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Background: Early detection of soft tissue sarcoma (STS) recurrence is essential; however, the role and timeline of Magnetic resonance imaging (MRI) surveillance are still under debate. The aim of this study was to determine whether local recurrence (LR) could be identified via clinical examination alone and to assess the MRI morphology of primary STS and LR., Methods: This retrospective study included all patients with STS recurrence after surveillance for at least five years from the tumor database of the Medical University of Vienna from 2000 until December 2023. The characteristics of primary STS and LR and the time interval to recurrence and clinical detectability were assessed. The MRIs of LR and posttherapeutic changes (PTC) were compared with the initial MRIs., Results: A total of 57 patients (60% male; mean age 58.5 ± 18.0 years) with STS and histologically confirmed LR were included. The mean time interval to LR was 2.3 ± 1.8 years (range 108 to 3037 days). The clinically detectable recurrences were significantly larger than the inapparent ones (71.9 cm 3 vs. 7.0 cm 3 ; p < 0.01). The MRI morphology of all LRs (26/26) closely resembled the initial STS. For comparison, nine patients were included with clinically suspected LRs, which were histologically proven to be PTC. None of these resembled the primary STS., Conclusion: Based on clinical symptoms alone, especially small and early recurrences can be missed, which supports the importance of MRI surveillance.

Background: Ultra-low-dose CT (ULDCT) examinations of the chest at only twice the radiation dose of a chest X-ray (CXR) now offer a valuable imaging alternative to CXR. This trial prospectively compares ULDCT and CXR for the detection rate of diagnoses and their clinical relevance in a low-prevalence cohort of non-traumatic emergency department patients., Methods: In this prospective crossover cohort trial, 294 non-traumatic emergency department patients with a clinically indicated CXR were included between May 2nd and November 26th of 2019 (www.clinicaltrials.gov: NCT03922516). All participants received both CXR and ULDCT, and were randomized into two arms with inverse reporting order. The detection rate of CXR was calculated from 'arm CXR' (n = 147; CXR first), and of ULDCT from 'arm ULDCT' (n = 147; ULDCT first). Additional information reported by the second exam in each arm was documented. From all available clinical and imaging data, expert radiologists and emergency physicians built a compound reference standard, including radiologically undetectable diagnoses, and assigned each finding to one of five clinical relevance categories for the respective patient., Findings: Detection rates for main diagnoses by CXR and ULDCT (mean effective dose: 0.22 mSv) were 9.1% (CI [5.2, 15.5]; 11/121) and 20.1% (CI [14.2, 27.7]; 27/134; P  = 0.016), respectively. As an additional imaging modality, ULDCT added 9.1% (CI [5.2, 15.5]; 11/121) of main diagnoses to prior CXRs, whereas CXRs did not add a single main diagnosis (0/134; P  < 0.001). Notably, ULDCT also offered higher detection rates than CXR for all other clinical relevance categories, including findings clinically irrelevant for the respective emergency department visit with 78.5% (CI [74.0, 82.5]; 278/354) vs. 16.2% (CI [12.7, 20.3]; 58/359) as a primary modality and 68.2% (CI [63.3, 72.8]; 245/359) vs. 2.5% (CI [1.3, 4.7]; 9/354) as an additional imaging modality., Interpretation: In non-traumatic emergency department patients, ULDCT of the chest offered more than twice the detection rate for main diagnoses compared to CXR., Funding: The Department of Biomedical Imaging and Image-guided Therapy of Medical University of Vienna received funding from Siemens Healthineers (Erlangen, Germany) to employ two research assistants for one year., Competing Interests: The Department of Biomedical Imaging and Image-guided Therapy of Medical University of Vienna has grants and contracts with more than 100 partners (organizational, academic, industry), all through official contracts with the Medical University of Vienna. Among these was funding from Siemens Healthineers (Erlangen, Germany) to employ two research assistants for one year for this study as well as grants independent of this study. CW was employed as research assistant by Medical University of Vienna for one year, enabled by funding from Siemens Healthineers and furthermore reports support for congress fees, travel and accommodation costs, unrelated to this study, by Medical University of Vienna. DT reports consulting fees from Roche and Siemens Healthineers, support for attending meetings and/or travel from Siemens Healthineers and participation on the DSM board, all unrelated to this study. HP reports honoraria as a speaker from AstraZeneca, BMS, Boehringer Ingelheim, Janssen, MSD, Novartis, Roche, Sanofi, Siemens Healthcare and Takeda as well as participation on the advisory board of AstraZeneca, Boehringer Ingelheim, Janssen, MSD and Sanofi, all unrelated to this study. MS reports support for congress fees, travel and accommodation costs, unrelated to this study, by Medical University of Vienna. RES reports honoraria as an educational speaker from Siemens Healthineers and a pending patent developed with Siemens Healthineers, all unrelated to this study. PA reports honoraria as a speaker from Siemens Healthineers, unrelated to this study. WB reports unpaid participation on the editorial board of Medical Physics and Zeitschrift fuer Medizinische Physik, both unrelated to this study. CH reports unpaid participation on the Photon Counting CT advisory board of Siemens Healthineers as well as stock ownership of Hologic until 2021, all unrelated to this study. HR was the PI of grants to the Medical University of Vienna from Siemens Healthineers until June 2018 and is still scientifically involved in several studies concerning these grants, but did not and does not receive remuneration nor is he part of the contracts; HR further reports honoraria as a clinical speaker from Siemens Healthineers until December 2019 and unpaid participation on the editorial board of European Radiology. The other authors declare no further competing interests., (© 2023 The Author(s).)

