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Mircea Gabriel Stoleriu,1,2,&ast; Michael Pienn,3,4,&ast; Rudolf A Joerres,5 Peter Alter,6 Tamas Fero,7 Martin Urschler,8 Gabor Kovacs,3,9 Horst Olschewski,3,9 Hans-Ulrich Kauczor,7,10 Mark Wielpütz,7,10 Bertram Jobst,7,10 Tobias Welte,11 Jürgen Behr,2,12 Franziska C Trudzinski,10,13 Robert Bals,14,15 Henrik Watz,16 Claus F Vogelmeier,6 Jürgen Biederer,10,17,18,&ast; Kathrin Kahnert2,12,19,&ast; On behalf of the COSYCONET Study Group1Division for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Medical Center; Munich-Gauting, Gauting, 82131, Germany; 2Institute for Lung Health and Immunity and Comprehensive Pneumology Center with the CPC-M bioArchive; Helmholtz Center Munich; Member of the German Lung Research Center (DZL), Munich, 81377, Germany; 3Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; 4Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; 5Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Hospital of Ludwig-Maximilians-University Munich (LMU), Munich, 80336, Germany; 6Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, 35033, Germany; 7Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; 8Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria; 9University Clinic for Internal Medicine, Medical University of Graz, Division of Pulmonology, Graz, Austria; 10Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany; 11Department of Respiratory Medicine and Infectious Disease, Member of the German Center of Lung Research, Hannover School of Medicine, Hannover, Germany; 12Department of Medicine V, LMU University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Munich, Germany; 13Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany; 14Department of Internal Medicine V-Pulmonology, Allergology and Respiratory Critical Care Medicine, Saarland University, Homburg, 66421, Germany; 15Helmholtz Institute for Pharmaceutical Research, Saarbrücken, 66123, Germany; 16Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Centre North, German Centre for Lung Research, Großhansdorf, Germany; 17Faculty of Medicine, Christian-Albrechts-Universität Zu Kiel, Kiel, Germany; 18University of Latvia, Faculty of Medicine, Riga, LV-1586, Latvia; 19MediCenterGermering, Germering, Germany&ast;These authors contributed equally to this workCorrespondence: Mircea Gabriel Stoleriu, Division of Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Marchioninistr. 15, 81377 Munich and Robert-Koch-Allee 2, Gauting, 82131, Germany, Tel +49 89 85791 4201, Email gabriel.stoleriu@helmholtz-munich.dePurpose: The aim of this study was to evaluate the association between computed tomography (CT) quantitative pulmonary vessel morphology and lung function, disease severity, and mortality risk in patients with chronic obstructive pulmonary disease (COPD).Patients and Methods: Participants of the prospective nationwide COSYCONET cohort study with paired inspiratory-expiratory CT were included. Fully automatic software, developed in-house, segmented arterial and venous pulmonary vessels and quantified volume and tortuosity on inspiratory and expiratory scans. The association between vessel volume normalised to lung volume and tortuosity versus lung function (forced expiratory volume in 1 sec [FEV1]), air trapping (residual volume to total lung capacity ratio [RV/TLC]), transfer factor for carbon monoxide (TLCO), disease severity in terms of Global Initiative for Chronic Obstructive Lung Disease (GOLD) group D, and mortality were analysed by linear, logistic or Cox proportional hazard regression.Results: Complete data were available from 138 patients (39% female, mean age 65 years). FEV1, RV/TLC and TLCO, all as % predicted, were significantly (p < 0.05 each) associated with expiratory vessel characteristics, predominantly venous volume and arterial tortuosity. Associations with inspiratory vessel characteristics were absent or negligible. The patterns were similar for relationships between GOLD D and mortality with vessel characteristics. Expiratory venous volume was an independent predictor of mortality, in addition to FEV1.Conclusion: By using automated software in patients with COPD, clinically relevant information on pulmonary vasculature can be extracted from expiratory CT scans (although not inspiratory scans); in particular, expiratory pulmonary venous volume predicted mortality.Trial Registration: NCT01245933.Keywords: COPD, computed tomography, pulmonary vasculature, vessel volume, vessel tortuosity, lung function

