver of higher nil values. In the active TB group, after reclassifying the results based on a TB antigen tube IFN-γ level of 0.48 IU/mL, 14/36 cases with negative results and 15/19 cases with indeterminate results became positive, while 1/376 cases with positive results became negative. Overall, the sensitivity for detecting active TB improved from 87.2 to 93.7%. Conclusion: The results of our comprehensive assessment can aid in IGRA interpretation. Since nil values are governed by TB infection rather than reflecting background noise, TB antigen tube IFN-γ levels should be used without subtracting nil values. Despite indeterminate results, TB antigen tube IFN-γ levels can be informative. [ABSTRACT FROM AUTHOR]

Ciliated muconodular papillary tumor (CMPT) is a rare benign lung tumor characterized by ciliated columnar cells, mucous cells, and basal cells. Herein, we report a case of CMPT with 11 years of preoperative follow‐up, depicting the natural course of the tumor and changes in computed tomography (CT) findings. A 39‐year‐old man had a 5‐mm solid pulmonary nodule in the right lower lobe that had slowly grown and transformed into a thin‐walled cavitary lesion. Right lower lobe lobectomy was performed and the tumor was confirmed to be a CMPT. Although it is difficult to diagnose CMPT with CT findings alone, CMPT should be considered as a possible diagnosis when a slowly growing nodule undergoes cavitary changes. [ABSTRACT FROM AUTHOR]

Extranodal marginal zone lymphoma of mucosa‐associated lymphoid tissue (MALT) in the thymus is a rare disease. Furthermore, amyloid deposition in thymic MALT lymphoma has not been previously described. Here, we report a case of a 35‐year‐old man with thymic MALT lymphoma with amyloid deposition and myasthenia gravis. Chest computed tomography revealed an anterior mediastinal mass with internal cystic component and extensive calcification. Total thymectomy was performed and histopathologic findings were compatible with a diffuse amyloid deposition in extranodal marginal zone MALT lymphoma. The results indicate that thymic MALT lymphoma should be considered as a possible diagnosis in patients with a solid and cystic thymic mass and autoimmune disease, including myasthenia gravis. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the clinical utility of staging chest CT in breast cancer by evaluating diagnostic yield (DY) of chest CT in detection of metastasis, according to the molecular subtype and clinical stage. This retrospective study included 840 patients with 855 breast cancers from January 2017 to December 2018. The number of patients in clinical stage 0/I, II, III and IV were 457 (53.5%), 298 (34.9%), 92 (10.8%) and 8 (0.9%), respectively. Molecular subtype was identified in 841 cancers and there were 709 (84.3%) luminal type, 55 (6.5%) human epidermal growth factor receptor 2 (HER2)-enriched type and 77 (9.2%) triple-negative (TN) type. The DYs in clinical stage 0/I, cII, cIII and cIV were 0.2% (1/457), 1.7% (5/298), 4.3% (4/92) and 100.0% (8/8), respectively. The DYs in luminal type, HER2-enriched type and TN type were 1.7% (12/709), 3.6% (2/55) and 2.6% (2/77), respectively. Clinical stage was associated with the DY (p = 0.000). However, molecular subtype was not related to the DY (p = 0.343). Molecular subtype could not provide useful information to determine whether staging chest CT should be performed in early-stage breast cancer. However, chest CT should be considered in advanced breast cancer. [ABSTRACT FROM AUTHOR]

Background: Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor with limited clinical data that can guide treatment choices. The diagnosis of EHE is based on its unique histological, immunohistochemical, and molecular characteristics. Differential diagnoses are broad and include autoimmune diseases. Treatments include hepatic resection, liver transplantation, systemic/regional chemotherapy, and radiotherapy., Case Description: We describe EHE in a patient with weight loss and general weakness. The prognosis of EHE is variable, with few cases demonstrating an indolent clinical course, whereas others tend to metastasize. In our case, hepatic EHE had metastasized to the lungs and brain. Histopathological examination of the liver tissue revealed an epithelial hemangioendothelioma. On CK7 staining, hepatocytes were clearly reactive and arranged in the plates (CK7: negative), with positive immunohistochemical staining for CD34 (CD34: positive) alone. Surveillance was conducted and the clinical course was better than expected, probably due to her relatively good general condition, the lack of genetic factors associated with her familial medical history, and normal levels of tumor markers such as α-fetoprotein and carcinoembryonic antigen (CEA). During a follow-up examination, she was asymptomatic with a healthy general appearance., Conclusions: The prognosis of EHE is variable, with few cases demonstrating an indolent clinical course, whereas others tend to metastasize. The treatment method for EHE should be determined according to the patient's condition., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://acr.amegroups.com/article/view/10.21037/acr-23-51/coif). The authors have no conflicts of interest to declare., (2024 AME Case Reports. All rights reserved.)

