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This study aimed to investigate the relationship between imaging features of pure ground-glass opacities (pGGOs) and the pathological subtypes of minimally invasive adenocarcinoma (MIA) and precursor lesions. A retrospective analysis was conducted on data from 1521 patients diagnosed with GGOs as lung adenocarcinoma or precursor lesions between January 2015 and March 2021. The pGGOs were categorized into atypical adenomatous hyperplasia (AAH) / adenocarcinoma in situ (AIS) and MIA groups. Clinical information and CT imaging features were collected. Statistical analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis were performed. A total of 127 patients with 139 pGGOs were included. Maximum radiodensity, minimum radiodensity, mean radiodensity, variance, and skewness showed significant differences between the two groups. Maximum radiodensity and maximum cross-sectional area were identified as risk factors for pathology. The logistic regression model yielded an area under the curve (AUC) of 0.747 (95% CI, 0.666-0.816) for predicting pathological subtypes. The intensity features of pGGOs were found to be significantly different between AAH/AIS and MIA groups. Maximum radiodensity and skewness were independent risk factors for pathology. However, these features did not exhibit satisfactory diagnostic efficiency., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objective: To construct a combined model based on the CT and clinical characteristics of acquired immune deficiency syndrome (AIDS) with infection of Talaromyces marneffei (TM) and evaluate the diagnostic efficacy of the combined model., Methods: A retrospective analysis was conducted on 225 patients with AIDS patients with pulmonary infection admitted to the Shanghai Public Health Clinical Center from February 2012 to October 2022. Based on the final microbiological test results, they were divided into a group infected with TM and a group not infected with TM. Univariate and multivariate analyses were conducted on the lung CT imaging and clinical characteristics of these 225 patients. A nomogram was used to construct a combined model, and a calibration plot was drawn to test the diagnostic efficacy of the combined model., Results: Multivariate logistic regression analysis showed that fever, rash, elevated PLT, elevated Hb, CD4 + T lymphocyte count < 50/ul, and lung CT histology features including diffuse punctate and nodular shadows, mass-like consolidation, consolidation shadows, single or multiple lung abscesses or cyst shadows, and pleural effusion were independent risk factors for the diagnosis of AIDS with TM infection (P < 0.05). The construction of a joint model using nomogram and calibration plot showed that the constructed joint model had a high degree of fit., Conclusion: The combined model constructed in this study has certain clinical value for evaluating whether AIDS co-infection is caused by TM., Clinical Trial: Not applicable., Competing Interests: Declarations. Ethical approval: This retrospective study adhered to the Declaration of Helsinki and was authorized by the Ethics Committee of the Shanghai Public Health Clinical Center (ethics number:2018-S022-02). Informed Consent was waived due to retrospective nature. Consent for publication: All authors agree for publication. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Pulmonary diseases such as COVID-19 and pneumonia, are life-threatening conditions, that require prompt and accurate diagnosis for effective treatment. Chest X-ray (CXR) has become the most common alternative method for detecting pulmonary diseases such as COVID-19, pneumonia, and lung opacity due to their availability, cost-effectiveness, and ability to facilitate comparative analysis. However, the interpretation of CXRs is a challenging task., Methods: This study presents an automated deep learning (DL) model that outperforms multiple state-of-the-art methods in diagnosing COVID-19, Lung Opacity, and Viral Pneumonia. Using a dataset of 21,165 CXRs, the proposed framework introduces a seamless combination of the Vision Transformer (ViT) for capturing long-range dependencies, DenseNet201 for powerful feature extraction, and global average pooling (GAP) for retaining critical spatial details. This combination results in a robust classification system, achieving remarkable accuracy., Results: The proposed methodology delivers outstanding results across all categories: achieving 99.4% accuracy and an F1-score of 98.43% for COVID-19, 96.45% accuracy and an F1-score of 93.64% for Lung Opacity, 99.63% accuracy and an F1-score of 97.05% for Viral Pneumonia, and 95.97% accuracy with an F1-score of 95.87% for Normal subjects., Conclusion: The proposed framework achieves a remarkable overall accuracy of 97.87%, surpassing several state-of-the-art methods with reproducible and objective outcomes. To ensure robustness and minimize variability in train-test splits, our study employs five-fold cross-validation, providing reliable and consistent performance evaluation. For transparency and to facilitate future comparisons, the specific training and testing splits have been made publicly accessible. Furthermore, Grad-CAM-based visualizations are integrated to enhance the interpretability of the model, offering valuable insights into its decision-making process. This innovative framework not only boosts classification accuracy but also sets a new benchmark in CXR-based disease diagnosis., Competing Interests: Declarations. Ethics approval and consent to participate: This research is done on publicly available datasets that are already published and are therefore exempt from approval. Consent for publication: The research is conducted on a publicly available anonymous dataset therefore this section is not applicable for this research. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable., (© 2025. The Author(s).)

Purpose of Review: This review highlights key ultrasound applications for evaluating extra-articular involvement in rheumatic diseases, including the lungs, vessels, salivary glands, muscles, nerves, skin, and nails. It explores recent advances, emerging areas of assessment, and future research directions. Additionally, the review examines current limitations in the routine use of ultrasound for these purposes and considers the potential of new technologies, such as shear-wave elastography, contrast-enhanced ultrasound, and artificial intelligence, to enhance the early detection and monitoring of extra-articular manifestations in rheumatic diseases., Recent Findings: Extra-articular manifestations in patients with rheumatic diseases are crucial for diagnosis, management (including treatment strategies), and prognosis, making accurate assessment essential. Growing evidence supports the role of ultrasound in assessing these manifestations for diagnosis, monitoring, and gaining insights into disease pathogenesis. Recent studies emphasize the significant utility of ultrasound in evaluating extra-articular involvement across various organ systems, including the lungs, vessels, salivary glands, muscles, nerves, skin, and nails. Technological advances, such as shear-wave elastography, contrast-enhanced ultrasound, and artificial intelligence, are expanding the scope and precision of ultrasound applications. Despite its potential, challenges such as operator dependency, lack of standardized protocols, and the need for specialized training hinder its widespread adoption. Ultrasound is a non-invasive, cost-effective, and radiation-free imaging modality with high diagnostic accuracy, making it a valuable tool for assessing extra-articular manifestations in rheumatic diseases. Emerging technologies may further enhance its clinical utility. However, efforts to standardize techniques and improve accessibility are necessary to optimize its integration into routine practice., Competing Interests: Declarations. Competing Interests: The authors declare no competing interests., (© 2025. The Author(s).)