Objectives: We hypothesized that semiquantitative visual scoring of lung MRI is suitable for GOLD-grade specific characterization of parenchymal and airway disease in COPD and that MRI scores correlate with quantitative CT (QCT) and pulmonary function test (PFT) parameters., Methods: Five hundred ninety-eight subjects from the COSYCONET study (median age = 67 (60-72)) at risk for COPD or with GOLD1-4 underwent PFT, same-day paired inspiratory/expiratory CT, and structural and contrast-enhanced MRI. QCT assessed total lung volume (TLV), emphysema, and air trapping by parametric response mapping (PRM Emph , PRM fSAD ) and airway disease by wall percentage (WP). MRI was analyzed using a semiquantitative visual scoring system for parenchymal defects, perfusion defects, and airway abnormalities. Descriptive statistics, Spearman correlations, and ANOVA analyses were performed., Results: TLV, PRM Emph , and MRI scores for parenchymal and perfusion defects were all higher with each GOLD grade, reflecting the extension of emphysema (all p < 0.001). Airway analysis showed the same trends with higher WP and higher MRI large airway disease scores in GOLD3 and lower WP and MRI scores in GOLD4 (p = 0.236 and p < 0.001). Regional heterogeneity was less evident on MRI, while PRM Emph and MRI perfusion defect scores were higher in the upper lobes, and WP and MRI large airway disease scores were higher in the lower lobes. MRI parenchymal and perfusion scores correlated moderately with PRM Emph (r = 0.61 and r = 0.60) and moderately with FEV1/FVC (r = -0.56)., Conclusion: Multi-center semiquantitative MRI assessments of parenchymal and airway disease in COPD matched GOLD grade-specific imaging features on QCT and detected regional disease heterogeneity. MRI parenchymal disease scores were correlated with QCT and lung function parameters., Key Points: Question Do MRI-based scores correlate with QCT and PFT parameters for GOLD-grade specific disease characterization of COPD? Findings MRI can visualize the parenchymal and airway disease features of COPD. Clinical relevance Lung MRI is suitable for GOLD-grade specific disease characterization of COPD and may serve as a radiation-free imaging modality in scientific and clinical settings, given careful consideration of its potential and limitations., Competing Interests: Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Philip Konietzke. Conflict of interest: P.K. has no relevant relationships. O.W. airway analysis technology is licensed to Imbio, LLC. S.M.F.T. has no relevant relationships. S.N. has no relevant relationships. F.W. has no relevant relationships. M.K. employee at Boehringer Ingelheim. B.J.J. has no relevant relationships. C.F.V. grants or contracts from the German Ministry of Education and Science (BMBF), AstraZeneca, Boehringer Ingelheim, Grifols, GlaxoSmithKline, and Novartis; consulting fees from Aerogen, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, and Nuvaira; payment or honoraria for lectures/presentations from Aerogen, AstraZeneca, Boehringer Ingelheim. R.A.J. has no relevant relationships. H.-U.K. Bayer provided consumables to the consortium; the institution receives payment from Siemens, Philips, and Boehringer Ingelheim; consulting fees to the author from Median; and payment or honoraria for lectures/presentations to the author from Siemens, Philips, Boehringer Ingelheim, MSD, and Sanofi. C.P.H. grants/contracts from Siemens (2012–2014), Pfizer (2012–2014), MeVis (2012, 2013), Boehringer Ingelheim (2014), and German Center for Lung Research (2011ff); consulting fees from Schering-Plough (2009 and 2010), Pfizer (2008–2014), Basilea (2008, 2009, and 2010), Boehringer Ingelheim (2010–2014), Novartis (2010, 2012, and 2014), Roche (2010), Astellas (2011 and 2012), Gilead (2011–2015), MSD (2011–2013), Lilly (2011), Intermune (2013–2014), and Fresenius (2013 and 2014); lecture fees from Gilead (2008–2014), Essex (2008, 2009, and 2010), Schering-Plough (2008, 2009, and 2010), AstraZeneca (2008–2014 and 2022), Lilly (2008, 2009, and 2012), Roche (2008 and 2009), MSD (2009–2014), Pfizer (2010–2014), Bracco (2010 and 2011), MEDA Pharma (2011), Intermune (2011–2014), Chiesi (2012), Siemens (2012), Covidien (2012), Pierre Fabre (2012), Boehringer Ingelheim (2012, 2013, and 2022), Grifols (2012), Novartis (2013–2016), Basilea (2015 and 2016), and Bayer (2016); patent: Method and Device For Representing the Microstructure of the Lungs. IPC8 Class: AA61B5055FI, PAN: 20080208038, Inventors: W Schreiber, U Wolf, AW Scholz, C.P.H.; participation on a data safety monitoring board or advisory board: Schering-Plough (2009 and 2010), Pfizer (2008–2014), Basilea (2008, 2009, and 2010), Boehringer Ingelheim (2010–2014, 2022ff), Novartis (2010, 2012, and 2014), Roche (2010), Astellas (2011 and 2012), Gilead (2011–2015), MSD (2011–2013), Lilly (2011), Intermune (2013–2014), Fresenius (2013 and 2014); leadership or fiduciary roles: chest working group of the German Roentgen Society (national guidelines: bronchial carcinoma, mesothelioma, COPD, screening for bronchial carcinoma, CT and MRI of the chest, pneumonia); consultant of ECIL-3, ECCMID, EORTC/MSG (guideline for diagnosis of infections in immunocompromised hosts); founding member of the working team in infections in immunocompromised hosts of the German Society of Hematology/Oncology (guideline for diagnosis of infections in immunocompromised hosts); faculty member of European Society of Thoracic Radiology (ESTI), European Respiratory Society (ERS), and member in EIBALL (European Imaging Biomarkers Alliance); editor of Medizinische Klinik, Intensivmedizin und Notfallmedizin at Springer publishing; stock/stock options GSK. B.J.J. has no relevant relationships. M.O.W. Bayer provided contrast material for MRI examinations; study grants were paid to institutions from Vertex Pharmaceuticals and Boehringer Ingelheim; and consultancy fees were paid to institutions from Vertex Pharmaceuticals and Boehringer Ingelheim. J.B. Siemens Healthineers helped with MRI protocol design; Bayer provided contrast material used in the study; payment for honorarium for presentation at a workshop from Roche, Boehringer Ingelheim, and Fuji; and president of the European Society of Thoracic Imaging 2022–2023. Statistics and biometry: No complex statistical methods were necessary for this paper. Informed consent: Written informed consent was obtained from all subjects (patients) in this study. Ethical approval: Institutional ethics committee approval was obtained (Ethik-Kommission der Medizinischen Fakultät der Universität Heidelberg, S-656/2012) and all subjects gave their written informed consent prior to the study conduct. Study subjects or cohorts overlap: Some study subjects or cohorts have been previously reported in https://doi.org/10.1007/s00330-024-10610-0 (Phenotyping of COPD with MRI in comparison to same-day CT in a multi-center trial) and “COPD phenotyping based on QCT” (under review). Methodology: Prospective Observational Multicenter study, (© 2025. The Author(s).)

Background: Pleural infections present significant clinical challenges, particularly in elderly or immunosuppressed patients, leading to prolonged hospital stay, high morbidity and high mortality. While CT and X-ray are standard imaging modalities, MRI's potential remain unexplored due to historical limitations in scan duration and patient discomfort. Advances in MRI technology, however, may enable its broader use in thoracic imaging. The study aimed to explore the feasibility of thoracic MRI from the radiographers' and patients' perspectives., Methods: A prospective feasibility study was conducted involving thirteen patients with pleural infections who underwent thoracic MRI as an add-on within 48 h of the conventional contrast-enhanced chest CT. Feasibility was assessed on technical success, and scan duration. Patients and radiographers experiences were evaluated through questionnaires and qualitative comments., Results: Technical success was high as all thirteen patients completed the scans. The mean in-room time was 30.7±5.5 minutes and the mean scan time was 23 ± 5.4 minutes. Radiographers reported the MRI scans as feasible with few patients requiring breaks or assistance. Most patients found the MRI experience manageable though two reported difficulties with breath-hold instructions. No patients were challenged by lying in supine position and no patients felt very anxious. No significant movement- or breathing artefacts were identified on MRI., Conclusion: Thoracic MRI is feasible with high technical success, acceptable scan time, and good patient experience in patients with pleural infections offering potential as a radiation-free imaging modality. Furthermore, compared to CT, the use of MRI showed potential advantages in identifying pleural effusion septations., Competing Interests: Declaration of competing interest None of the authors have conflicts of interest related to this project., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Fibrotic lung diseases (FLDs) represent a subgroup of interstitial lung diseases (ILDs), which can progress over time and carry a poor prognosis. Imaging has increased diagnostic discrimination in the evaluation of FLDs. International guidelines have stated the role of radiologists in the diagnosis and management of FLDs, in the context of the interdisciplinary discussion. Chest computed tomography (CT) with high-resolution technique is recommended to correctly recognise signs, patterns, and distribution of individual FLDs. Radiologists may be the first to recognise the presence of previously unknown interstitial lung abnormalities (ILAs) in various settings. A systematic approach to CT images may lead to a non-invasive diagnosis of FLDs. Careful comparison of serial CT exams is crucial in determining either disease progression or supervening complications. This 'Essentials' aims to provide radiologists a concise and practical approach to FLDs, focusing on CT technical requirements, pattern recognition, and assessment of disease progression and complications. Hot topics such as ILAs and progressive pulmonary fibrosis (PPF) are also discussed. KEY POINTS: Chest CT with high-resolution technique is the recommended imaging modality to diagnose pulmonary fibrosis. CT pattern recognition is central for an accurate diagnosis of fibrotic lung diseases (FLDs) by interdisciplinary discussion. Radiologists are to evaluate disease behaviour by accurately comparing serial CT scans., (© 2024. The Author(s).)

