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Leonie Biener,1,&ast; Hussein Morobeid,1,&ast; Carmen Pizarro,1 Daniel Kuetting,2 Georg Nickenig,1 Dirk Skowasch1 1Department of Internal Medicine II – Cardiology, Pneumology, Angiology, University Hospital of Bonn, Bonn, Germany; 2Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, Bonn, Germany&ast;These authors contributed equally to this workCorrespondence: Leonie Biener, Department of Internal Medicine II – Cardiology, Pneumology, Angiology, University Hospital of Bonn, Venusberg Campus 1, Bonn, 53127, Germany, Email Leonie.Biener@ukbonn.deBackground: Patients with severe asthma (SA) benefit from biologic therapy substantially. However, the impact of smoking-related comorbidities remains unclear due to the exclusion of patients with ≥ 10 pack-years from asthma studies. Our aim was to examine the effects of emphysema on biologic treatment response in SA in this retrospective cohort study.Methods: Pulmonary emphysema was examined using computed tomography. Patients with SA were included and divided into two groups based on emphysema quantity (≥ 5% or < 5%). They received either anti-IgE (22.1%), anti-IL-5-(receptor) (52.3%), or anti-IL-4/IL-13 (25.6%) biologic therapy. Treatment response was assessed after 7.8 ± 2.5 months based on acute exacerbations (AE), oral corticosteroid (OCS) therapy, Asthma Control Test (ACT), forced expiratory volume in 1 second (FEV1) and using the Biologics Asthma Response Score (BARS).Results: This study comprised 86 patients (mean age 56.1 ± 12.8 years; 54% female). Half (43, 50.0%) were never-smokers, half ex-smokers with an average of 26.9 ± 18.2 pack-years. Patients with ≥ 5% emphysema were more often ex-smokers (80% vs 41%, p=0.002), had poorer lung function (FEV1 median 1.3 [interquartile range: 1.0;1.6] vs 1.8[1– 2;2.4] L, p=0.037), and more comorbid COPD (50% vs 21%, p=0.012). However, no significant differences were noted in treatment response regarding annualized AE rate (− 2.5[− 5;-1] vs − 3.0[− 5;-2] n/year, p=0.295) and OCS reduction (− 4[− 10;0] vs − 5[− 10;0] mg, p=0.691), ACT score (5[3;9] vs 4[0;9] points, p=0.579) or FEV1 improvement (0.03[− 0.15;0.25] vs 0.23[− 0.5;0.49] L, p=0.052), BARS (p=0.312), and remission rates (15.0% vs 19.7%, p=0.753).Conclusion: In patients with severe asthma, those with comorbid emphysema show similar treatment response to biologic therapy. Therefore, suitable patients should not be denied biologics due to the presence of emphysema.Keywords: severe asthma, emphysema, smoking, biologic therapy

Purpose: To explore the potential differences in epicardial adipose tissue (EAT) volume and attenuation measurements between photon-counting detector (PCD) and energy-integrating detector (EID)-CT systems., Methods: Fifty patients (mean age 69 ± 8 years, 41 male [82 %]) were prospectively enrolled for a research coronary CT angiography (CCTA) on a PCD-CT within 30 days after clinical EID-based CCTA. EID-CT acquisitions were reconstructed using a Bv40 kernel at 0.6 mm slice thickness. The PCD-CT acquisition was reconstructed at a down-sampled resolution (0.6 mm, Bv40; [PCD-DS]) and at ultra-high resolutions (PCD-UHR) with a 0.2 mm slice thickness and Bv40, Bv48, and Bv64 kernels. EAT segmentation was performed semi-automatically at about 1 cm intervals and interpolated to cover the whole epicardium within a threshold of -190 to -30 HU. A subgroup analysis was performed based on quartile groups created from EID-CT data and PCD-UHR Bv48 data. Differences were measured using repeated-measures ANOVA and the Friedman test. Correlations were tested using Pearson's and Spearman's rho, and agreement using Bland-Altman plots., Results: EAT volumes significantly differed between some reconstructions (e.g., Eid-Ct: 138 ml [IQR 100, 188]; PCD-DS: 147 ml [110, 206]; P<0.001). Overall, correlations between PCD-UHR and EID-CT EAT volumes were excellent, e.g. PCD-UHR Bv48 : r: 0.976 (95 % CI: 0.958, 0.987); P<0.001; with good agreement (mean bias: -9.5 ml; limits of agreement [LoA]: -40.6, 21.6). On the other hand, correlations regarding EAT attenuation was moderate, e.g. PCD-UHR BV48 : r: 0.655 (95 % CI: 0.461, 0.790); P<0.001; mean bias: 6.5 HU; LoA: -2.0, 15.0., Conclusion: EAT attenuation and volume measurements demonstrated different absolute values between PCD-UHR, PCD-DS as well as EID-CT reconstructions, but showed similar tendencies on an intra-individual level. New protocols and threshold ranges need to be developed to allow comparison between PCD-CT and EID-CT data., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: UJS receives institutional research support and / or personal fees from Bayer, Bracco, Elucid Bioimaging, Guerbet, HeartFlow, Keya Medical, and Siemens. AVS receives institutional research support and / or personal fees from Elucid Bioimaging and Siemens. TE received a speaker fee and travel support from Siemens, institutional research support by Siemens and is a consultant at Circle CVI. JOD is an employee of Siemens., (Copyright © 2024. Published by Elsevier B.V.)