The motion of organs and tissues causes X-ray localization error during radiation therapy. Physical phantoms utilizing materials with tissue-equivalent mechanical and radiological properties are therefore desired to simulate organ motion for radiotherapy optimization. However, the development of such materials is still a challenge. Alginate hydrogel has similar properties to extra cellular matrix, which make it promising for use as a tissue-equivalent material. In this study, alginate hydrogel foams with desired mechanical and radiological properties were synthesized by in-situ release of Ca 2+ . The air volume ratio was carefully controlled to obtain hydrogel foams tailored to specific mechanical and radiological properties. Both the macroscopic and microscopic morphologies of the materials were characterized, and the compressive behaviors of the hydrogel foams were investigated. Radiological properties were estimated theoretically and validated through CT scanning experiments. This study has elucidated the development of future tissue-equivalent materials, which could be applied for optimization of radiation dosage and quality control during radiotherapy., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: The incorporation of artificial intelligence (AI) into point-of-care ultrasound (POCUS) platforms has rapidly increased. The number of B-lines present on lung ultrasound (LUS) serve as a useful tool for the assessment of pulmonary congestion. Interpretation, however, requires experience and therefore AI automation has been pursued. This study aimed to test the agreement between the AI software embedded in a major vendor POCUS system and visual expert assessment., Methods: This single-center prospective study included 55 patients hospitalized for various respiratory symptoms, predominantly acutely decompensated heart failure. A 12-zone protocol was used. Two experts in LUS independently categorized B-lines into 0, 1-2, 3-4, and ≥ 5. The intraclass correlation coefficient (ICC) was used to determine agreement., Results: A total of 672 LUS zones were obtained, with 584 (87%) eligible for analysis. Compared with expert reviewers, the AI significantly overcounted number of B-lines per patient (23.5 vs. 2.8, p < 0.001). A greater proportion of zones with > 5 B-lines was found by the AI than by the reviewers (38% vs. 4%, p < 0.001). The ICC between the AI and reviewers was 0.28 for the total sum of B-lines and 0.37 for the zone-by-zone method. The interreviewer agreement was excellent, with ICCs of 0.92 and 0.91, respectively., Conclusion: This study demonstrated excellent interrater reliability of B-line counts from experts but poor agreement with the AI software embedded in a major vendor system, primarily due to overcounting. Our findings indicate that further development is needed to increase the accuracy of AI tools in LUS., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Regional Ethics Review Board of Lund, Sweden. (Dnr 2020–03088). Informed, signed consent was obtained from all patients who participated in the study. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Pulmonary fibrosis is a characteristic feature of interstitial lung disease. Current clinical diagnostic methods provide a snapshot of the lung structure without information on disease activity. Collagen hybridizing peptides offer the opportunity to detect collagen remodeling through their hybridization with denatured collagen. Here, we sought to develop a 99m Tc-labeled collagen hybridizing tracer to track denatured collagen in vivo and validate it in a murine model of pulmonary fibrosis. Methods: Imaging agents consisting of a polyhistidine or a poly-histidine-glutamic acid [(HE) 3 ] peptide connected to an N-terminal targeting moiety with 9 glycine-proline-hydroxyproline repeats [(GPO) 9 ] through a 3-glycine linker were synthesized. After radiolabeling with 99m Tc-tricarbonyl, the labeled products' purity and stability were evaluated by high-performance liquid chromatography and γ-well counting, and their biodistributions were compared in mice. To induce pulmonary fibrosis, the lungs of 8- to 10-wk-old mice were exposed to bleomycin (or saline as control). At 3 wk after induction, SPECT/CT imaging with 99m Tc-(HE) 3 -(GPO) 9 was performed 1 h after injection and was followed by tissue collection to assess 99m Tc-(HE) 3 -(GPO) 9 biodistribution by γ-well counting and to evaluate lung histology. The specificity of the tracer uptake was assessed using a scrambled homolog. A group of animals underwent serial imaging 3 and 8-10 wk after induction. Results: The specific activity of the final radiolabeled product was 70.3 ± 14.8 GBq/µmol. Radiolabeled tracers were stable in blood for at least 2 h and showed rapid blood clearance. 99m Tc-(HE) 3 -(GPO) 9 showed lower liver uptake in biodistribution studies and was selected for in vivo imaging studies. SPECT/CT imaging of bleomycin-treated mice 3 wk after induction showed higher specific 99m Tc-(HE) 3 -(GPO) 9 lung uptake than that of control mice ( P < 0.01) and that of bleomycin-treated mice 8-10 wk after induction, when fibrosis was resolved ( P < 0.05). There was a significant correlation between lung uptake quantified by SPECT/CT and γ-well counting (Pearson R = 0.83, P < 0.001) and significant correlations between tracer uptake and indices of tissue fibrosis. Conclusion: 99m Tc-(HE) 3 -(GPO) 9 enables SPECT imaging of collagen turnover in pulmonary fibrosis. This approach expands the scope of existing diagnostic tools in fibrosis and can lead to better patient management by monitoring the effect of antifibrotic therapies., (© 2025 by the Society of Nuclear Medicine and Molecular Imaging.)

Background: Despite advancements in vaccination and the transition from pandemic to endemic, SARS-CoV-2 continues to pose a medical challenge, particularly among children. In this context, imaging diagnostics, such as chest x-rays, are crucial to the initial treatment of patients. This study aims to characterize the radiological findings in pediatric patients with confirmed SARS-CoV-2 infection in Colombia between April 2020 and November 2021, as well as describe the clinical presentation, including those admission to intensive care., Methods: In Colombia, a multicenter cohort comprised patients aged 29 days to 17 years with confirmed SARS-CoV-2 infection and chest X-ray taken within 72 h of hospitalization. In two separate groups, four radiologists evaluated the images. A fifth radiologist reviewed all the X-rays; and subsequently, these readings were used to calculate the kappa coefficient and to solve discrepancies among the other radiologists. The results were compared from admission to intensive care., Results: Analysis was conducted on 392 patients with a median age of 2 years, the majority of whom (42%) were infants. Sixty-eight percent of the radiographs had normal results. Peribronchial thickening and interstitial opacity were the most common aberrant findings (59%), followed by alveolar opacity (12%). 88 percent of findings were bilateral. In our cohort, peribronchial thickening was the most common radiological pattern found in patients admitted the PICU and with ventilatory failure. Interobserver agreement was low for peribronchial thickening (kappa = 0.1), but higher for consolidations and alveolar opacities (kappa = 0.4 and 0.5, respectively)., Conclusion: In pediatric patients with SARS-CoV-2, radiological findings are nonspecific and interobserver agreement is minimal. Although consolidation and alveolar opacities demonstrated greater concordance, they did not appear to reflect the clinical presentation; therefore, our results can suggest chest radiography is not considered useful for determining the severity of COVID-19 in children. There is a need for more investigations., (© 2025 Wiley Periodicals LLC.)

Background: Intravascular large B-cell lymphoma (IVLBCL) is a rare and aggressive subtype of non-Hodgkin lymphoma. Although autopsy findings have revealed that IVLBCL often involves the lungs, its clinical features and imaging manifestations have rarely been reported. This study aimed to explore the pulmonary imaging manifestations of three patients with pulmonary IVLBCL., Case: We retrospectively reviewed the clinical data and chest computed tomography (CT) images of three patients diagnosed with pulmonary IVLBCL between January 2010 and July 2023 in our hospital. In this case series, three patients (2 males and 1 female, aged 51-65 years) presented with a variety of symptoms. Laboratory tests revealed elevated lactate dehydrogenase levels in all three individuals. Chest CT scans revealed bilateral ground-glass opacities (GGOs) in the lungs in all cases. Although previous case reports have often depicted GGOs as ill-defined, two of the three cases manifested multiple well-circumscribed GGOs. Two cases underwent fluorodeoxyglucose positron emission tomography (FDG) PET/CT scans, which showed increased FDG uptake in pulmonary lesions (SUVmax values of 1.9 and 1.7, respectively)., Conclusion: Chest CT images of patients with pulmonary IVLBCL mainly manifested as bilateral GGOs of the lungs, with ill-defined GGO infiltrations being more common. FDG PET/CT demonstrates high diagnostic sensitivity for detecting pulmonary involvement in IVLBCL. Even when chest CT scans reveal no visible abnormalities, FDG PET/CT can detect enhanced metabolic uptake in areas with lesions for certain patients., (© 2025 The Author(s). Cancer Reports published by Wiley Periodicals LLC.)