Objectives: A prospective, multi-centre study to evaluate concordance of morphologic lung MRI and CT in chronic obstructive pulmonary disease (COPD) phenotyping for airway disease and emphysema., Methods: A total of 601 participants with COPD from 15 sites underwent same-day morpho-functional chest MRI and paired inspiratory-expiratory CT. Two readers systematically scored bronchial wall thickening, bronchiectasis, centrilobular nodules, air trapping and lung parenchyma defects in each lung lobe and determined COPD phenotype. A third reader acted as adjudicator to establish consensus. Inter-modality and inter-reader agreement were assessed using Cohen's kappa (im-κ and ir-κ)., Results: The mean combined MRI score for bronchiectasis/bronchial wall thickening was 4.5/12 (CT scores, 2.2/12 for bronchiectasis and 6/12 for bronchial wall thickening; im-κ, 0.04-0.3). Expiratory right/left bronchial collapse was observed in 51 and 47/583 on MRI (62 and 57/599 on CT; im-κ, 0.49-0.52). Markers of small airways disease on MRI were 0.15/12 for centrilobular nodules (CT, 0.34/12), 0.94/12 for air trapping (CT, 0.9/12) and 7.6/12 for perfusion deficits (CT, 0.37/12 for mosaic attenuation; im-κ, 0.1-0.41). The mean lung defect score on MRI was 1.3/12 (CT emphysema score, 5.8/24; im-κ, 0.18-0.26). Airway-/emphysema/mixed COPD phenotypes were assigned in 370, 218 and 10 of 583 cases on MRI (347, 218 and 34 of 599 cases on CT; im-κ, 0.63). For all examined features, inter-reader agreement on MRI was lower than on CT., Conclusion: Concordance of MRI and CT for phenotyping of COPD in a multi-centre setting was substantial with variable inter-modality and inter-reader concordance for single diagnostic key features., Clinical Relevance Statement: MRI of lung morphology may well serve as a radiation-free imaging modality for COPD in scientific and clinical settings, given that its potential and limitations as shown here are carefully considered., Key Points: • In a multi-centre setting, MRI and CT showed substantial concordance for phenotyping of COPD (airway-/emphysema-/mixed-type). • Individual features of COPD demonstrated variable inter-modality concordance with features of pulmonary hypertension showing the highest and bronchiectasis showing the lowest concordance. • For all single features of COPD, inter-reader agreement was lower on MRI than on CT., (© 2024. The Author(s).)

Introduction: The aim of this study was to apply quantitative computed tomography (QCT) for GOLD-grade specific disease characterization and phenotyping of air-trapping, emphysema, and airway abnormalities in patients with chronic obstructive pulmonary disease (COPD) from a nationwide cohort study., Methods: As part of the COSYCONET multicenter study, standardized CT in ex- and inspiration, lung function assessment (FEV1/FVC), and clinical scores (BODE index) were prospectively acquired in 525 patients (192 women, 327 men, aged 65.7 ± 8.5 years) at risk for COPD and at GOLD1-4. QCT parameters such as total lung volume (TLV), emphysema index (EI), parametric response mapping (PRM) for emphysema (PRMEmph) and functional small airway disease (PRMfSAD), total airway volume (TAV), wall percentage (WP), and total diameter (TD) were computed using automated software., Results: TLV, EI, PRMfSAD, and PRMEmph increased incrementally with each GOLD grade (p &lt; 0.001). Aggregated WP5-10 of subsegmental airways was higher from GOLD1 to GOLD3 and lower again at GOLD4 (p &lt; 0.001), whereas TD5-10 was significantly dilated only in GOLD4 (p &lt; 0.001). Fifty-eight patients were phenotyped as "non-airway non-emphysema type," 202 as "airway type," 96 as "emphysema type," and 169 as "mixed type." FEV1/FVC was best in "non-airway non-emphysema type" compared to other phenotypes, while "mixed type" had worst FEV1/FVC (p &lt; 0.001). BODE index was 0.56 ± 0.72 in the "non-airway non-emphysema type" and highest with 2.55 ± 1.77 in "mixed type" (p &lt; 0.001)., Conclusion: QCT demonstrates increasing hyperinflation and emphysema depending on the GOLD grade, while airway wall thickening increases until GOLD3 and airway dilatation occur in GOLD4. QCT identifies four disease phenotypes with implications for lung function and prognosis., (© 2024 S. Karger AG, Basel.)

Objectives: To evaluate the performance and potential biases of deep-learning models in detecting chronic obstructive pulmonary disease (COPD) on chest CT scans across different ethnic groups, specifically non-Hispanic White (NHW) and African American (AA) populations., Materials and Methods: Inspiratory chest CT and clinical data from 7549 Genetic epidemiology of COPD individuals (mean age 62 years old, 56-69 interquartile range), including 5240 NHW and 2309 AA individuals, were retrospectively analyzed. Several factors influencing COPD binary classification performance on different ethnic populations were examined: (1) effects of training population: NHW-only, AA-only, balanced set (half NHW, half AA) and the entire set (NHW + AA all); (2) learning strategy: three supervised learning (SL) vs. three self-supervised learning (SSL) methods. Distribution shifts across ethnicity were further assessed for the top-performing methods., Results: The learning strategy significantly influenced model performance, with SSL methods achieving higher performances compared to SL methods (p < 0.001), across all training configurations. Training on balanced datasets containing NHW and AA individuals resulted in improved model performance compared to population-specific datasets. Distribution shifts were found between ethnicities for the same health status, particularly when models were trained on nearest-neighbor contrastive SSL. Training on a balanced dataset resulted in fewer distribution shifts across ethnicity and health status, highlighting its efficacy in reducing biases., Conclusion: Our findings demonstrate that utilizing SSL methods and training on large and balanced datasets can enhance COPD detection model performance and reduce biases across diverse ethnic populations. These findings emphasize the importance of equitable AI-driven healthcare solutions for COPD diagnosis., Critical Relevance Statement: Self-supervised learning coupled with balanced datasets significantly improves COPD detection model performance, addressing biases across diverse ethnic populations and emphasizing the crucial role of equitable AI-driven healthcare solutions., Key Points: Self-supervised learning methods outperform supervised learning methods, showing higher AUC values (p < 0.001). Balanced datasets with non-Hispanic White and African American individuals improve model performance. Training on diverse datasets enhances COPD detection accuracy. Ethnically diverse datasets reduce bias in COPD detection models. SimCLR models mitigate biases in COPD detection across ethnicities., (© 2024. The Author(s).)