Objectives: To implement and evaluate a super-fast and high-quality biparametric MRI (bpMRI) protocol for prostate imaging acquired at a new ultra-high gradient 3.0-T MRI system., Methods: Participants with clinically suspected prostate cancer prospectively underwent a multiparametric MRI (mpMRI) on a new 3.0-T MRI scanner (maximum gradient strength: 200 mT/m, maximum slew rate: 200 T/m/s). The bpMRI protocol was extracted from the full mpMRI protocol, including axial T2-weighted and diffusion-weighted (DWI) sequences (b0/800, b1500). Overall image quality was rated by two readers on a five-point Likert scale from (1) non-diagnostic to (5) excellent. PI-RADS 2.1 scores were assessed by three readers separately for the bpMRI and mpMRI protocols. Cohen's and Fleiss' κ were calculated for PI-RADS agreement between protocols and interrater reliability between readers, respectively., Results: Seventy-seven male participants (mean age, 66 ± 8 years) were included. Acquisition time of the bpMRI protocol was reduced by 62% (bpMRI: 5 min, 33 ± 21 s; mpMRI: 14 min, 50 ± 42 s). The bpMRI protocol showed excellent overall image quality for both the T2-weighted (median score both readers: 5 [IQR: 4-5]) and DWI (b1500) sequence (median score reader 1: 4 [IQR: 4-5]; reader 2: 4 [IQR: 4-4]). PI-RADS score agreement between protocols was excellent (Cohen's κ range: 0.91-0.95 [95% CI: 0.89, 0.99]) with an overall good interrater reliability (Fleiss' κ, 0.86 [95% CI: 0.80, 0.92])., Conclusion: Ultra-high gradient MRI allows the establishment of a high-quality and rapidly acquired bpMRI with high PI-RADS agreement to a full mpMRI protocol., Trials Registration: Clinicaltrials.gov, NCT06244680, Registered 06 February 2024, retrospectively registered, https://classic., Clinicaltrials: gov/ct2/show/NCT06244680 ., Critical Relevance Statement: A novel 3.0-Tesla MRI system with an ultra-high gradient performance enabled high-quality biparametric prostate MRI in 5.5 min while achieving excellent PI-RADS agreement with a standard multiparametric protocol., Key Points: Multi- and biparametric prostate MRIs were prospectively acquired utilizing a maximum gradient of 200 mT/m. Super-fast biparametric MRIs showed excellent image quality and had high PI-RADS agreement with multiparametric MRIs. Implementation of high gradient MRI in clinical routine allows accelerated and high-quality biparametric prostate examinations., Competing Interests: Declarations. Ethics approval and consent to participate: The institutional review committee (Ethikkommission Bonn) approved the prospective study under reference number 198/23-EP. Oral and written informed consent was acquired from any individual in this study before participation. Consent for publication: Consent for publication was acquired from any individual in this study before participation. Competing interests: A.I.: Grants from the Medical Faculty Bonn and the German Research Foundation. J.E.: Editorial Board member of Cancers. U.A.: Speakers bureau payments from Siemens; advisory board member for Bayer. Editorial Board member of Investigative Radiology and Die Radiologie. C.P.: Payment for lectures from Guerbet and Julius Zorn; support for attending meetings or travel from Guerbet and Julius Zorn; advisory board member for Guerbet. Editorial Board member of Investigative Radiology. J.L.: Consulting fees from Bayer; payment for presentation from Philips. Editorial Board member of Investigative Radiology, Radiology: Cardiothoracic Imaging, Die Radiologie and Frontiers in Cardiovascular Medicine. The other authors declare that they have no competing interests., (© 2024. The Author(s).)

Objectives: To compare standard-resolution balanced steady-state free precession (bSSFP) cine images with cine images acquired at low resolution but reconstructed with a deep learning (DL) super-resolution algorithm., Materials and Methods: Cine cardiovascular magnetic resonance (CMR) datasets (short-axis and 4-chamber views) were prospectively acquired in healthy volunteers and patients at normal (cine NR : 1.89 × 1.96 mm 2 , reconstructed at 1.04 × 1.04 mm 2 ) and at a low-resolution (2.98 × 3.00 mm 2 , reconstructed at 1.04 × 1.04 mm 2 ). Low-resolution images were reconstructed using compressed sensing DL denoising and resolution upscaling (cine DL ). Left ventricular ejection fraction (LVEF), end-diastolic volume index (LVEDVi), and strain were assessed. Apparent signal-to-noise (aSNR) and contrast-to-noise ratios (aCNR) were calculated. Subjective image quality was assessed on a 5-point Likert scale. Student's paired t-test, Wilcoxon matched-pairs signed-rank-test, and intraclass correlation coefficient (ICC) were used for statistical analysis., Results: Thirty participants were analyzed (37 ± 16 years; 20 healthy volunteers and 10 patients). Short-axis views whole-stack acquisition duration of cine DL was shorter than cine NR (57.5 ± 8.7 vs 98.7 ± 12.4 s; p < 0.0001). No differences were noted for: LVEF (59 ± 7 vs 59 ± 7%; ICC: 0.95 [95% confidence interval: 0.94, 0.99]; p = 0.17), LVEDVi (85.0 ± 13.5 vs 84.4 ± 13.7 mL/m 2 ; ICC: 0.99 [0.98, 0.99]; p = 0.12), longitudinal strain (-19.5 ± 4.3 vs -19.8 ± 3.9%; ICC: 0.94 [0.88, 0.97]; p = 0.52), short-axis aSNR (81 ± 49 vs 69 ± 38; p = 0.32), aCNR (53 ± 31 vs 45 ± 27; p = 0.33), or subjective image quality (5.0 [IQR 4.9, 5.0] vs 5.0 [IQR 4.7, 5.0]; p = 0.99)., Conclusion: Deep-learning reconstruction of cine images acquired at a lower spatial resolution led to a decrease in acquisition times of 42% with shorter breath-holds without affecting volumetric results or image quality., Key Points: Question Cine CMR acquisitions are time-intensive and vulnerable to artifacts. Findings Low-resolution upscaled reconstructions using DL super-resolution decreased acquisition times by 35-42% without a significant difference in volumetric results or subjective image quality. Clinical relevance DL super-resolution reconstructions of bSSFP cine images acquired at a lower spatial resolution reduce acquisition times while preserving diagnostic accuracy, improving the clinical feasibility of cine imaging by decreasing breath hold duration., (© 2024. The Author(s).)