Deep learning methods have significantly improved medical image analysis, particularly in detecting COVID-19 chest X-rays. Nonetheless, these methodologies frequently inhibit some drawbacks, such as limited interpretability, extensive computational resources, and the need for extensive datasets. To tackle these issues, we introduced two novel algorithms: the Dynamic Co-Occurrence Grey Level Matrix (DC-GLM) and the Contextual Adaptation Multiscale Gabor Network (CAMSGNeT). Ground-glass opacity, consolidation, and fibrosis are key indicators of COVID-19 that are effectively captured by DC-GLM, which is designed to adaptively respond to diverse texture sizes and orientations. It emphasizes coarse texture patterns, adeptly catching significant structural alterations in the texture of chest X-rays, enhancing diagnostic precision by documenting the spatial correlations among pixel intensities and facilitating the detection of both significant and minor irregularities. To enhance coarse feature extraction, we introduced CAMSGNeT, which emphasizes fine features via Contextual Adaptive Diffusion. In contrast to conventional multiscale Gabor filtering, CAMSGNeT improves feature extraction by modifying the diffusion process according to both gradients and local texture complexity. The Contextual Adaptation Diffusion approach adjusts the diffusion coefficient by incorporating both gradient and local variance, enabling intricate texture areas to preserve finer details while smoothing regions are diffused to decrease noise. Air bronchograms and crazy-paving patterns are maintained by this adaptive method, which enhances edge identification and texture characteristics while preserving essential tiny details. Finally, a simple optimized sequential neural network analyzes these refined features, resulting in enhanced classification accuracy. Feature importance analysis improves the model's interpretability by revealing the contributions of individual features to its decisions. Our methodology outperforms numerous state-of-the-art models, achieving 98.27% and 100% accuracy on two datasets, providing a more interpretable, precise, and resource-efficient solution for COVID-19 detection., Competing Interests: Declaration of competing interest 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 © 2025 Elsevier Ltd. All rights reserved.)

Hyperpolarized gas (HPG) magnetic resonance (MR) imaging allows for the quantification of pulmonary defects with the ventilation defect percentage (VDP). Although informative, VDPs lack information regarding the spatial distribution of defects. We developed a method of quantifying the focality/sparseness of ventilation defects in hyperpolarized-gas lung MR images. The study involved a total of 56 subjects: 14 asthmatics (age mean ± sd = 45.1 ± 18.9), 25 COPD subjects (age = 60.6 ± 10.4), and 17 CF subjects (age = 21.8 ± 8.4). The analyzed data are from four different studies: Study 1 used a 3-T gradient echo (GRE) sequence, Study 2 used a 1.5-T GRE sequence, Study 3 used a 1.5-T two-dimensional spiral sequence, and Study 4 used a 1.5-T three-dimensional balanced steady-state free precession (bSSFP) sequence. We developed an algorithm that quantifies the focality/sparseness of ventilation defects as a subject's cluster index (CI). The algorithm was assessed on synthesized spherical defect clusters and 3D lung volume defects of varying sizes/distributions. CI and whole-lung VDP were calculated for asthmatic, COPD, and CF subjects. Pearson correlation coefficients and linear regression models between CI and FEV1pp, as well as CI and VDP, were performed to evaluate CI among asthma, COPD, and CF. T tests were performed to evaluate CI/VDP ratios among previously mentioned lung diseases. p values less than 0.05 were statistically significant. Subject CI well represents defect focality by visual inspection. Pearson correlation coefficients between CI and VDP were r = 0.60 (p = 2.21 × 10 -2 ) for asthma, r = 0.79 (p = 3.15 × 10 -6 ) for COPD, and r = 0.84 (p = 2.80 × 10 -5 ) for CF. Pearson correlation coefficients between CI and FEV1pp was r = -0.47 (p = 0.0002). Analysis of variance (ANOVA) and a Tukey's honestly significant difference (HSD) test revealed that the ratio of whole-lung CI/VDP was significantly different between asthma/CF (p = 0.04) and CF/COPD (p = 0.008), but not among asthma/COPD (p = 0.95). This method of volumetric quantification of defect spatial distribution may provide information regarding defect cluster size in which VDP alone is uninformative., (© 2025 John Wiley & Sons Ltd.)

Congenital pulmonary vascular disease is a daunting and diverse topic spanning both pulmonary arterial and venous anomalies. Given advancements in treatment, patients with congenital anomalies have longer life expectancies into adulthood and practicing radiologists are bound to come across these patients during their daily practice. Additionally, many anomalies are discovered incidentally on imaging, yet may still have implications for patient care. This article provides an overview of entities most likely encountered in adulthood, highlighting key pre-operative and post-operative imaging features and relevant clinical considerations., Competing Interests: Disclosures The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Rationale: Equivocal interstitial lung abnormality (ILA) involves less than 5% of any lung zone or presents unilaterally without satisfying the diagnostic criteria for ILA. However, the prevalence and prognosis of equivocal ILA are unknown. Objectives: We sought to investigate the prevalence and long-term prognosis of equivocal ILA. Methods: This retrospective cohort study included individuals who underwent chest computed tomography as part of a health check-up program in 2010 at St. Luke's International Hospital in Tokyo, Japan. ILA and equivocal ILA were diagnosed using the Fleischner Society criteria. The primary outcome was the annual rate of forced vital capacity (FVC) decline in the groups with ILA, equivocal ILA, and no ILA, evaluated using a mixed-effects model. Radiological progression was also evaluated. Results: Among the 20,896 individuals included in the study, ILA and equivocal ILA were present in 2.0% (95% confidence interval = 1.8-2.2) and 0.4% (95% confidence interval = 0.4-0.5) of individuals, respectively. Follow-up pulmonary function tests were available for 18,101 (87%) individuals, with a median follow-up time of 8.3 years (interquartile range = 4.0-9.0). Individuals with equivocal ILA showed a significantly greater rate of FVC decline than those without ILA (-36.7 vs. -27.7 ml/yr; P  = 0.008). Of the 86 individuals with equivocal ILA, 20 (23%) exhibited progression during the follow-up period; of these, 19 progressed to definite ILA. Conclusions: Individuals with equivocal ILA showed a significant tendency for FVC decline compared with those without ILA. A considerable number of cases progressed to definite ILA, warranting careful attention. Clinicians should be aware that even mild interstitial changes that do not meet the current criteria for ILA may deteriorate.