Background: Patients with COPD are often affected by loss of bone mineral density (BMD) and osteoporotic fractures. Natriuretic peptides (NP) are known as cardiac markers, but have also been linked to fragility-associated fractures in the elderly. As their functions include regulation of fluid and mineral balance, they also might affect bone metabolism, particularly in systemic disorders such as COPD., Research Question: We investigated the association between NP serum levels, vertebral fractures and BMD assessed by chest computed tomography (CT) in patients with COPD., Methods: Participants of the COSYCONET cohort with CT scans were included. Mean vertebral bone density on CT (BMD-CT) as a risk factor for osteoporosis was assessed at the level of TH12 (AI-Rad Companion), and vertebral compression fractures were visually quantified by two readers. Their relationship with N-terminal pro-B-type natriuretic peptide (NT-proBNP), Mid-regional pro-atrial natriuretic peptide (MRproANP) and Midregional pro-adrenomedullin (MRproADM) was determined using group comparisons and multivariable analyses., Results: Among 418 participants (58% male, median age 64 years, FEV 1 59.6% predicted), vertebral fractures in TH12 were found in 76 patients (18.1%). Compared to patients without fractures, these had elevated serum levels (p ≤ 0.005) of MRproANP and MRproADM. Using optimal cut-off values in multiple logistic regression analyses, MRproANP levels ≥ 65 nmol/l (OR 2.34; p = 0.011) and age (p = 0.009) were the only significant predictors of fractures after adjustment for sex, BMI, smoking status, FEV 1 % predicted, SGRQ Activity score, daily physical activity, oral corticosteroids, the diagnosis of cardiac disease, and renal impairment. Correspondingly, MRproANP (p < 0.001), age (p = 0.055), SGRQ Activity score (p = 0.061) and active smoking (p = 0.025) were associated with TH12 vertebral density., Interpretation: MRproANP was a marker for osteoporotic vertebral fractures in our COPD patients from the COSYCONET cohort. Its association with reduced vertebral BMD on CT and its known modulating effects on fluid and ion balance are suggestive of direct effects on bone mineralization., Trial Registration: ClinicalTrials.gov NCT01245933, Date of registration: 18 November 2010., (© 2024. The Author(s).)

Objectives: To quantify regional manifestations related to COPD as anomalies from a modeled distribution of normal-appearing lung on chest CT using a deep learning (DL) approach, and to assess its potential to predict disease severity., Materials and Methods: Paired inspiratory/expiratory CT and clinical data from COPDGene and COSYCONET cohort studies were included. COPDGene data served as training/validation/test data sets (N = 3144/786/1310) and COSYCONET as external test set (N = 446). To differentiate low-risk (healthy/minimal disease, [GOLD 0]) from COPD patients (GOLD 1-4), the self-supervised DL model learned semantic information from 50 × 50 × 50 voxel samples from segmented intact lungs. An anomaly detection approach was trained to quantify lung abnormalities related to COPD, as regional deviations. Four supervised DL models were run for comparison. The clinical and radiological predictive power of the proposed anomaly score was assessed using linear mixed effects models (LMM)., Results: The proposed approach achieved an area under the curve of 84.3 ± 0.3 (p < 0.001) for COPDGene and 76.3 ± 0.6 (p < 0.001) for COSYCONET, outperforming supervised models even when including only inspiratory CT. Anomaly scores significantly improved fitting of LMM for predicting lung function, health status, and quantitative CT features (emphysema/air trapping; p < 0.001). Higher anomaly scores were significantly associated with exacerbations for both cohorts (p < 0.001) and greater dyspnea scores for COPDGene (p < 0.001)., Conclusion: Quantifying heterogeneous COPD manifestations as anomaly offers advantages over supervised methods and was found to be predictive for lung function impairment and morphology deterioration., Clinical Relevance Statement: Using deep learning, lung manifestations of COPD can be identified as deviations from normal-appearing chest CT and attributed an anomaly score which is consistent with decreased pulmonary function, emphysema, and air trapping., Key Points: • A self-supervised DL anomaly detection method discriminated low-risk individuals and COPD subjects, outperforming classic DL methods on two datasets (COPDGene AUC = 84.3%, COSYCONET AUC = 76.3%). • Our contrastive task exhibits robust performance even without the inclusion of expiratory images, while voxel-based methods demonstrate significant performance enhancement when incorporating expiratory images, in the COPDGene dataset. • Anomaly scores improved the fitting of linear mixed effects models in predicting clinical parameters and imaging alterations (p < 0.001) and were directly associated with clinical outcomes (p < 0.001)., (© 2023. The Author(s).)

Objectives: With the introduction of clinical photon-counting detector computed tomography (PCD-CT) and its novel reconstruction techniques, a quantitative investigation of different acquisition and reconstruction settings is necessary to optimize clinical acquisition protocols for metal artifact reduction., Materials and Methods: A multienergy phantom was scanned on a clinical dual-source PCD-CT (NAEOTOM Alpha; Siemens Healthcare GmbH) with 4 different central inserts: water-equivalent plastic, aluminum, steel, and titanium. Acquisitions were performed at 120 kVp and 140 kVp (CTDI vol 10 mGy) and reconstructed as virtual monoenergetic images (VMIs; 110-150 keV), as T3D, and with the standard reconstruction "none" (70 keV VMI) using different reconstruction kernels (Br36, Br56) and with as well as without iterative metal artifact reduction (iMAR). Metal artifacts were quantified, calculating relative percentages of metal artifacts. Mean CT numbers of an adjacent water-equivalent insert and different tissue-equivalent inserts were evaluated, and eccentricity of metal rods was measured. Repeated-measures analysis of variance was performed for statistical analysis., Results: Metal artifacts were most prevalent for the steel insert (12.6% average artifacts), followed by titanium (4.2%) and aluminum (1.0%). The strongest metal artifact reduction was noted for iMAR (with iMAR: 1.4%, without iMAR: 10.5%; P < 0.001) or VMI (VMI: 110 keV 2.6% to 150 keV 3.3%, T3D: 11.0%, and none: 16.0%; P < 0.001) individually, with best results when combining iMAR and VMI at 110 keV (1.2%). Changing acquisition tube potential (120 kV: 6.6%, 140 kV: 5.2%; P = 0.33) or reconstruction kernel (Br36: 5.5%, Br56: 6.4%; P = 0.17) was less effective. Mean CT numbers and standard deviations were significantly affected by iMAR (with iMAR: -3.0 ± 21.5 HU, without iMAR: -8.5 ± 24.3 HU; P < 0.001), VMI (VMI: 110 keV -3.6 ± 21.6 HU to 150 keV -1.4 ± 21.2 HU, T3D: -11.7 ± 23.8 HU, and none: -16.9 ± 29.8 HU; P < 0.001), tube potential (120 kV: -4.7 ± 22.8 HU, 140 kV: -6.8 ± 23.0 HU; P = 0.03), and reconstruction kernel (Br36: -5.5 ± 14.2 HU, Br56: -6.8 ± 23.0 HU; P < 0.001). Both iMAR and VMI improved quantitative CT number accuracy and metal rod eccentricity for the steel rod, but iMAR was of limited effectiveness for the aluminum rod., Conclusions: For metal artifact reduction in PCD-CT, a combination of iMAR and VMI at 110 keV demonstrated the strongest artifact reduction of the evaluated options, whereas the impact of reconstruction kernel and tube potential was limited., Competing Interests: Conflicts of interest and sources of funding: The authors received institutional grants from Bayer Healthcare AG, Canon, Guerbet, and Siemens Healthcare GmbH unrelated to this specific work. In addition, André Euler and Hatem Alkadhi are part of the speaker’s bureau of Siemens Healthcare GmbH. Stephan Skornitzke has become an employee of Philips., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Chronic obstructive pulmonary disease (COPD) poses a substantial global health burden, demanding advanced diagnostic tools for early detection and accurate phenotyping. In this line, this study seeks to enhance COPD characterization on chest computed tomography (CT) by comparing the spatial and quantitative relationships between traditional parametric response mapping (PRM) and a novel self-supervised anomaly detection approach, and to unveil potential additional insights into the dynamic transitional stages of COPD., Methods: Non-contrast inspiratory and expiratory CT of 1,310 never-smoker and GOLD 0 individuals and COPD patients (GOLD 1-4) from the COPDGene dataset were retrospectively evaluated. A novel self-supervised anomaly detection approach was applied to quantify lung abnormalities associated with COPD, as regional deviations. These regional anomaly scores were qualitatively and quantitatively compared, per GOLD class, to PRM volumes (emphysema: PRM Emph , functional small-airway disease: PRM fSAD ) and to a Principal Component Analysis (PCA) and Clustering, applied on the self-supervised latent space. Its relationships to pulmonary function tests (PFTs) were also evaluated., Results: Initial t-Distributed Stochastic Neighbor Embedding (t-SNE) visualization of the self-supervised latent space highlighted distinct spatial patterns, revealing clear separations between regions with and without emphysema and air trapping. Four stable clusters were identified among this latent space by the PCA and Cluster Analysis. As the GOLD stage increased, PRM Emph , PRM fSAD , anomaly score, and Cluster 3 volumes exhibited escalating trends, contrasting with a decline in Cluster 2. The patient-wise anomaly scores significantly differed across GOLD stages ( p  < 0.01), except for never-smokers and GOLD 0 patients. In contrast, PRM Emph , PRM fSAD , and cluster classes showed fewer significant differences. Pearson correlation coefficients revealed moderate anomaly score correlations to PFTs (0.41-0.68), except for the functional residual capacity and smoking duration. The anomaly score was correlated with PRM Emph ( r  = 0.66, p  < 0.01) and PRM fSAD ( r  = 0.61, p  < 0.01). Anomaly scores significantly improved fitting of PRM-adjusted multivariate models for predicting clinical parameters ( p  < 0.001). Bland-Altman plots revealed that volume agreement between PRM-derived volumes and clusters was not constant across the range of measurements., Conclusion: Our study highlights the synergistic utility of the anomaly detection approach and traditional PRM in capturing the nuanced heterogeneity of COPD. The observed disparities in spatial patterns, cluster dynamics, and correlations with PFTs underscore the distinct - yet complementary - strengths of these methods. Integrating anomaly detection and PRM offers a promising avenue for understanding of COPD pathophysiology, potentially informing more tailored diagnostic and intervention approaches to improve patient outcomes., 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 © 2024 Almeida, Norajitra, Lüth, Wald, Weru, Nolden, Jäger, von Stackelberg, Heußel, Weinheimer, Biederer, Kauczor and Maier-Hein.)