Background: Coronary computed tomography angiography (CCTA) offers non-invasive diagnostics of the coronary arteries. Vessel evaluation requires the administration of intravenous contrast. The purpose of this study was to evaluate the utility of gadolinium-based contrast agent (GBCA) as an alternative to iodinated contrast for CCTA on a first-generation clinical dual-source photon-counting-detector (PCD)-CT system., Methods: A dynamic circulating phantom containing a three-dimensional-printed model of the thoracic aorta and the coronary arteries were used to evaluate injection protocols using gadopentetate dimeglumine at 50%, 100%, 150%, and 200% of the maximum approved clinical dose (0.3 mmol/kg). Virtual monoenergetic image (VMI) reconstructions ranging from 40 keV to 100 keV with 5 keV increments were generated on a PCD-CT. Contrast-to-noise ratio (CNR) was calculated from attenuations measured in the aorta and coronary arteries and noise measured in the background tissue. Attenuation of at least 350 HU was deemed as diagnostic., Results: The highest coronary attenuation (441 ± 23 HU, mean ± standard deviation) and CNR (29.5 ± 1.5) was achieved at 40 keV and at the highest GBCA dose (200%). There was a systematic decline of attenuation and CNR with higher keV reconstructions and lower GBCA doses. Only reconstructions at 40 and 45 keV at 200% and 40 keV at 150% GBCA dose demonstrated sufficient attenuation above 350 HU., Conclusion: Current PCD-CT protocols and settings are unsuitable for the use of GBCA for CCTA at clinically approved doses. Future advances to the PCD-CT system including a 4-threshold mode, as well as multi-material decomposition may add new opportunities for k-edge imaging of GBCA., Relevance Statement: Patients allergic to iodine-based contrast media and the future of multicontrast CT examinations would benefit greatly from alternative contrast media, but the utility of GBCA for coronary photon-counting-dector-CT angiography remains limited without further optimization of protocols and scanner settings., Key Points: GBCA-enhanced coronary PCD-CT angiography is not feasible at clinically approved doses. GBCAs have potential applications for the visualization of larger vessels, such as the aorta, on PCD-CT angiography. Higher GBCA doses and lower keV reconstructions achieved higher attenuation values and CNR., (© 2024. The Author(s).)

Objectives: To assess the prognostic value of cardiac MRI (CMR) parameters for the occurrence of major adverse cardiac events (MACE) in patients with infarct-like myocarditis., Methods: In this retrospective single-center study, patients with CMR-confirmed acute myocarditis with infarct-like presentation were identified (2007-2020). Functional and structural parameters were analyzed including late gadolinium enhancement (LGE). The primary endpoint was the occurrence of MACE up to 5 years after discharge., Results: In total, 130 patients (mean age, 40 ± 19 years; 97 men, 75%) with infarct-like myocarditis were included. CMR was conducted a median of 3 days (interquartile range [IQR], 1-5) after symptom onset. MACE occurred in 18/130 patients (14%) during a median follow-up of 19.3 months (IQR, 4.5-53). The median extent of LGE was 7% (IQR, 4-10). LGE affected the subepicardium in 111/130 patients (85%), the midwall in 45/130 patients (35%), and both the subepicardium and midwall in 27/130 patients (21%). Transmural extension of non-ischemic LGE lesions was observed in 15/130 patients (12%) and septal LGE in 42/130 patients (32%). In univariable Cox regression analysis, a significant association was found between the occurrence of MACE and both, quantified LGE extent and transmural LGE pattern. In multivariable analysis, transmural extension of LGE was an independent predictor for MACE (hazard ratio, 6.34; 95% confidence interval: 2.29-17.49; p < 0.001). Patients with the transmural extension of LGE had a shorter event-free time on Kaplan-Meier analysis (log-rank p < 0.001)., Conclusions: MACE occurred in 14% of patients with infarct-like myocarditis during follow-up. A transmural extension of non-ischemic LGE was associated with a worse long-term prognosis., Critical Relevance Statement: CMR-based assessment of transmural extension of non-ischemic LGE holds the potential to serve as an easily assessable marker for risk stratification in patients with infarct-like myocarditis., Key Points: The prognostic value of CMR was studied in patients with infarct-like myocarditis. The extent of LGE and transmural extension were linked to adverse cardiac events. Transmural non-ischemic LGE can serve as an easily assessable prognostic marker., (© 2024. The Author(s).)