Objectives: The aims of this study were to describe the frequency of pleuropulmonary computed tomography (CT) findings in patients with IgG4-related disease (IgG4-RD) and to compare clinical and laboratory characteristics between patients with and without pleuropulmonary involvement in chest CT., Methods: This is a study conducted within the IgG4-RD study group of the Argentine Society of Rheumatology (GESAR IgG4) cohort of patients with IgG4-RD. Member centers of the group were requested to submit pulmonary CT scans of the patients. Lung lesions were classified into 4 subtypes: (1) nodules, (2) ground-glass opacity, (3) interstitial-alveolar involvement, and (4) bronchovascular involvement. The presence of pleural involvement and mediastinal adenopathy was also assessed., Results: We examined data from 28 patients, with 17 (61%) showing pulmonary involvement. The subtypes of pulmonary involvement, in order of frequency, were as follows: type 4 (n = 17, 100%), type 3 (n = 10, 59%), type 2 (n = 6, 36%), and type 1 (n = 5, 29%). Pleural lesions were observed in 2 (12%) cases, and mediastinal adenopathies were found in 4 (23%) cases. No demographic, clinical, or laboratory differences were noted between patients with and without pulmonary involvement, except for serum levels of IgG4, which were higher among patients without pulmonary involvement (339.0 [293.1-1592.1 mg/dL] vs 2869 [1156.3-4037.4 mg/dL]; p = 0.022)., Conclusions: In this case series, the predominant subtype of pulmonary involvement was septal thickening and increased bronchovascular tissue. Patients with and without pleuropulmonary involvement exhibited similar clinical and laboratory manifestations, except for serum IgG4, which was higher in patients without pleuropulmonary involvement., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Hyperpolarized 129 Xe MRI presents opportunities to assess regional pulmonary microstructure and function. Ongoing advancements in hardware, sequences, and image processing have helped it become increasingly adopted for both research and clinical use. As the number of applications and users increase, standardization becomes crucial. To that end, this study developed an executable, open-source 129 Xe image processing pipeline (XIPline) to provide a user-friendly, graphical user interface-based analysis pipeline to analyze and visualize 129 Xe MR data, including scanner calibration, ventilation, diffusion-weighted, and gas exchange images., Methods: The customizable XIPline is designed in MATLAB to analyze data from all three major scanner platforms. Calibration data is processed to calculate optimal flip angle and determine 129 Xe frequency offset. Data processing includes loading, reconstructing, registering, segmenting, and post-processing images. Ventilation analysis incorporates three common algorithms to calculate ventilation defect percentage and novel techniques to assess defect distribution and ventilation texture. Diffusion analysis features ADC mapping, modified linear binning to account for ADC age-dependence, and common diffusion morphometry methods. Gas exchange processing uses a generalized linear binning for data acquired using 1-point Dixon imaging., Results: The XIPline workflow is demonstrated using analysis from representative calibration, ventilation, diffusion, and gas exchange data., Conclusion: The application will reduce redundant effort when implementing new techniques across research sites by providing an open-source framework for developers. In its current form, it offers a robust and adaptable platform for 129 Xe MRI analysis to ensure methodological consistency, transparency, and support for collaborative research across multiple sites and MRI manufacturers., (© 2024 The Author(s). Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Pediatric patients are affected by a wide variety of pulmonary vascular diseases ranging from congenital anomalies diagnosed at birth to acquired diseases that present later in childhood and into adolescence. While some pulmonary vascular diseases present similarly to those seen in adults, other forms are unique to children. Knowledge of the characteristic imaging features of these diseases is essential to facilitate prompt diagnosis and guide clinical management., Competing Interests: Disclosure The authors do not have any relevant disclosures., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To compare texture-based analysis using convolutional neural networks (CNNs) against lung densitometry in detecting chest computed tomography (CT) image abnormalities., Material and Methods: A U-NET was used for lung segmentation, and an ensemble of 7 CNN architectures was trained for the classification of low-attenuation areas (LAAs; emphysema, cysts), normal-attenuation areas (NAAs; normal parenchyma), and high-attenuation areas (HAAs; ground-glass opacities, crazy paving/linear opacity, consolidation). Lung densitometry also computes (LAAs, ≤-950 HU), NAAs (-949 to -700 HU), and HAAs (-699 to -250 HU). CNN-based and densitometry-based severity indices (CNN and Dens, respectively) were calculated as (LAA+HAA)/(LAA+NAA+HAA) in 812 CT scans from 176 normal subjects, 343 patients with emphysema, and 293 patients with interstitial lung disease (ILD). The correlation between CNN-derived and densitometry-derived indices was analyzed, alongside a comparison of severity indices among patient subgroups with emphysema and ILD, using the Spearman correlation and ANOVA with Bonferroni correction., Results: CNN-derived and densitometry-derived severity indices (SIs) showed a strong correlation (ρ=0.90) and increased with disease severity. CNN-SIs differed from densitometry SIs, being lower for emphysema and higher for moderate to severe ILD cases. CNN estimations for normal attenuation areas were higher than those from densitometry across all groups, indicating a potential for more accurate characterization of lung abnormalities., Conclusions: CNN outputs align closely with densitometry in assessing lung abnormalities on CT scans, offering improved estimates of normal areas and better distinguishing similar abnormalities. However, this requires higher computing power., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Pulmonary hypertension is a rare but important clinical problem that presents a sometimes challenging diagnostic dilemma. The diagnosis of pulmonary hypertension relies on a combination of clinical testing and radiologic imaging, with chest computed tomography (CT) often serving as the primary imaging modality for comprehensive evaluation of the chest. Chest CT can be used to evaluate for causes of pulmonary hypertension including chronic lung disease, pulmonary artery obstruction, and congenital heart disease. Recognizing common appearances of these conditions will enable expedient diagnosis., Competing Interests: Disclosure The authors have no relevant financial disclosures related to the contents of this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Radiological follow-up of oncology patients requires the detection of metastatic lung lesions and the quantitative analysis of their changes in longitudinal imaging studies. Our aim was to evaluate SimU-Net, a novel deep learning method for the automatic analysis of metastatic lung lesions and their temporal changes in pairs of chest CT scans., Materials and Methods: SimU-Net is a simultaneous multichannel 3D U-Net model trained on pairs of registered prior and current scans of a patient. It is part of a fully automatic pipeline for the detection, segmentation, matching, and classification of metastatic lung lesions in longitudinal chest CT scans. A data set of 5040 metastatic lung lesions in 344 pairs of 208 prior and current chest CT scans from 79 patients was used for training/validation (173 scans, 65 patients) and testing (35 scans, 14 patients) of a standalone 3D U-Net models and 3 simultaneous SimU-Net models. Outcome measures were the lesion detection and segmentation precision, recall, Dice score, average symmetric surface distance (ASSD), lesion matching, and classification of lesion changes from computed versus manual ground-truth annotations by an expert radiologist., Results: SimU-Net achieved a mean lesion detection recall and precision of 0.93±0.13 and 0.79±0.24 and a mean lesion segmentation Dice and ASSD of 0.84±0.09 and 0.33±0.22 mm. These results outperformed the standalone 3D U-Net model by 9.4% in the recall, 2.4% in Dice, and 15.4% in ASSD, with a minor 3.6% decrease in precision. The SimU-Net pipeline achieved perfect precision and recall (1.0±0.0) for lesion matching and classification of lesion changes., Conclusions: Simultaneous deep learning analysis of metastatic lung lesions in prior and current chest CT scans with SimU-Net yields superior accuracy compared with individual analysis of each scan. Implementation of SimU-Net in the radiological workflow may enhance efficiency by automatically computing key metrics used to evaluate metastatic lung lesions and their temporal changes., Competing Interests: L.J. and J.S. are co-founders and consultants of HighRAD Ltd. Richard Lederman, Shalom Rochman and Adi Szeskin are consultants of HighRAD. The remaining authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