Introduction: Due to hypoxic vasoconstriction, perfusion is interesting in the lungs. Magnetic Resonance Imaging (MRI) perfusion imaging based on Dynamic Contrast Enhancement (DCE) has been demonstrated in patients with Chronic Obstructive Pulmonary Diseases (COPD) using visual scores, and quantification methods were recently developed further. Inter-patient correlations of echo time-dependent observed T 1 [T 1 (TE)] have been shown with perfusion scores, pulmonary function testing, and quantitative computed tomography. Here, we examined T 1 (TE) quantification and quantitative perfusion MRI together and investigated both inter-patient and local correlations between T 1 (TE) and quantitative perfusion., Methods: 22 patients (age 68.0 ± 6.2) with COPD were examined using morphological MRI, inversion recovery multi-echo 2D ultra-short TE (UTE) in 1-2 slices for T 1 (TE) mapping, and 4D Time-resolved angiography With Stochastic Trajectories (TWIST) for DCE. T 1 (TE) maps were calculated from 2D UTE at five TEs from 70 to 2,300 μs. Pulmonary Blood Flow (PBF) and perfusion defect (QDP) maps were produced from DCE measurements. Lungs were automatically segmented on UTE images and morphological MRI and these segmentations registered to DCE images. DCE images were separately registered to UTE in corresponding slices and divided into corresponding subdivisions. Spearman's correlation coefficients were calculated for inter-patient correlations using the entire segmented slices and for local correlations separately using registered images and subdivisions for each TE. Median T 1 (TE) in normal and defect areas according to QDP maps were compared., Results: Inter-patient correlations were strongest on average at TE 2  = 500 μs, reaching up to |ρ| = 0.64 for T 1 with PBF and |ρ| = 0.76 with QDP. Generally, local correlations of T 1 with PBF were weaker at TE 2 than at TE 1 or TE 3 and with maximum values of |ρ| = 0.66 (from registration) and |ρ| = 0.69 (from subdivision). In 18 patients, T 1 was shorter in defect areas than in normal areas, with the relative difference smallest at TE 2 ., Discussion: The inter-patient correlations of T 1 with PBF and QDP found show similar strength and TE-dependence as those previously reported for visual perfusion scores and quantitative computed tomography. The local correlations and median T 1 suggest that not only base T 1 but also the TE-dependence of observed T 1 in normal areas is closer to that found previously in healthy volunteers than in defect areas., Competing Interests: MK was an employee of Boehringer Ingelheim. 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., (Copyright © 2024 Triphan, Konietzke, Biederer, Eichinger, Vogelmeier, Jörres, Kauczor, Heußel, Jobst and Wielpütz.)

Background: Screening for lung cancer with low radiation dose computed tomography has a strong evidence base, is being introduced in several European countries and is recommended as a new targeted cancer screening programme. The imperative now is to ensure that implementation follows an evidence-based process that will ensure clinical and cost effectiveness. This European Respiratory Society (ERS) task force was formed to provide an expert consensus for the management of incidental findings which can be adapted and followed during implementation., Methods: A multi-European society collaborative group was convened. 23 topics were identified, primarily from an ERS statement on lung cancer screening, and a systematic review of the literature was conducted according to ERS standards. Initial review of abstracts was completed and full text was provided to members of the group for each topic. Sections were edited and the final document approved by all members and the ERS Science Council., Results: Nine topics considered most important and frequent were reviewed as standalone topics (interstitial lung abnormalities, emphysema, bronchiectasis, consolidation, coronary calcification, aortic valve disease, mediastinal mass, mediastinal lymph nodes and thyroid abnormalities). Other topics considered of lower importance or infrequent were grouped into generic categories, suitable for general statements., Conclusions: This European collaborative group has produced an incidental findings statement that can be followed during lung cancer screening. It will ensure that an evidence-based approach is used for reporting and managing incidental findings, which will mean that harms are minimised and any programme is as cost-effective as possible., Competing Interests: Conflict of interest: All declarations are outside the submitted work. Unless otherwise stated, authors do not make any relevant disclosures. A. Brunelli declares honoraria from AstraZeneca, Ethicon, Medtronic, MSD and Roche. J. Chorostowska declares honoraria from AstraZeneca, MSD, Pfizer, Takeda, Amgen, Grifols, CSL Behring, Novartis, Chiesi, Celon Pharma, Adamed and Mero Biopharma. A. Devaraj declares consulting fees from Boehringer Ingelheim, Roche, Vicore and Brainomix, and personal stock/options in Brainomix. D. Deruysscher declares grants/honoraria from AstraZeneca, BMS, Beigne and Philips. H. Prosch declares grants and honoraria from Boehringer Ingelheim, AstraZeneca, Siemens and MSD. A. Kerpel-Fronius declares honoraria from MSD and Boehringer Ingelheim, and conference expenses from Roche and Bracco. W. van Geffen is local PI for trials funded by MSD and Roche. H-U. Kauczor declares honoraria and grants from Boehringer Ingelheim, Philips, Siemens and MSD, and honoraria from Sanofi. P.M. Putora declares grants to his institution from AstraZeneca and Bayer. M-P. Revel declares honoraria from MSD, Boehringer Ingelheim, GE Healthcare, Bracco and Gleamer, grants from the French Ministry of Health and French Cancer Institute, and software from Aidence, Mevis, Coreline and Gleamer. R. Vliegenthart declares honoraria from Siemens Healthineers and Bayer, and research grants from the Dutch Cancer Foundation, Siemens Heathineers, the Dutch Heart Foundation and the Netherlands Organisation for Scientific Research. A. Snoeckx declares grants from the Foundation Agaist Cancer and the Flemish Cancer Society, and advisory board work for Agfa. G. Veronesi declares honoraria from AstraZeneca, Medtronic and Roche, and grants from INAIL and IARC. D.R. Baldwin declares honoraria for speaking from Roche, MSD and AstraZeneca, and research grants from CRUK, NIHR, Innovate UK, Small Business Research Initiative, NHS Digital, NHS England, Roy Castle Lung Foundation, European Commission Horizon and Yourshire Cancer; and is advisor to the UK National Screening Committee., (This article has been co-published with permission in the European Journal of Cardio-Thoracic Surgery and in the European Respiratory Journal. Copyright © The authors 2023. Published by the European Respiratory Society. All rights reserved. For reproduction rights and permissions contact permissions@ersnet.org. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.)