Background Photon-counting detector (PCD) CT enables ultra-high-resolution lung imaging and may shed light on morphologic correlates of persistent symptoms after COVID-19. Purpose To compare PCD CT with energy-integrating detector (EID) CT for noninvasive assessment of post-COVID-19 lung abnormalities. Materials and Methods For this prospective study, adult participants with one or more COVID-19-related persisting symptoms (resting or exertional dyspnea, cough, fatigue) underwent same-day EID and PCD CT between April 2022 and June 2022. The 1.0-mm EID CT images and, subsequently, 1.0-, 0.4-, and 0.2-mm PCD CT images were reviewed for the presence of lung abnormalities. Subjective and objective EID and PCD CT image quality were evaluated using a five-point Likert scale (-2 to 2) and lung signal-to-noise ratios (SNRs). Results Twenty participants (mean age, 54 years ± 16 [SD]; 10 men) were included. EID CT showed post-COVID-19 lung abnormalities in 15 of 20 (75%) participants, with a median involvement of 10% of lung volume [IQR, 0%-45%] and 3.5 lobes [IQR, 0-5]. Ground-glass opacities and linear bands (10 of 20 participants [50%] for both) were the most frequent findings at EID CT. PCD CT revealed additional lung abnormalities in 10 of 20 (50%) participants, with the most common being bronchiectasis (10 of 20 [50%]). Subjective image quality was improved for 1.0-mm PCD versus 1.0-mm EID CT images (median, 1; IQR, 1-2; P < .001) and 0.4-mm versus 1.0-mm PCD CT images (median, 1; IQR, 1-1; P < .001) but not for 0.4-mm versus 0.2-mm PCD CT images (median, 0; IQR, 0-0.5; P = .26). PCD CT delivered higher lung SNR versus EID CT for 1.0-mm images (mean difference, 0.53 ± 0.96; P = .03) but lower SNR for 0.4-mm versus 1.0-mm images and 0.2-mm vs 0.4-mm images (-1.52 ± 0.68 [ P < .001] and -1.15 ± 0.43 [ P < .001], respectively). Conclusion Photon-counting detector CT outperformed energy-integrating detector CT in the visualization of subtle post-COVID-19 lung abnormalities and image quality. © RSNA, 2023 Supplemental material is available for this article.

A wide spectrum of conditions, from life-threatening to non-urgent, can manifest with acute dyspnea, thus presenting major challenges for the treating physician when establishing the diagnosis and severity of the underlying disease. Imaging plays a decisive role in the assessment of acute dyspnea of cardiac and/or pulmonary origin. This article presents an overview of the current imaging modalities used to narrow the differential diagnosis in the assessment of acute dyspnea of cardiac or pulmonary origin. The current indications, findings, accuracy, and limits of each imaging modality are reported. Chest radiography is usually the primary imaging modality applied. There is a low radiation dose associated with this method, and it can assess the presence of fluid in the lung or pleura, consolidations, hyperinflation, pneumothorax, as well as heart enlargement. However, its low sensitivity limits the ability of the chest radiograph to accurately identify the causes of acute dyspnea. CT provides more detailed imaging of the cardiorespiratory system, and therefore, better sensitivity and specificity results, but it is accompanied by higher radiation exposure. Ultrasonography has the advantage of using no radiation, and is fast and feasible as a bedside test and appropriate for the assessment of unstable patients. However, patient-specific factors, such as body habitus, may limit its image quality and interpretability. Advances in knowledge This review provides guidance to the appropriate choice of imaging modalities in the diagnosis of patients with dyspnea of cardiac or pulmonary origin., Competing Interests: Competing interests: Ruxandra-Iulia Milos, Carmen Bartha, Benedikt H. Heidinger, Florian Prayer, Lucian Beer, Christian Wassipaul, Daria Kifjak, Martin Watzenböck – no conflict of interests to declare; Sebastian Röhrich – consulting activities contextflow GmbH; Helmut Prosch – Speaker honoria: AstraZeneca, BMS, Boehringer Ingelheim, Siemens Healthcare, Takeda. Research grants: Boehringer Ingelheim, (© 2023 The Authors. Published by the British Institute of Radiology.)