This study aims to develop an anomaly-detection scheme for lesions in CT images. Our database consists of lung CT images obtained from 1500 examinees. It includes 1200 normal and 300 abnormal cases. In this study, SVDD (Support Vector Data Description) mapping the normal latent variables into a hypersphere as small as possible on the latent space is introduced to VQ-VAE (Vector Quantized-Variational Auto-Encoder). VQ-VAE with SVDD is constructed from two encoders, two decoders, and an embedding space. The first encoder compresses the input image into the latent-variable map, whereas the second encoder maps the normal latent variables into a hypersphere as small as possible. The first decoder then up-samples the mapped latent variables into a latent-variable map with the original size. The second decoder finally reconstructs the input image from the latent-variable map replaced by the embedding representations. The data of each examinee is classified as abnormal or normal based on the anomaly score defined as the combination of the difference between the input image and the reconstructed image and the distance between the latent variables and the center of the hypersphere. The area under the ROC curve for VQ-VAE with SVDD was 0.76, showing an improvement when compared with the conventional VAE (0.63, p < .001). VQ-VAE with SVDD developed in this study can yield higher anomaly-detection accuracy than the conventional VAE. The proposed method is expected to be useful for identifying examinees with lesions and reducing interpretation time in CT screening., Competing Interests: Declarations. Conflict of interest: No conflicts of interest. Ethical approval: Ethical approval for case use was obtained from the institutional review board (IRB) of both the authors’ institutions. Informed consent: The institutional review board approved this retrospective study and waived the requirement for informed consent from the patients., (© 2024. The Author(s).)

Hyperpolarized 129 Xe MRI/MRS enables quantitative mapping of function in lung airspaces, membrane tissue, and red blood cells (RBCs) within the pulmonary capillaries. The RBC signal also exhibits cardiogenic oscillations that are reduced in precapillary pulmonary hypertension (PH). This effect is obscured in patients with concomitant defects in transfer from airspaces to RBCs, which increase RBC oscillation amplitudes. Here, we provide a framework for interpreting RBC oscillations and show their relationship to pulsatile blood flow, capillary blood volume, capillary compliance, and impedance of the capillary and venous circulation. This framework was first applied to characterize RBC oscillations in a cohort of subjects with pulmonary disease but no known PH ( n = 129). 129 Xe MRI of RBC transfer was used to estimate capillary blood volume, and as it decreased, RBC oscillations sharply increased ([Formula: see text] = 0.53), consistent with model predictions. Model-derived fit parameters were then used to estimate the distribution of pulmonary vascular resistance (PVR) across arterial, capillary, and venous circulation and to correct oscillations for RBC transfer defects. Seventy percent of PVR was estimated to arise from pulmonary arteries, 11% from capillaries, and 19% from veins. When tested in a second cohort of subjects who underwent 129 Xe MRI/MRS and right heart catheterization ( n = 40), oscillations corrected for capillary blood volume correlated moderately with PVR ( r 2 = 0.27, P = 0.0014). For every 1.96 Wood units (WU) increase in PVR, corrected oscillations decreased by 1 absolute percentage point. This work demonstrates that, although 129 Xe-RBC oscillations are only indirectly sensitive to precapillary obstruction, corrected oscillations below 7.5% were 100% specific for elevated PVR. NEW & NOTEWORTHY Cardiogenic oscillations in the 129 Xe red blood cell (RBC) resonance decrease in precapillary pulmonary hypertension (PH) but are enhanced when capillary blood volume is reduced. To separate these effects, we developed a physiological model that used 129 Xe gas exchange MRI to estimate blood volume, which was used to correct oscillation amplitude measurements. Corrected amplitudes correlated significantly with pulmonary vascular resistance, highlighting the potential for future noninvasive detection of PH.

This document provides a comprehensive analysis of the use of point-of-care ultrasound in heart failure (HF), offering detailed recommendations on echocardiography, lung ultrasound, and venous ultrasound. These advanced imaging techniques allow for an accurate, detailed, and non-invasive evaluation of heart failure, facilitating rapid and effective clinical decision-making. Echocardiography enables a rapid assessment of cardiac function at the point of care, enhancing traditional physical examination and being essential for the management of heart failure (HF). Lung ultrasound provides a detailed view of the pulmonary status, crucial for diagnosing pulmonary congestion without using ionizing radiation, ideal for continuous monitoring. Venous ultrasound evaluates systemic congestion by measuring the inferior vena cava and other parameters, aiding in the estimation of right atrial pressure and monitoring pressure and volume overload, improving patient understanding and prognosis. Together, the use of these ultrasound modalities not only complements but enriches the traditional physical examination, establishing themselves as indispensable tools in the comprehensive and effective management of patients with heart failure. By incorporating these techniques into clinical practice, healthcare professionals can achieve better evaluation, diagnosis, and treatment, resulting in more personalized management of these patients., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2025 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Infected region segmentation is crucial for pulmonary infection diagnosis, severity assessment, and monitoring treatment progression. High-performance segmentation methods rely heavily on fully annotated, large-scale training datasets. However, manual labeling for pulmonary infections demands substantial investments of time and labor. While weakly supervised learning can greatly reduce annotation efforts, previous developments have focused mainly on natural or medical images with distinct boundaries and consistent textures. These approaches is not applicable to pulmonary infection segmentation, which should contend with high topological and intensity variations, irregular and ambiguous boundaries, and poor contrast in 3D contexts. In this study, we propose a cascading point-annotation framework to segment pulmonary infections, enabling optimization on larger datasets and superior performance on external data. Via comparing the representation of annotated points and unlabeled voxels, as well as establishing global uncertainty, we develop two regularization strategies to constrain the network to a more holistic lesion pattern understanding under sparse annotations. We further encompass an enhancement module to improve global anatomical perception and adaptability to spatial anisotropy, alongside a texture-aware variational module to determine more regionally consistent boundaries based on common textures of infection. Experiments on a large dataset of 1,072 CT volumes demonstrate our method outperforming state-of-the-art weakly-supervised approaches by approximately 3%-6% in dice score and is comparable to fully-supervised methods on external datasets. Moreover, our approach demonstrates robust performance even when applied to an unseen infection subtype, Mycoplasma pneumoniae, which was not included in the training datasets. These results collectively underscore rapid and promising applicability for emerging pulmonary infections., Competing Interests: Declaration of competing interest 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 © 2025. Published by Elsevier Ltd.)