This statement from the European Society of Thoracic imaging (ESTI) explains and summarises the essentials for understanding and implementing Artificial intelligence (AI) in clinical practice in thoracic radiology departments. This document discusses the current AI scientific evidence in thoracic imaging, its potential clinical utility, implementation and costs, training requirements and validation, its' effect on the training of new radiologists, post-implementation issues, and medico-legal and ethical issues. All these issues have to be addressed and overcome, for AI to become implemented clinically in thoracic radiology. KEY POINTS: • Assessing the datasets used for training and validation of the AI system is essential. • A departmental strategy and business plan which includes continuing quality assurance of AI system and a sustainable financial plan is important for successful implementation. • Awareness of the negative effect on training of new radiologists is vital., (© 2023. The Author(s).)

The need for airway imaging is defined by the limited sensitivity of common clinical tests like spirometry, lung diffusion (DLCO) and blood gas analysis to early changes of peripheral airways and to inhomogeneous regional distribution of lung function deficits. Therefore, X-ray and computed tomography (CT) are frequently used to complement the standard tests.As an alternative, magnetic resonance imaging (MRI) offers radiation-free lung imaging, but at lower spatial resolution. Non-contrast enhanced MRI shows healthy airways down to the first subsegmental level/4 th order (CT: eighth). Bronchiectasis can be identified by wall thickening and fluid accumulation. Smaller airways become visible, when altered by peribronchiolar inflammation or mucus retention (tree-in-bud sign).The strength of MRI is functional imaging. Dynamic, time-resolved MRI directly visualizes expiratory airway collapse down to the lobar level (CT: segmental level). Obstruction of even smaller airways becomes visible as air trapping on the expiratory scans. MRI with hyperpolarized noble gases ( 3 He, 129 Xe) directly shows the large airways and peripheral lung ventilation. Dynamic contrast-enhanced MRI (DCE MRI) indirectly shows airway dysfunction as perfusion deficits resulting from hypoxic vasoconstriction of the dependent lung volumes. Further promising scientific approaches such as non-contrast enhanced, ventilation-/perfusion-weighted MRI from periodic signal changes of respiration and blood flow are in development.In summary, MRI of the lungs and airways excels with its unique combination of morphologic and functional imaging capacities for research ( e.g., in chronic obstructive lung disease or asthma) as well as for clinical imaging ( e.g., in cystic fibrosis)., Competing Interests: FundingOpen Access funding enabled and organized by Projekt DEAL.