Background: The acquisition of contrast-enhanced T1 maps to calculate extracellular volume (ECV) requires contrast agent administration and is time consuming. This study investigates generative adversarial networks for contrast-free, virtual extracellular volume (vECV) by generating virtual contrast-enhanced T1 maps., Methods and Results: This retrospective study includes 2518 registered native and contrast-enhanced T1 maps from 1000 patients who underwent cardiovascular magnetic resonance at 1.5 Tesla. Recent hematocrit values of 123 patients (hold-out test) and 96 patients from a different institution (external evaluation) allowed for calculation of conventional ECV. A generative adversarial network was trained to generate virtual contrast-enhanced T1 maps from native T1 maps for vECV creation. Mean and SD of the difference per patient (ΔECV) were calculated and compared by permutation of the 2-sided t test with 10 000 resamples. For ECV and vECV, differences in area under the receiver operating characteristic curve (AUC) for discriminating hold-out test patients with normal cardiovascular magnetic resonance versus myocarditis or amyloidosis were tested with Delong's test. ECV and vECV showed a high agreement in patients with myocarditis (ΔECV: hold-out test, 2.0%±1.5%; external evaluation, 1.9%±1.7%) and normal cardiovascular magnetic resonance (ΔECV: hold-out test, 1.9%±1.4%; external evaluation, 1.5%±1.2%), but variations in amyloidosis were higher (ΔECV: hold-out test, 6.2%±6.0%; external evaluation, 15.5%±6.4%). In the hold-out test, ECV and vECV had a comparable AUC for the diagnosis of myocarditis (ECV AUC, 0.77 versus vECV AUC, 0.76; P =0.76) and amyloidosis (ECV AUC, 0.99 versus vECV AUC, 0.96; P =0.52)., Conclusions: Generation of vECV on the basis of native T1 maps is feasible. Multicenter training data are required to further enhance generalizability of vECV in amyloidosis.

Aims: To evaluate different cardiovascular magnetic resonance (CMR) parameters for the differentiation of light chain amyloidosis (AL) and transthyretin-related amyloidosis (ATTR)., Methods and Results: In total, 75 patients, 53 with cardiac amyloidosis {20 patients with AL [66 ± 12 years, 14 males (70%)] and 33 patients with ATTR [78 ± 5 years, 28 males (88%)]} were retrospectively analysed regarding CMR parameters such as T1 and T2 mapping, extracellular volume (ECV), late gadolinium enhancement (LGE) distribution patterns, and myocardial strain, and compared to a control cohort with other causes of left ventricular hypertrophy {LVH; 22 patients [53 ± 16 years, 17 males (85%)]}. One-way ANOVA and receiver operating characteristic analysis were used for statistical analysis. ECV was the single best parameter to differentiate between cardiac amyloidosis and controls [area under the curve (AUC): 0.97, 95% confidence intervals (CI): 0.89-0.99, P < 0.0001, cut-off: >30%]. T2 mapping was the best single parameter to differentiate between AL and ATTR amyloidosis (AL: 63 ± 4 ms, ATTR: 58 ± 2 ms, P < 0.001, AUC: 0.86, 95% CI: 0.74-0.94, cut-off: >61 ms). Subendocardial LGE was predominantly observed in AL patients (10/20 [50%] vs. 5/33 [15%]; P = 0.002). Transmural LGE was predominantly observed in ATTR patients (23/33 [70%] vs. 2/20 [10%]; P < 0.001). The diagnostic performance of T2 mapping to differentiate between AL and ATTR amyloidosis was further increased with the inclusion of LGE patterns [AUC: 0.96, 95% CI: (0.86-0.99); P = 0.05]., Conclusion: ECV differentiates cardiac amyloidosis from other causes of LVH. T2 mapping combined with LGE differentiates AL from ATTR amyloidosis with high accuracy on a patient level., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Cardiovascular magnetic resonance (CMR) is an emerging imaging modality for assessing the anatomy and function of the fetal heart in congenital heart disease (CHD). This study aimed to evaluate myocardial strain using fetal CMR feature tracking (FT) in different subtypes of CHD., Methods: Fetal CMR FT analysis was retrospectively performed on four-chamber cine images acquired with Doppler ultrasound gating at 3T. Left ventricular (LV) global longitudinal strain (GLS), LV global radial strain (GRS), LV global longitudinal systolic strain rate, and right ventricular (RV) GLS were quantified using dedicated software optimized for fetal strain analysis. Analysis was performed in normal fetuses and different CHD subtypes (d-transposition of the great arteries [dTGA], hypoplastic left heart syndrome [HLHS], coarctation of the aorta [CoA], tetralogy of Fallot [TOF], RV-dominant atrioventricular septal defect [AVSD], and critical pulmonary stenosis or atresia [PS/PA]). Analysis of variance with Tukey post-hoc test was used for group comparisons., Results: A total of 60 fetuses were analyzed (8/60 (13%) without CHD, 52/60 (87%) with CHD). Myocardial strain was successfully assessed in 113/120 ventricles (94%). Compared to controls, LV GLS was significantly reduced in fetuses with HLHS (-18.6±2.7% vs -6.2±5.6%; p<0.001) and RV-dominant AVSD (-18.6±2.7% vs -7.7±5.0%; p = 0.003) and higher in fetuses with CoA (-18.6±2.7% vs -25.0±4.3%; p = 0.038). LV GRS was significantly reduced in fetuses with HLHS (25.7±7.5% vs 11.4±9.7%; p = 0.024). Compared to controls, RV GRS was significantly reduced in fetuses with PS/PA (-16.1±2.8% vs -8.3±4.2%; p = 0.007). Across all strain parameters, no significant differences were present between controls and fetuses diagnosed with dTGA and TOF., Conclusion: Fetal myocardial strain assessment with CMR FT in CHD is feasible. Distinct differences are present between various types of CHD, suggesting potential implications for clinical decision-making and prognostication in fetal CHD., Competing Interests: Declaration of competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