Rationale and Objectives: Hyperpolarized 129 Xe MRI quantifies ventilation-defect-percent (VDP), the ratio of 129 Xe signal-void to the anatomic 1 H MRI thoracic-cavity-volume. VDP is associated with airway inflammation and disease control and serves as a treatable trait in therapy studies. Semi-automated VDP pipelines require time-intensive observer interactions. Current convolutional neural network (CNN) approaches for quantifying VDP lack external validation, which limits multicenter utilization. Our objective was to develop an automated and externally validated deep-learning pipeline to quantify pulmonary 129 Xe MRI VDP., Materials and Methods: 1 H and 129 Xe MRI data from the primary site (Site1) were used to train and test a CNN segmentation and registration pipeline, while two independent sites (Site2 and Site3) provided external validation. Semi-automated and CNN-based registration error was measured using mean-absolute-error (MAE) while segmentation error was measured using generalized-Dice-similarity coefficient (gDSC). CNN and semi-automated VDP were compared using linear regression and Bland-Altman analysis., Results: Training/testing used data from 205 participants (healthy volunteers, asthma, COPD, long-COVID; mean age=54 ± 16y; 119 females) from Site1. External validation used data from 71 participants. CNN and semi-automated 1 H and 129 Xe registrations agreed (MAE=0.3°, R 2 =0.95 rotation; 1.1%, R 2 =0.79 scaling; 0.2/0.5px, R 2 =0.96/0.95, x/y-translation; all p < .001). Thoracic-cavity and ventilation segmentations were also spatially corresponding (gDSC=0.92 and 0.88, respectively). CNN VDP correlated with semi-automated VDP (Site1 R 2 /ρ = .97/.95, bias=-0.5%; Site2 R 2 /ρ = .85/.93, bias=-0.9%; Site3 R 2 /ρ = .95/.89, bias=-0.8%, all p < .001)., Conclusion: An externally validated CNN registration/segmentation model demonstrated strong agreement with low error compared to the semi-automated method. CNN and semi-automated registrations, thoracic-cavity-volume and ventilation-volume segmentations were highly correlated with high gDSC for the datasets., Competing Interests: Declaration of Competing Interest 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 Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Background: Treatment of locally advanced non small cell lung cancer (LA-NSCLC) is based on (chemo)radiotherapy, which may cause acute lung toxicity: radiation pneumonitis (RP). Its frequency seems to increase by the use of adjuvant durvalumab therapy., Aims: To identify clinical, dosimetric, and radiomic factors associated with grade (G)≥2 RP and build a prediction model based on selected parameters., Patients and Methods: This is a retrospective multicenter cohort study including patients receiving radiation therapy between 2015 and 2019 for LA-NSCLC. Baseline computed tomography scanners were segmented to extract radiomic features from the "Lung - Tumor" volume. Variables associated with the risk of G≥2 RP in the descriptive analysis were then selected for explanatory analysis, followed by predictive analysis., Results: 153 patients were included in 4 centers (51 with G≥2 RP). Factors associated with G≥2 RP included a high initial hemoglobin level, dosimetric factors (mean dose to healthy lungs, lung V20Gy and V13Gy), the addition of maintenance durvalumab, and 7 radiomic features (intensity distribution and texture). Other factors were associated with an increased risk of G≥2 RP in our explanatory model, such as older age, low Tiffeneau ratio, and a decreased initial platelet count. The best-performing predictive model was a random forest-based learning model using clinical, dosimetric, and radiomic variables, with an area under the ROC curve of 0.72 (95%CI [0.63; 0.80]) versus 0.64 for models using one type of data., Conclusion: The addition of radiomic features to clinical and dosimetric ones improves prediction of the occurrence of G≥2 RP in patients receiving radiotherapy for lung cancer., Competing Interests: Disclosure Cécile Evin: Merck, Léo Razakamanantsoa : none, François Gardavaud: none, Léa Papillon: employed by SOPHiA GENETICS, Hamza Boulaala: employed by SOPHiA GENETICS, Loïc Ferrer: employed by SOPHiA GENETICS, Olivier Gallinato: employed by SOPHiA GENETICS, Thierry Colin: employed by SOPHiA GENETICS, Sondos Ben Moussa: none, Yara Harfouch: none, Jean-Noël Foulquier: none, Sophie Guillerm: none, Jean-Emmanuel Bibault: none, Florence Huguet : BMS, Merck, MSD, Amgen, Mathilde Wagner: none, Eleonor Rivin del Campo: none., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Patient respiration is characterized by respiratory parameters, such as cycle, amplitude, and baseline drift. In treatment planning using four-dimensional computed tomography (4DCT) images, the target dose may be affected by variations in image reconstruction techniques and respiratory parameters. This study aimed to optimize 4DCT image reconstruction techniques for the treatment planning of lung stereotactic body radiotherapy (SBRT) based on respiratory parameters using respiratory motion phantom. We quantified respiratory parameters using 30 respiratory motion datasets. The 4DCT images were acquired, and the phase- and amplitude-based reconstruction images (RI) were created. The target dose was calculated based on these reconstructed images. Statistical analysis was performed using Pearson's correlation coefficient (r) to determine the relationship between respiratory parameters and target dose in each reconstructed technique and respiratory region. In the inhalation region of phase-based RI, r of the target dose and baseline drift was -0.52. In particular, the target dose was significantly reduced for respiratory parameters with a baseline drift of 0.8 mm/s and above. No other respiratory parameters or respiratory regions were significantly correlated with target dose in phase-based RI. In amplitude-based RI, there were no significant differences in the correlation between all respiratory parameters and target dose in the exhalation or inhalation regions. These results showed that the target dose of the amplitude-based RI did not depend on changes in respiratory parameters or respiratory regions, compared to the phase-based RI. However, it is possible to guarantee the target dose by considering respiratory parameters during the inhalation region of the phase-based RI., Competing Interests: Declarations. Conflict of interest: The authors have no conflicts of interest to declare that are relevant to the content of this article. Ethical approval: This study was conducted in accordance with the Declaration of Helsinki and the Japanese ethical guidelines for epidemiologic research. Consent to participate: Participation consent was not required for this study as it involved the analysis of pre-existing, anonymized data, and did not involve any direct interaction with human subjects. Consent to publish: Formal consent to publish individual participant data was not obtained for this study. The research exclusively involved the analysis of aggregated and de-identified data, and no personally identifiable information is presented in this manuscript., (© 2024. The Author(s), under exclusive licence to Japanese Society of Radiological Technology and Japan Society of Medical Physics.)

Objectives: With SARS-CoV-2 evolving, disease severity and presentation have changed due to changes in mechanisms of entry and effector site as well as due to effects of vaccination- and/or infection-acquired immunity. We re-assessed fetal lung pathology in pregnancies with uncomplicated SARS-CoV-2 infections during the late, omicron-dominated pandemic phase to inform disease understanding and pregnancy consultation., Methods: In this case-control study, fetal lung volumes were assessed by fetal MRI in 24 pregnancies affected by mild maternal SARS-CoV-2 infection during the omicron-dominated pandemic phase with prevailing immunity through vaccination and/or prior SARS-CoV-2 infection., Results: Fetal lung volumes (normalized to estimated fetal weight) in 24 pregnancies (GA 33.3 ± 3.8, 12 female fetuses) following mild, uncomplicated SARS-CoV-2 infection did not differ significantly from both, published reference values (96.3% ± 22.5% of 50th percentile reference values, p = 0.43), or fetal lung volumes of a site-specific, non-COVID control group (n = 15, 94.2% ± 18.5%, p = 0.76). Placental assessment revealed no group differences in thrombotic changes or placental heterogeneity (p > 0.05, respectively), and fetal lung volume did not correlate with placental heterogeneity when adjusting for gestational age at scan (p > 0.05)., Conclusion: Assessment of fetal lung volume by MRI revealed unaffected lung growth in pregnancies affected by uncomplicated SARS-CoV-2 infection in the omicron-dominated pandemic phase in the presence of prevailing hybrid immunity. This finding contrasts sharply with the observed reduction in fetal lung volume following maternal alpha-variant infection in the pre-vaccination era and might reflect tropism- as well as immunity-related effects., Key Points: Question: Is fetal lung development affected by mild maternal SARS-CoV-2 infection during the omicron-dominated phase of the pandemic?, Findings: Fetal lung volume in 24 affected pregnancies did not differ significantly from published reference values or fetal lung volumes in 15 site-specific, non-COVID-affected control pregnancies., Clinical Relevance: Preserved fetal lung volume following mild maternal SARS-CoV-2 infection during the omicron-dominated phase contrasts with previous findings of reduced volume in unvaccinated pregnancies during the alpha-dominated pandemic phase. These observations might reflect tropism- as well as immunity-related effects., Competing Interests: Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Prof. Dr. S.S. Conflict of interest: O.D. is a member of the Scientific Editorial Board of European Radiology (section: Megnetic Resonance). They have not participated in the selection nor review processes for this article. The remaining authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry: Two authors have significant statistical expertize: Regina Schinner (Dipl. stat.) and Tanja Burkard (Master in Biostatistics). Informed consent: Only if the study is on human subjects: written informed consent was obtained from all subjects (patients) in this study. Ethical approval: Institutional Review Board approval (#LMU-207–33) was obtained. Study subjects or cohorts overlap: We published our finding of reduced fetal lung volume following mild maternal SARS-CoV-2 infection in the early, alpha-dominated phase of the pandemic as a Letter in The Lancet Respiratory Medicine in 2022 ( https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00060-1/fulltext?s=04 ). This prompted us to conduct a follow-up study in the late, omicron-dominated phase of the pandemic, with prevailing hybrid immunity. The non-COVID control group is identical in both studies. There is no overlap in the SARS-CoV-2 positive study cohorts. Methodology: Prospective Case-control study Performed at one institution, (© 2024. The Author(s).)