Purpose: To investigate morphofunctional chest MRI for the detection and management of incidental pulmonary nodules in participants with chronic obstructive pulmonary disease (COPD)., Materials and Methods: In this prospective study, 567 participants (mean age, 66 years ± 9 [SD]; 340 men) underwent same-day contrast-enhanced MRI and nonenhanced low-dose CT (LDCT) in a nationwide multicenter trial (clinicaltrials.gov: NCT01245933). Nodule dimensions, morphologic features, and Lung Imaging Reporting and Data System (Lung-RADS) category were assessed at MRI by two blinded radiologists, and consensual LDCT results served as the reference standard. Comparisons were performed using the Student t test, and agreements were assessed using the Cohen weighted κ., Results: A total of 525 nodules larger than 3 mm in diameter were detected at LDCT in 178 participants, with a mean diameter of 7.2 mm ± 6.1 (range, 3.1-63.1 mm). Nodules were not detected in the remaining 389 participants. Sensitivity and positive predictive values with MRI for readers 1 and 2, respectively, were 63.0% and 84.8% and 60.2% and 83.9% for solid nodules ( n = 495), 17.6% and 75.0% and 17.6% and 60.0% for part-solid nodules ( n = 17), and 7.7% and 100% and 7.7% and 50.0% for ground-glass nodules ( n = 13). For nodules 6 mm or greater in diameter, sensitivity and positive predictive values were 73.3% and 92.2% for reader 1 and 71.4% and 93.2% for reader 2, respectively. Readers underestimated the long-axis diameter at MRI by 0.5 mm ± 1.7 (reader 1) and 0.5 mm ± 1.5 (reader 2) compared with LDCT ( P < .001). For Lung-RADS categorization per nodule using MRI, there was substantial to perfect interreader agreement (κ = 0.75-1.00) and intermethod agreement compared with LDCT (κ = 0.70-1.00 and 0.69-1.00)., Conclusion: In a multicenter setting, morphofunctional MRI showed moderate sensitivity for detection of incidental pulmonary nodules in participants with COPD but high agreement with LDCT for Lung-RADS classification of nodules.Clinical trial registration no. NCT01245933 and NCT02629432 Keywords: MRI, CT, Thorax, Lung, Chronic Obstructive Pulmonary Disease, Screening© RSNA, 2023 Supplemental material is available for this article., Competing Interests: Disclosures of conflicts of interest: Q.L. No relevant relationships. L.Z. No relevant relationships. O.v.S. No relevant relationships. S.M.F.T. No relevant relationships. J.B. Siemens Healthineers helped with MRI protocol design; Bayer provided contrast material used in the study; payment for honorarium for presentation at a workshop from Roche, Boehringer Ingelheim, and Fuji; president of European Society of Thoracic Imaging 2022–2023. O.W. No relevant relationships. M.E. Honoraria to author and institution from Vertex Pharmaceutical. C.F.V. Grants or contracts from German Ministry of Education and Science (BMBF), AstraZeneca, Boehringer Ingelheim, Grifols, GlaxoSmithKline, and Novartis; consulting fees from Aerogen, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, and Nuvaira; payment or honoraria for lectures/presentations from Aerogen, AstraZeneca, Boehringer Ingelheim, CSL Behring, Chiesi, GlaxoSmithKline, Grifols, Insmed, MedUpdate, Novartis, Roche, and Sanofi; support for attending meetings or travel from Boehringer Ingelheim and Sanofi; participation on a data safety monitoring or advisory board from AstraZeneca and Sanofi; Chair of the Science Committee of GOLD, Chairman of the German Lung Foundation (DLS). R.A.J. No relevant relationships. H.U.K. Bayer provided consumables to the consortium; institution receives payment from Siemens, Philips, and Boehringer Ingelheim; consulting fees to author from Median; payment or honoraria for lectures/presentations to author from Siemens, Philips, Boehringer Ingelheim, MSD, and Sanofi. C.P.H. Grants/contracts from Siemens (2012–2014), Pfizer (2012–2014), MeVis (2012, 2013), Boehringer Ingelheim (2014), and German Center for Lung Research (2011ff); consulting fees from Schering-Plough (2009, 2010), Pfizer (2008–2014), Basilea (2008, 2009, 2010), Boehringer Ingelheim (2010–2014), Novartis (2010, 2012, 2014), Roche (2010), Astellas (2011, 2012), Gilead (2011–2015), MSD (2011–2013), Lilly (2011), Intermune (2013-2014), and Fresenius (2013, 2014); lecture fees from Gilead (2008–2014), Essex (2008, 2009, 2010), Schering-Plough (2008, 2009, 2010), AstraZeneca (2008–2014, 2022), Lilly (2008, 2009, 2012), Roche (2008, 2009), MSD (2009–2014), Pfizer (2010–2014), Bracco (2010, 2011), MEDA Pharma (2011), Intermune (2011–2014), Chiesi (2012), Siemens (2012), Covidien (2012), Pierre Fabre (2012), Boehringer Ingelheim (2012, 2013, 2022), Grifols (2012), Novartis (2013–2016), Basilea (2015, 2016), and Bayer (2016); patent: Method and Device For Representing the Microstructure of the Lungs. IPC8 Class: AA61B5055FI, PAN: 20080208038, Inventors: W Schreiber, U Wolf, AW Scholz, CP Heussel; participation on a data safety monitoring board or advisory board: Schering-Plough (2009, 2010), Pfizer (2008–2014), Basilea (2008, 2009, 2010), Boehringer Ingelheim (2010–2014, 2022ff), Novartis (2010, 2012, 2014), Roche (2010), Astellas (2011, 2012), Gilead (2011–2015), MSD (2011–2013), Lilly (2011), Intermune (2013–2014), Fresenius (2013, 2014); leadership or fiduciary roles: chest working group of the German Roentgen Society (national guidelines: bronchial carcinoma, mesothelioma, COPD, screening for bronchial carcinoma, CT and MRI of the chest, pneumonia); consultant of ECIL-3, ECCMID, EORTC/MSG (guideline for diagnosis of infections in immunocompromised hosts); founding member of the working team in infections in immunocompromised hosts of the German Society of Hematology/Oncology (guideline for diagnosis of infections in immunocompromised hosts); faculty member of European Society of Thoracic Radiology (ESTI), European Respiratory Society (ERS), and member in EIBALL (European Imaging Biomarkers Alliance); editor of Medizinische Klinik, Intensivmedizin und Notfallmedizin at Springer publishing; stock/stock options GSK. B.J.J. No relevant relationships. M.O.W. Bayer provided contrast material for MRI examinations; study grants paid to institution from Vertex Pharmaceuticals and Boehringer Ingelheim; consultancy fees paid to institution from Vertex Pharmaceuticals and Boehringer Ingelheim., (© 2023 by the Radiological Society of North America, Inc.)

Absorption-based clinical computed tomography (CT) is the current imaging method of choice in the diagnosis of lung diseases. Many pulmonary diseases are affecting microscopic structures of the lung, such as terminal bronchi, alveolar spaces, sublobular blood vessels or the pulmonary interstitial tissue. As spatial resolution in CT is limited by the clinically acceptable applied X-ray dose, a comprehensive diagnosis of conditions such as interstitial lung disease, idiopathic pulmonary fibrosis or the characterization of small pulmonary nodules is limited and may require additional validation by invasive lung biopsies. Propagation-based imaging (PBI) is a phase sensitive X-ray imaging technique capable of reaching high spatial resolutions at relatively low applied radiation dose levels. In this publication, we present technical refinements of PBI for the characterization of different artificial lung pathologies, mimicking clinically relevant patterns in ventilated fresh porcine lungs in a human-scale chest phantom. The combination of a very large propagation distance of 10.7 m and a photon counting detector with [Formula: see text] pixel size enabled high resolution PBI CT with significantly improved dose efficiency, measured by thermoluminescence detectors. Image quality was directly compared with state-of-the-art clinical CT. PBI with increased propagation distance was found to provide improved image quality at the same or even lower X-ray dose levels than clinical CT. By combining PBI with iodine k-edge subtraction imaging we further demonstrate that, the high quality of the calculated iodine concentration maps might be a potential tool for the analysis of lung perfusion in great detail. Our results indicate PBI to be of great value for accurate diagnosis of lung disease in patients as it allows to depict pathological lesions non-invasively at high resolution in 3D. This will especially benefit patients at high risk of complications from invasive lung biopsies such as in the setting of suspected idiopathic pulmonary fibrosis (IPF)., (© 2023. The Author(s).)

Background: Chest computed tomography (CT) is increasingly used for phenotyping and monitoring of patients with COPD. The aim of this work was to evaluate the association of Pi10 as a measure of standardized airway wall thickness on CT with exacerbations, mortality, and response to triple therapy., Methods: Patients of GOLD grades 1-4 of the COSYCONET cohort with prospective CT scans were included. Pi10 was automatically computed and analyzed for its relationship to COPD severity, comorbidities, lung function, respiratory therapy, and mortality over a 6-year period, using univariate and multivariate comparisons., Results: We included n  = 433 patients (61%male). Pi10 was dependent on both GOLD grades 1-4 ( p  = 0.009) and GOLD groups A-D ( p  = 0.008); it was particularly elevated in group D, and ROC analysis yielded a cut-off of 0.26 cm. Higher Pi10 was associated to lower FEV 1 % predicted and higher RV/TLC, moreover the annual changes of lung function parameters ( p  < 0.05), as well as to an airway-dominated phenotype and a history of myocardial infarction ( p  = 0.001). These associations were confirmed in multivariate analyses. Pi10 was lower in patients receiving triple therapy, in particular in patients of GOLD groups C and D. Pi10 was also a significant predictor for mortality ( p  = 0.006), even after including multiple other predictors., Conclusion: In summary, Pi10 was found to be predictive for the course of the disease in COPD, in particular mortality. The fact that Pi10 was lower in patients with severe COPD receiving triple therapy might hint toward additional effects of this functional therapy on airway remodeling., Registration: ClinicalTrials.gov, Identifier: NCT01245933.