Objective: To assess whether computed tomography (CT) conversion across different scan parameters and manufacturers using a routable generative adversarial network (RouteGAN) can improve the accuracy and variability in quantifying interstitial lung disease (ILD) using a deep learning-based automated software., Materials and Methods: This study included patients with ILD who underwent thin-section CT. Unmatched CT images obtained using scanners from four manufacturers (vendors A-D), standard- or low-radiation doses, and sharp or medium kernels were classified into groups 1-7 according to acquisition conditions. CT images in groups 2-7 were converted into the target CT style (Group 1: vendor A, standard dose, and sharp kernel) using a RouteGAN. ILD was quantified on original and converted CT images using a deep learning-based software (Aview, Coreline Soft). The accuracy of quantification was analyzed using the dice similarity coefficient (DSC) and pixel-wise overlap accuracy metrics against manual quantification by a radiologist. Five radiologists evaluated quantification accuracy using a 10-point visual scoring system., Results: Three hundred and fifty CT slices from 150 patients (mean age: 67.6 ± 10.7 years; 56 females) were included. The overlap accuracies for quantifying total abnormalities in groups 2-7 improved after CT conversion (original vs. converted: 0.63 vs. 0.68 for DSC, 0.66 vs. 0.70 for pixel-wise recall, and 0.68 vs. 0.73 for pixel-wise precision; P < 0.002 for all). The DSCs of fibrosis score, honeycombing, and reticulation significantly increased after CT conversion (0.32 vs. 0.64, 0.19 vs. 0.47, and 0.23 vs. 0.54, P < 0.002 for all), whereas those of ground-glass opacity, consolidation, and emphysema did not change significantly or decreased slightly. The radiologists' scores were significantly higher ( P < 0.001) and less variable on converted CT., Conclusion: CT conversion using a RouteGAN can improve the accuracy and variability of CT images obtained using different scan parameters and manufacturers in deep learning-based quantification of ILD., Competing Interests: Joon Beom Seo, Namkug Kim, and Ho Yun Lee, contributing editors of the Korean Journal of Radiology, were not involved in the editorial evaluation or decision to publish this article. Jong Chul Ye, Hyunjong Kim, Joon Beom Seo, Sang Min Lee, and Hye Jeon Hwang hold a patent for tomography image processing method using single neural network based on unsupervised learning for image standardization and apparatus therefor (Patent No. KR-10-2021-0040878). In this study, this patented item was used. Joon Beom Seo and Namkug Kim hold a patent on a method for an automatic classifier of lung diseases (Patent No. KR-10-0998630) and have received royalty payments from Coreline Soft, Co., Ltd. Joon Beom Seo, Namkug Kim, Sang Min Lee holds stock/stock options in Coreline Soft, Co., Ltd., Korea. Hee Jun Park was an employee of Coreline Soft, Co., Ltd., Korea. All remaining authors have declared no conflicts of interest., (Copyright © 2023 The Korean Society of Radiology.)

Purpose: End-stage lung diseases result in anatomical changes of the thoracic cavity. However, very few studies have assessed changes in the thoracic cavity after lung transplantation (LTx). This study aimed to evaluate the relationships between thoracic cavity volume (TCV) changes after LTx and underlying lung disease., Methods: We reviewed 89 patients who underwent a pre-LTx pulmonary function test (PFT), chest computed tomography (CT) scan, and 1-year follow-up CT after LTx. These patients were classified into two groups according to pre-LTx PFT as follows: obstructive group [forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio < 70%] and restrictive group (FEV1/FVC ratio > 70%). We measured TCV using CT scan before and at 1 year after LTx and compared the TCV change in the two groups., Results: In the restrictive group, TCV increased after LTx (preop: 2,347.8 ± 709.5 mL, 1-year postop: 3,224.4 ± 919.0 mL, p < 0.001). In contrast, in the obstructive group, it decreased after LTx (preop: 4,662.9 ± 1,296.3 mL, 1-year postop: 3,711.1 ± 891.7 mL, p < 0.001). We observed that restrictive lung disease, taller stature, lower body mass index, and larger donor lung were independently associated with increased TCV after LTx., Conclusion: The disease-specific chest remodeling caused by restriction and hyperinflation is at least, in part, reversible. After LTx, the chest remodeling appears to occur in the opposite direction to the disease-specific remodeling caused by the underlying lung disease in recipients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Yu, Park, Paik, Lee, You, Shin, Jung and Haam.)

We explored whether baseline indexed epicardial fat volume (EFVi) and serial changes in EFVi were associated with increase in coronary plaque volume as assessed by multidetector computed tomography.We retrospectively reviewed 87 patients with coronary artery plaque, identified during either baseline or follow-up cardiac computed tomography (CT) examinations. Each plaque volume was measured in volumetric units using a semiautomatic software tool. EFVi was quantified by calculating the total volume of epicardial tissue of CT density -190 to -30 HU, indexed to the body surface area. Clinical cardiovascular risk factors were extracted by medical record review at the time of the cardiac CT examinations. The relationship between EFVi and coronary plaque volume was explored by regression analysis.Although the EFVi did not change significantly from baseline to the time of the follow-up CT (65.7 ± 21.8 vs 66.0 ± 21.8 cm/m, P = 0.620), the plaque volumes were increased significantly on the follow-up CT scans. The annual change in EFVi was not accompanied by a parallel change in coronary plaque volume (P = 0.096-0.500). On univariate analysis, smoking, hypercholesterolemia, 10-year coronary heart disease risk, obesity, and baseline EFVi predicted rapid increases in lipid-rich and fibrous plaque volumes. On multivariate analysis, baseline EFVi (odds ratio = 1.029, P = 0.016) was an independent predictor of a rapid increase in lipid-rich plaque volume.EFVi was shown to be an independent predictor of a rapid increase in lipid-rich plaque volume. However, changes in EFVi were not associated with parallel changes in coronary plaque volume., Competing Interests: The authors have no funding and conflicts of interest to disclose.