Background: A major goal of contemporary obstetrical practice is to optimize fetal growth and development throughout pregnancy. To date, fetal growth during prenatal care is assessed by performing ultrasonographic measurement of 2-dimensional fetal biometry to calculate an estimated fetal weight. Our group previously established 2-dimensional fetal growth standards using sonographic data from a large cohort with multiple sonograms. A separate objective of that investigation involved the collection of fetal volumes from the same cohort., Objective: The Fetal 3D Study was designed to establish standards for fetal soft tissue and organ volume measurements by 3-dimensional ultrasonography and compare growth trajectories with conventional 2-dimensional measures where applicable., Study Design: The National Institute of Child Health and Human Development Fetal 3D Study included research-quality images of singletons collected in a prospective, racially and ethnically diverse, low-risk cohort of pregnant individuals at 12 U.S. sites, with up to 5 scans per fetus (N=1730 fetuses). Abdominal subcutaneous tissue thickness was measured from 2-dimensional images and fetal limb soft tissue parameters extracted from 3-dimensional multiplanar views. Cerebellar, lung, liver, and kidney volumes were measured using virtual organ computer aided analysis. Fractional arm and thigh total volumes, and fractional lean limb volumes were measured, with fractional limb fat volume calculated by subtracting lean from total. For each measure, weighted curves (fifth, 50th, 95th percentiles) were derived from 15 to 41 weeks' using linear mixed models for repeated measures with cubic splines., Results: Subcutaneous thickness of the abdomen, arm, and thigh increased linearly, with slight acceleration around 27 to 29 weeks. Fractional volumes of the arm, thigh, and lean limb volumes increased along a quadratic curvature, with acceleration around 29 to 30 weeks. In contrast, growth patterns for 2-dimensional humerus and femur lengths demonstrated a logarithmic shape, with fastest growth in the second trimester. The mid-arm area curve was similar in shape to fractional arm volume, with an acceleration around 30 weeks, whereas the curve for the lean arm area was more gradual. The abdominal area curve was similar to the mid-arm area curve with an acceleration around 29 weeks. The mid-thigh and lean area curves differed from the arm areas by exhibiting a deceleration at 39 weeks. The growth curves for the mid-arm and thigh circumferences were more linear. Cerebellar 2-dimensional diameter increased linearly, whereas cerebellar 3-dimensional volume growth gradually accelerated until 32 weeks followed by a more linear growth. Lung, kidney, and liver volumes all demonstrated gradual early growth followed by a linear acceleration beginning at 25 weeks for lungs, 26 to 27 weeks for kidneys, and 29 weeks for liver., Conclusion: Growth patterns and timing of maximal growth for 3-dimensional lean and fat measures, limb and organ volumes differed from patterns revealed by traditional 2-dimensional growth measures, suggesting these parameters reflect unique facets of fetal growth. Growth in these three-dimensional measures may be altered by genetic, nutritional, metabolic, or environmental influences and pregnancy complications, in ways not identifiable using corresponding 2-dimensional measures. Further investigation into the relationships of these 3-dimensional standards to abnormal fetal growth, adverse perinatal outcomes, and health status in postnatal life is warranted., (Published by Elsevier Inc.)