Asynchronous calibration could allow opportunistic screening based on routine CT for early osteoporosis detection. In this phantom study, a bone mineral density (BMD) calibration phantom and multi-energy CT (MECT) phantom were imaged on eight different CT scanners with multiple tube voltages (80-150 kV p ) and image reconstruction settings (e.g. soft/hard kernel). Reference values for asynchronous BMD estimation were calculated from the BMD-phantom and validated with six calcium composite inserts of the MECT-phantom with known ground truth. Relative errors/changes in estimated BMD were calculated and investigated for influence of tube voltage, CT scanner and reconstruction setting. Reference values for 282 acquisitions were determined, resulting in an average relative error between calculated BMD and ground truth of - 9.2% ± 14.0% with a strong correlation (R 2  = 0.99; p < 0.0001). Tube voltage and CT scanner had a significant effect on calculated BMD (p < 0.0001), with relative differences in BMD of 3.8% ± 28.2% when adapting reference values for tube voltage, - 5.6% ± 9.2% for CT scanner and 0.2% ± 0.2% for reconstruction setting, respectively. Differences in BMD were small when using reference values from a different CT scanner of the same model (0.0% ± 1.4%). Asynchronous phantom-based calibration is feasible for opportunistic BMD assessment based on CT images with reference values adapted for tube voltage and CT scanner model., (© 2022. The Author(s).)

Chronic obstructive pulmonary disease (COPD) is frequently associated with coronary artery disease (CAD). When considering computed tomography (CT) for COPD phenotyping, coronary vessel wall calcification would be a potential marker of cardiac disease. However, non-ECG gated scans as used in COPD monitoring do not comply with established quantitative approaches using ECG-triggered CT and the Agatston score. We studied the diagnostic potential of Agatston scores from non-triggered scans for cardiac disease. The study population was a sub-group of the COPD cohort COSYCONET that underwent CT scanning in addition to comprehensive clinical assessments, echocardiographic data and physician-based diagnoses of comorbidities. Agatston scores from non-contrast enhanced, non-triggered CT were used to identify a cut-off value for CAD via ROC analysis. 399 patients were included (152 female, mean age 66.0 ± 8.2 y). In terms of CAD, an Agatston score ≥1500 AU performed best (AUC 0.765; 95% CI: 0.700, 0.831) and was superior to the conventional cut-off value (400 AU). Using this value for defining groups, there were differences (p &lt; 0.05) in lung function, left atrial diameter and left ventricular end-systolic diameter as well as CT-determined central airway wall thickness pointing towards a bronchitis phenotype. In multivariate analysis, BMI, hyperlipidemia, arterial hypertension, GOLD D (p &lt; 0.05) but particularly Agatston score ≥1500 AU (Odds ratio 10.5; 95% CI: 4.8; 22.6)) were predictors of CAD. We conclude that in COPD patients, Agatston scores derived from non-ECG gated CT showed a much higher cut-off value (1500 AU) for actionable coronary artery disease than the score derived from ECG-triggered CT in cardiology patients., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests. Financial support provided to individuals is disclosed on the conflict of interest declaration provided from each single author., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Pulmonary perfusion abnormalities are prevalent in patients with chronic obstructive pulmonary disease (COPD), are potentially reversible, and may be associated with emphysema development. Therefore, we aimed to evaluate the clinical meaningfulness of perfusion defects in percent (QDP) using DCE-MRI., Methods: We investigated a subset of baseline DCE-MRIs, paired inspiratory/expiratory CTs, and pulmonary function testing (PFT) of 83 subjects (age = 65.7 ± 9.0 years, patients-at-risk, and all GOLD groups) from one center of the "COSYCONET" COPD cohort. QDP was computed from DCE-MRI using an in-house developed quantification pipeline, including four different approaches: Otsu's method, k-means clustering, texture analysis, and 80 th percentile threshold. QDP was compared with visual MRI perfusion scoring, CT parametric response mapping (PRM) indices of emphysema (PRM Emph ) and functional small airway disease (PRM fSAD ), and FEV1/FVC from PFT., Results: All QDP approaches showed high correlations with the MRI perfusion score (r = 0.67 to 0.72, p < 0.001), with the highest association based on Otsu's method (r = 0.72, p < 0.001). QDP correlated significantly with all PRM indices (p < 0.001), with the strongest correlations with PRM Emph  (r = 0.70 to 0.75, p < 0.001). QDP was distinctly higher than PRM Emph  (mean difference = 35.85 to 40.40) and PRM fSAD (mean difference = 15.12 to 19.68), but in close agreement when combining both PRM indices (mean difference = 1.47 to 6.03) for all QDP approaches. QDP correlated moderately with FEV1/FVC (r = - 0.54 to - 0.41, p < 0.001)., Conclusion: QDP is associated with established markers of disease severity and the extent corresponds to the CT-derived combined extent of PRM Emph  and PRM fSAD . We propose to use QDP based on Otsu's method for future clinical studies in COPD., Key Points: • QDP quantified from DCE-MRI is associated with visual MRI perfusion score, CT PRM indices, and PFT. • The extent of QDP from DCE-MRI corresponds to the combined extent of PRM Emph  and PRM fSAD from CT. • Assessing pulmonary perfusion abnormalities using DCE-MRI with QDP improved the correlations with CT PRM indices and PFT compared to the quantification of pulmonary blood flow and volume., (© 2021. The Author(s).)

Imaging speed, spatial resolution and availability have made CT the favored cross-sectional imaging modality for evaluating various respiratory diseases of children - but only for the price of a radiation exposure. MRI is increasingly being appreciated as an alternative to CT, not only for offering three-dimensional (3-D) imaging without radiation exposure at only slightly inferior spatial resolution, but also for its superior soft-tissue contrast and exclusive morpho-functional imaging capacities beyond the scope of CT. Continuing technical improvements and experience with this so far under-utilized modality contribute to a growing acceptance of MRI for an increasing number of indications, in particular for pediatric patients. This review article provides the reader with practical easy-to-use protocols for common clinical indications in children. This is intended to encourage pediatric radiologists to appreciate the new horizons for applications of this rapidly evolving technique in the field of pediatric respiratory diseases., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Even after more than 100 years, the chest X‑ray is still an important technique to detect important pathological changes of lungs, heart and vessels in a fast and low-dose manner. For the German-speaking regions, there are only recommendations available published by the "Ständigen Strahlenschutzkommission (SSK)" regarding the indication. These recommendations are not updated on a regular basis and more recent developments are only integrated with delayed., Methods: The chest division of the German Radiological Society has summarized their expertise for the usage and indication of the chest X‑ray. Especially within the field of oncology the usage of chest X‑ray is evaluated differently to the aforementioned recommendations; here chest computed tomography (CT) is much more sensitive for evaluation of metastasis and local invasion of tumors. Also, within the area of infectious diseases in non-immunocompetent patients, CT is the method of choice. Based on the structure of the current recommendations, many current guidelines and indications are summarized and presented within the context of the usage of chest X‑ray., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)