This retrospective study investigates perivascular adipose tissue (PVAT) alterations in CT as a marker of inflammation in patients with abdominal aortic aneurysms (AAA). 100 abdominal CT scans of patients with abdominal aortic aneurysms and 100 age and sex matched controls without underlying aortic disease were included. Artificial Intelligence (AI) assisted segmentation of the aorta and the surrounding adipose tissue was performed. Adipose tissue density was measured in Hounsfield units (HU) close (2-5mm, HU close ) and distant (10-12mm, HU distant ) to the aortic wall. To investigate alterations in adipose tissue density close to the aorta (HU close ) as a potential marker of inflammation, we calculated the difference HU Δ  = HU close -HU distant and the fat attenuation ratio HU ratio  = HU close /HU distant as normalized attenuation measures. These two markers were compared i) inter-individually between AAA patients and controls and ii) intra-individually between the aneurysmal and non-aneurysmal segments in AAA patients. Since most AAAs are generally observed infrarenal, the aneurysmal section of the AAA patients was compared with the infrarenal section of the aorta of the control patients. In inter-individual comparisons, higher HU Δ and a lower HU ratio were observed (aneurysmal: 8.9 ± 5.1 HU vs. control: 6.9 ± 4.8 HU, p-value = 0.006; aneurysmal: 89.8 ± 5.7% vs. control: 92.1 ± 5.5% p-value = 0.004). In intra-individual comparisons, higher HU Δ and lower HU ratio were observed (aneurysmal: 8.9 ± 5.1 HU vs. non-aneurysmal: 5.5 ± 4.1 HU, p-value < 0.001; aneurysmal: 89.8 ± 5.7% vs. non-aneurysmal 93.3 ± 4.9%, p-value < 0.001). The results indicate PVAT density alterations in AAA patients. This motivates further research to establish non-invasive imaging markers for vascular and perivascular inflammation in AAA., (© 2024. The Author(s).)

Light sheet fluorescence microscopy (LSFM) is a transformative imaging method that enables the visualization of non-dissected specimen in real-time 3D. Optical clearing of tissues is essential for LSFM, typically employing toxic solvents. Here, we test the applicability of a non-hazardous alternative, ethyl cinnamate (ECi). We comprehensively characterized autofluorescence (AF) spectra in diverse murine tissues-ocular globe, knee, and liver-employing LSFM under various excitation wavelengths (405-785 nm) to test the feasibility of unstained samples for diagnostic purposes, in particular regarding percutaneous biopsies, as they constitute to most harvested type of tissue sample in clinical routine. Ocular globe structures were best discerned with 640 nm excitation. Knee tissue showed complex variation in AF spectra variation influenced by tissue depth and structure. Liver exhibited a unique AF pattern, likely linked to vasculature. Hepatic tissue samples were used to demonstrate the compatibility of our protocol for antibody staining. Furthermore, we employed machine learning to augment raw images and segment liver structures based on AF spectra. Radiologists rated representative samples transferred to the clinical assessment software. Learning-generated images scored highest in quality. Additionally, we investigated an actual murine biopsy. Our study pioneers the application of AF spectra for tissue characterization and diagnostic potential of optically cleared unstained percutaneous biopsies, contributing to the clinical translation of LSFM., (© 2024. The Author(s).)

Purpose: Inflammatory changes in epicardial (EAT) and pericardial adipose tissue (PAT) are associated with increased overall cardiovascular risk. Using routine, preinterventional cardiac CT data, we examined the predictive value of quantity and quality of EAT and PAT for outcome after transcatheter aortic valve replacement (TAVR)., Materials and Methods: Cardiac CT data of 1197 patients who underwent TAVR at the in-house heart center between 2011 and 2020 were retrospectively analyzed. The amount and density of EAT and PAT were quantified from single-slice CT images at the level of the aortic valve. Using established risk scores and known independent risk factors, a clinical benchmark model (BMI, Chronic kidney disease stage, EuroSCORE 2, STS Prom, year of intervention) for outcome prediction (2-year mortality) after TAVR was established. Subsequently, we tested whether the additional inclusion of area and density values of EAT and PAT in the clinical benchmark model improved prediction. For this purpose, the cohort was divided into a training (n=798) and a test cohort (n=399)., Results: Within the 2-year follow-up, 264 patients died. In the training cohort, particularly the addition of EAT density to the clinical benchmark model showed a significant association with outcome (hazard ratio 1.04, 95% CI: 1.01-1.07; P =0.013). In the test cohort, the outcome prediction of the clinical benchmark model was also significantly improved with the inclusion of EAT density (c-statistic: 0.589 vs. 0.628; P =0.026)., Conclusions: EAT density as a surrogate marker of EAT inflammation was associated with 2-year mortality after TAVR and may improve outcome prediction independent of established risk parameters., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background & Aims: Loss of venous access is threatening for patients with intestinal failure (IF) under long-term parenteral nutrition (PN). We aimed to identify the incidence of central venous catheter (CVC) complications, compare different devices, and analyze interventional recanalizing procedures to restore the patency of occluded CVCs., Methods: For this retrospective cohort study, patient data from a prospective IF database spanning 16 years was analyzed at a tertiary referral center. Catheter dwell times (CDTs) were distinguished by Kaplan-Meier survival analysis and subgroup analyses were performed for different CVC types (tunneled/port catheters). Specific complications (occlusion, catheter-related infection (CRI), displacement, and material defect) were analyzed. Explantation rates and CDTs were compared., Results: Overall, 193 CVCs in 77 patients with IF under PN could be enrolled (62.524 "CVC-days"). Broviac type "B" was found to be significantly superior to type "A" regarding occlusion, CRI, and material defects (log-rank test: p = 0.05; p = 0.026; p = 0.005 respectively). Port catheters were displaying the highest incidence of CRI (2.13 events/1000 catheter days). Interventional catheter recanalization was performed 91 times and significantly increased the CDT from a median of 131 days (IQR: 62; 258) to 389 days (IQR: 262; 731) (Mann-Whitney-U-test: p= <0.001) without increasing complications., Conclusions: Different complication rates and CDT were seen depending on CVC type. Tunneled catheters were significantly superior concerning CRI. Interventional catheter recanalization is a viable alternative to fibrinolytics to restore CVC patency, but long-term patency data is scarce., Competing Interests: Conflict of interest None declared., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Rationale and Objectives: Aim of this study was to assess the impact of contrast media dose (CMD) reduction on diagnostic quality of photon-counting detector CT (PCD-CT) and energy-integrating detector CT (EID-CT)., Methods: CT scans of the abdominal region with differing CMD acquired in portal venous phase on a PCD-CT were included and compared to EID-CT scans. Diagnostic quality and contrast intensity were rated. Additionally, readers had to assign the scans to reduced or regular CMD. Regions-of-interest (ROIs) were placed in defined segments of portal vein, inferior vena cava, liver, spleen, kidneys, abdominal aorta and muscular tissue. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated., Results: Overall 158 CT scans performed on a PCD-CT and 68 examinations on an EID-CT were analyzed. Overall diagnostic quality showed no significant differences for PCD-CT with standard CMD which scored a median 5 (IQR:5-5) and PCD-CT with 70% CMD scoring 5 (4-5). (For PCD-CT, 71.69% of the examinations with reduced CMD were assigned to regular CMD by the readers, for EID-CT 9.09%. Averaged for all measurements SNR for 50% CMD was reduced by 19% in PCD-CT (EID-CT 34%) and CNR by 48% (EID-CT 56%). Virtual monoenergetic images (VMI) 50keV for PCD-CT images acquired with 50% CMD showed an increase in SNR by 72% and CNR by 153%., Conclusions: Diagnostic interpretability of PCD-CT examinations with reduction of up to 50% CMD is maintained. PCD-CT deducted scans especially with 70% CMD were often not recognized as CMD reduced scans. Compared to EID-CT less decline in SNR and CNR is observed for CMD reduced PCD-CT images. Employing VMI 50keV for CMD-reduced PCD-CT images compensated for the effects., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Yannik Christian Layer reports a relationship with 10.13039/501100004830Siemens Healthcare AG that includes: funding grants., (© 2024 The Authors.)

Purpose: Due to a lack of data, there is an ongoing debate regarding the optimal frontline interventional therapy for unresectable hepatocellular carcinoma (HCC). The aim of the study is to compare the results of transarterial radioembolization (TARE) as the first-line therapy and as a subsequent therapy following prior transarterial chemoembolization (TACE) in these patients., Methods: A total of 83 patients were evaluated, with 38 patients having undergone at least one TACE session prior to TARE [27 male; mean age 67.2 years; 68.4% stage Barcelona clinic liver cancer (BCLC) B, 31.6% BCLC C]; 45 patients underwent primary TARE (33 male; mean age 69.9 years; 40% BCLC B, 58% BCLC C). Clinical [age, gender, BCLC stage, activity in gigabecquerel (GBq), Child-Pugh status, portal vein thrombosis, tumor volume] and procedural [overall survival (OS), local tumor control (LTC), and progression-free survival (PFS)] data were compared. A regression analysis was performed to evaluate OS, LTC, and PFS., Results: No differences were found in OS (95% CI: 1.12, P  = 0.289), LTC (95% CI: 0.003, P  = 0.95), and PFS (95% CI: 0.4, P  = 0.525). The regression analysis revealed a relationship between Child-Pugh score ( P  = 0.005), size of HCC lesions (>10 cm) ( P  = 0.022), and OS; neither prior TACE (Child-Pugh B patients; 95% CI: 0.120, P  = 0.729) nor number of lesions (>10; 95% CI: 2.930, P  = 0.087) correlated with OS., Conclusion: Prior TACE does not affect the outcome of TARE in unresectable HCC., 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., (© 2024 Wagenpfeil, Kupczyk, Bruners, Siepmann, Guendel, Luetkens, Isaak, Meyer, Kuetting, Pieper, Attenberger and Kuetting.)

Purpose: This study aims to evaluate deep learning (DL) denoising reconstructions for image quality improvement of Doppler ultrasound (DUS)-gated fetal cardiac MRI in congenital heart disease (CHD)., Methods: Twenty-five fetuses with CHD (mean gestational age: 35 ± 1 weeks) underwent fetal cardiac MRI at 3T. Cine imaging was acquired using a balanced steady-state free precession (bSSFP) sequence with Doppler ultrasound gating. Images were reconstructed using both compressed sensing (bSSFP CS) and a pre-trained convolutional neural network trained for DL denoising (bSSFP DL). Images were compared qualitatively based on a 5-point Likert scale (from 1 = non-diagnostic to 5 = excellent) and quantitatively by calculating the apparent signal-to-noise ratio (aSNR) and contrast-to-noise ratio (aCNR). Diagnostic confidence was assessed for the atria, ventricles, foramen ovale, valves, great vessels, aortic arch, and pulmonary veins., Results: Fetal cardiac cine MRI was successful in 23 fetuses (92%), with two studies excluded due to extensive fetal motion. The image quality of bSSFP DL cine reconstructions was rated superior to standard bSSFP CS cine images in terms of contrast [3 (interquartile range: 2-4) vs. 5 (4-5), P  < 0.001] and endocardial edge definition [3 (2-4) vs. 4 (4-5), P  < 0.001], while the extent of artifacts was found to be comparable [4 (3-4.75) vs. 4 (3-4), P  = 0.40]. bSSFP DL images had higher aSNR and aCNR compared with the bSSFP CS images (aSNR: 13.4 ± 6.9 vs. 8.3 ± 3.6, P  < 0.001; aCNR: 26.6 ± 15.8 vs. 14.4 ± 6.8, P  < 0.001). Diagnostic confidence of the bSSFP DL images was superior for the evaluation of cardiovascular structures (e.g., atria and ventricles: P  = 0.003)., Conclusion: DL image denoising provides superior quality for DUS-gated fetal cardiac cine imaging of CHD compared to standard CS image reconstruction., Competing Interests: Authors SZ and CK were employed by Philips GmbH Market DACH. The remaining 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. The authors declared that they were editorial board members of Frontiers at the time of submission. This had no impact on the peer review process or the final decision., (© 2024 Vollbrecht, Hart, Zhang, Katemann, Sprinkart, Isaak, Attenberger, Pieper, Kuetting, Geipel, Strizek and Luetkens.)

Aim of this study was to assess the impact of virtual monoenergetic images (VMI) on dental implant artifacts in photon-counting detector computed tomography (PCD-CT) compared to standard reconstructed polychromatic images (PI). 30 scans with extensive (≥ 5 dental implants) dental implant-associated artifacts were retrospectively analyzed. Scans were acquired during clinical routine on a PCD-CT. VMI were reconstructed for 100-190 keV (10 keV steps) and compared to PI. Artifact extent and assessment of adjacent soft tissue were rated using a 5-point Likert grading scale for qualitative assessment. Quantitative assessment was performed using ROIs in most pronounced hypodense and hyperdense artifacts, artifact-impaired soft tissue, artifact-free fat and muscle tissue. A corrected attenuation was calculated as difference between artifact-impaired tissue and tissue without artifacts. Qualitative assessment of soft palate and cheeks improved for all VMI compared to PI (Median PI: 1 (Range: 1-3) and 1 (1-3); e.g. VMI 130 keV 2 (1-5); p < 0.0001 and 2 (1-4); p < 0.0001). In quantitative assessment, VMI 130 keV showed best results with a corrected attenuation closest to 0 (PI: 30.48 ± 98.16; VMI 130 keV : - 0.55 ± 73.38; p = 0.0026). Overall, photon-counting deducted VMI reduce the extent of dental implant-associated artifacts. VMI of 130 keV showed best results and are recommended to support head and neck CT scans., (© 2024. The Author(s).)

Prognosis estimation in patients with cardiogenic shock (CS) is important to guide clinical decision making. Aim of this study was to investigate the predictive value of opportunistic CT-derived body composition analysis in CS patients. Amount and density of fat and muscle tissue of 152 CS patients were quantified from single-slice CT images at the level of the intervertebral disc space L3/L4. Multivariable Cox regression and Kaplan-Meier survival analyses were performed to evaluate the predictive value of opportunistically CT-derived body composition parameters on the primary endpoint of 30-day mortality. Within the 30-day follow-up, 90/152 (59.2%) patients died. On multivariable analyses, lactate (Hazard Ratio 1.10 [95% Confidence Interval 1.04-1.17]; p = 0.002) and patient age (HR 1.04 [95% CI 1.01-1.07], p = 0.017) as clinical prognosticators, as well as visceral adipose tissue (VAT) area (HR 1.004 [95% CI 1.002-1.007]; p = 0.001) and skeletal muscle (SM) area (HR 0.987 [95% CI 0.975-0.999]; p = 0.043) as imaging biomarkers remained as independent predictors of 30-day mortality. Kaplan-Meier survival analyses showed significantly increased 30-day mortality in patients with higher VAT area (p = 0.015) and lower SM area (p = 0.035). CT-derived VAT and SM area are independent predictors of dismal outcomes in CS patients and have the potential to emerge as new imaging biomarkers available from routine diagnostic CT., (© 2023. The Author(s).)

Background Deep learning (DL) reconstructions can enhance image quality while decreasing MRI acquisition time. However, DL reconstruction methods combined with compressed sensing for prostate MRI have not been well studied. Purpose To use an industry-developed DL algorithm to reconstruct low-resolution T2-weighted turbo spin-echo (TSE) prostate MRI scans and compare these with standard sequences. Materials and Methods In this prospective study, participants with suspected prostate cancer underwent prostate MRI with a Cartesian standard-resolution T2-weighted TSE sequence (T2 C ) and non-Cartesian standard-resolution T2-weighted TSE sequence (T2 NC ) between August and November 2022. Additionally, a low-resolution Cartesian DL-reconstructed T2-weighted TSE sequence (T2 DL ) with compressed sensing DL denoising and resolution upscaling reconstruction was acquired. Image sharpness was assessed qualitatively by two readers using a five-point Likert scale (from 1 = nondiagnostic to 5 = excellent) and quantitatively by calculating edge rise distance. The Friedman test and one-way analysis of variance with post hoc Bonferroni and Tukey tests, respectively, were used for group comparisons. Prostate Imaging Reporting and Data System (PI-RADS) score agreement between sequences was compared by using Cohen κ. Results This study included 109 male participants (mean age, 68 years ± 8 [SD]). Acquisition time of T2 DL was 36% and 29% lower compared with that of T2 C and T2 NC (mean duration, 164 seconds ± 20 vs 257 seconds ± 32 and 230 seconds ± 28; P < .001 for both). T2 DL showed improved image sharpness compared with standard sequences using both qualitative (median score, 5 [IQR, 4-5] vs 4 [IQR, 3-4] for T2 C and 4 [IQR, 3-4] for T2 NC ; P < .001 for both) and quantitative (mean edge rise distance, 0.75 mm ± 0.39 vs 1.15 mm ± 0.68 for T2 C and 0.98 mm ± 0.65 for T2 NC ; P < .001 and P = .01) methods. PI-RADS score agreement between T2 NC and T2 DL was excellent (κ range, 0.92-0.94 [95% CI: 0.87, 0.98]). Conclusion DL reconstruction of low-resolution T2-weighted TSE sequences enabled accelerated acquisition times and improved image quality compared with standard acquisitions while showing excellent agreement with conventional sequences for PI-RADS ratings. Clinical trial registration no. NCT05820113 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Turkbey in this issue.

Objectives: To find simple imaging-based features on cardiac magnetic resonance (CMR) that are associated with major adverse cardiovascular events (MACE) in takotsubo syndrome (TTS)., Methods: Patients with TTS referred for CMR between 2007 and 2021 were retrospectively evaluated. Besides standard CMR analysis, commonly known complications of TTS based on expert knowledge were assessed and summarised via a newly developed PE 2 RT score (one point each for pleural effusion, pericardial effusion, right ventricular involvement, and ventricular thrombus). Clinical follow-up data was reviewed up to three years after discharge. The relationship between PE 2 RT features and the occurrence of MACE (cardiovascular death or new hospitalisation due to acute myocardial injury, arrhythmia, or chronic heart failure) was examined using Cox regression analysis and Kaplan-Meier estimator., Results: Seventy-nine patients (mean age, 68 ± 14 years; 72 women) with TTS were included. CMR was performed in a median of 4 days (IQR, 2-6) after symptom onset. Over a median follow-up of 13.3 months (IQR, 0.4-36.0), MACE occurred in 14/79 (18%) patients: re-hospitalisation due to acute symptoms (9/79, 11%) or chronic heart failure symptoms (4/79, 5%), and cardiac death (1/79, 1%). Patients with MACE had a higher PE 2 RT score (median [IQR], 2 [2-3] vs 1 [0-1]; p < 0.001). PE 2 RT score was associated with MACE on Cox regression analysis (hazard ratio per PE 2 RT feature, 2.44; 95%CI: 1.62-3.68; p < 0.001). Two or more PE 2 RT complications were strongly associated with the occurrence of MACE (log-rank p < 0.001)., Conclusions: The introduced PE 2 RT complication score might enable an easy-to-assess outcome evaluation of TTS patients by CMR., Key Points: • Complications like pericardial effusion, pleural effusion, right ventricular involvement, and ventricular thrombus (summarised as PE 2 RT features) are relatively common in takotsubo syndrome. • The proposed PE 2 RT score (one point per complication) was associated with the occurrence of major adverse cardiac events on follow-up. • Complications easily detected by cardiac magnetic resonance imaging can help clinicians derive long-term prognostic information on patients with takotsubo syndrome., (© 2023. The Author(s).)