Purpose: The aim of this study was to find the optimal strength level of QIR for ultra-high-resolution (UHR) PCCT of the lung., Materials and Methods: This retrospective study included 24 patients who had unenhanced chest CT with the novel UHR scan protocol on the PCCT scanner between March 24, 2023 and May 18, 2023. Two sets of reconstructions were made using different slice thicknesses: standard resolution (SR, 1 mm) and ultra-high-resolution (UHR, 0.2 mm), reconstructed with all strength levels of QIR (0 to 4). Attenuation of the lung parenchyma, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were assessed as objective criteria of image quality. Two fellowship-trained radiologists compared image quality and noise level, sharpness of the images, and the airway details using a 5-point Likert scale. Wilcoxon signed-rank test was used for statistical analysis of reader scores, and one-way repeated measures analysis of variance for comparing the objective image quality scores., Results: Objective image quality linearly improved with higher strength levels of QIR, reducing image noise by 66% from QIR-0 to QIR-4 ( P <0.001). Subjective image noise was best for QIR-4 ( P <0.001). Readers rated QIR-1 and QIR-2 best for SR, and QIR-2 and QIR-3 best for UHR in terms of subjective image sharpness and airway detail, without significant differences between them ( P =0.48 and 0.56, respectively)., Conclusions: Higher levels of QIR provided excellent objective image quality, but readers' preference was for intermediate levels. Considering all metrics, we recommend QIR-3 for ultra-high-resolution PCCT of the lung., Competing Interests: J.O. was an employee of Siemens Medical Solutions USA Inc. U.J.S. received institutional research support and/or personal fees from Bayer, Bracco, Elucid Bioimaging, Guerbet, HeartFlow, Keya Medical, and Siemens. The remaining authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To perform a systematic review and meta-analysis of relevant studies to assess the diagnostic accuracy and safety outcomes of ultrasound (US)-guided transthoracic needle biopsy (TTNB) for peripheral lung and pleural lesions., Materials and Methods: A search was performed through Medline, Embase, Web of Science, and Cochrane Central from inception up to September 23, 2022 for diagnostic accuracy studies reporting US-guided TTNB (Prospero registration: CRD42021225168). The primary outcome was diagnostic accuracy, which was assessed by sensitivity, specificity, likelihood ratios (LR), and diagnostic odds ratio. Sensitivity and subgroup analyses were performed to evaluate inter-study heterogeneity. The secondary outcome was the frequency of complications. Random-effects models were used for the analyses. The risk of bias and the applicability of the included studies were assessed using the QUADAS-2 tool. Publication bias was assessed by testing the association between the natural logarithm of the diagnostic odds ratio and the effective sample size., Results: Of the 7841 citations identified, 83 independent cohorts (11,767 patients) were included in the analysis. The pooled sensitivity of US-TTNB was 88% (95% CI: 86%-91%, 80 studies). Pooled specificity was 100% (95% CI: 99%-100%, 72 studies), resulting in positive LR, negative LR, and diagnostic odds ratio of 946 (-743 to 2635), 0.12 (0.09 to 0.14), and 8141 (1344 to 49,321), respectively. Complications occurred in 4% (95% CI: 3%-5%) of the procedures, with pneumothorax being the most frequent (3%; 95% CI: 2%-3%, 72 studies) and resulting in chest tube placement in 0.4% (95% CI: 0.2%-0.7%, 64 studies) of the procedures., Conclusions: US-TTNB is an effective and safe procedure for pleural lesions and peripheral lung lesions., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Lung function assessment is essential for determining the optimal treatment strategy for radiation therapy in patients with lung tumors. This study aimed to develop radiomics and dosiomics approaches to estimate pulmonary function test (PFT) results in post-stereotactic body radiation therapy (SBRT). Sixty-four patients with lung tumors who underwent SBRT were included. Models were created to estimate the PFT results at 0-6 months (Cohort 1) and 6-24 months (Cohort 2) after SBRT. Radiomics and dosiomics features were extracted from the computed tomography (CT) images and dose distributions, respectively. To estimate the PFT results, Models A (dose-volume histogram [DVH] + radiomics features) and B (DVH + radiomics + dosiomics features) were created. In the PFT results, the forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were estimated using each model, and the ratio of FEV1 to FVC (FEV1/FVC) was calculated. The Pearson's correlation coefficient (Pearson r) and area under the curve (AUC) for FEV1/FVC (< 70%) were calculated. The models were evaluated by comparing them with the conventional calculation formulae (Conventional). The Pearson r (FEV1/FVC) values were 0.30, 0.64, and 0.69 for Conventional and Models A and B (Cohort 2), respectively, and the AUC (FEV1/FVC < 70%) values were 0.63, 0.80, and 0.78, respectively. This study demonstrates the possibility of estimating lung function after SBRT using radiomics and dosiomics features based on planning CT images and dose distributions., Competing Interests: Declarations. Conflicts of interest: The authors declare no conflicts of interest. Ethical approval: Our institutional review board approved this study. Considering the retrospective nature of this study and the fact that no human samples were obtained, the informed consent requirement was waived by the institutional review board., (© 2025. The Author(s), under exclusive licence to Japanese Society of Radiological Technology and Japan Society of Medical Physics.)

Aim: To evaluate the correlation between semi-quantitative analyses and visual scores of pulmonary perfusion Single Photon Emission Computed Tomography (SPECT)/ Computed Tomography (CT) imaging and pulmonary function test parameters (PFTs) in patients with interstitial lung diseases (ILDs)., Materials and Methods: This retrospective study included 35 patients with ILDs from China-Japan Friendship Hospital between January 2020 and December 2022. All patients underwent pulmonary perfusion SPECT/CT imaging and a pulmonary function test. Visual scores of pulmonary perfusion SPECT/CT images were determined using the Meyer method, and functional lung volumes of pulmonary perfusion were calculated using various cutoff values (5%-95% of the maximum pixel value). PFTs included forced expiratory volume in the first second (FEV1) and FEV1 as a percentage of the predicted value (FEV1%), forced vital capacity (FVC) and FVC as a percentage of the predicted value (FVC%), one-second rate (FEV1/FVC), pulmonary carbon monoxide dispersion (DLCO) and DLCO as a percentage of the predicted value (DLCO%). Pearson's correlation was calculated to compare visual scores and lung perfusion functional volumes with PFT indices., Results: Visual scores correlated with FEV1, FEV1%, FVC% and DLCO%, with a significant correlation observed for FEV1% (r = 0.576, P < 0.001). When taking the maximal pixel value of bilateral lung fields or unilateral lung field as 100%, lung perfusion volumes were significantly correlated with FEV1, FEV1%, FVC and FVC% at a threshold of 15%-30% (r s  > 0.6, P < 0.001)., Conclusion: Pulmonary perfusion volumes within the threshold of 15%-30% in pulmonary perfusion SPECT/CT imaging reliably reflect lung function and outperform visual scores in patients with ILDs., Competing Interests: Conflict of interest The authors declare no conflict of interest., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Antinuclear antibodies (ANA) are often found in ILD; whether ANA is associated with radiographic progression of quantitive interstitial lung changes is unknown. We performed longitudinal analyses of adults in the Multi-Ethnic Study of Atherosclerosis using linear mixed effects models with random intercept and slope to evaluate whether baseline ANA was associated with change in the amount of lung with high attenuation areas on CT (HAAs, percentage of imaged lung with -600 to -250 HU). In 6,638 subjects with 17,293 CT scans over 18 years, 741 (11 %) were ANA positive. ANA was not associated with HAA progression with ANA as a dichotomous variable (0.13 % less progression per year for ANA positive vs negative, 95%CI -0.33 %-0.07 %, p = 0.19) or as a continuous variable (0.004 % less progression per year per 10 % increase in ANA, 95%CI -0.01 %-0.005 %, p = 0.37). ANA was not associated with progression of HAA in community dwelling adults., Competing Interests: Declaration of competing interest KFF reports no conflicts of interest. MDG received consulting fees from AbbVie and research support from Glaxo-Smith Kline and Janssen. JSK reports no conflicts of interest. JYH received compensation from the National Kidney Foundation for his role as Statistics/Methods Editor of the American Journal of Kidney Diseases, from the Public Library of Science for his role as Statistical Advisor of PLOS ONE, and from the American Medical Association for his role as Statistical Reviewer of JAMA Network Open. AJP received consulting fees from Boehringer Ingelheim, United Therapeutics, Veracyte, Regeneron, Imvaria, and Eisai. EH is a founder and shareholder of VIDA Diagnostics, a company commercializing lung image analysis software developed, in part, at the University of Iowa. CJ reports grant funding from the NHLBI and participation on the medical advisory board for the Myositis Association. CFM reports no conflicts of interest. BMS reports no conflicts of interest. MEK served as a clinical trial site PI for United Therapeutics, Galapagos NV, Boehringer Ingelheim Pharmaceuticals, and Bellerophon Pulse Technologies Llc and Penn received research support for this work. SMK received consulting fees from Janssen, Regeneron, PureTech Health, and Morphic; payment or honoraria for presentations, speakers bureaus or manuscript writing from Janssen, Accredo, Actelion, Aerovate, Bayer, Inari Medical, Merck, United Therapeutics, Janssen, Liquidia, and Pfizer; support for attending meetings and/or travel from Aerovate; stock or stock options of Verve Therapeutics; participation on the editorial board of the European Respiratory Journal; receipt of equipment from PhysIQ; and participation on DSMB or advisory board of United Therapeutics, Keros, Acceleron, Vivus, Aerovate, and Proteo Biotech. RGB received funding from the COPD Foundation and American Lung Association. MRA serves as clinical trial site PI for United Therapeutics. EJB reports no conflicts of interest., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Lung compliance, a biomarker of pulmonary fibrosis, is generally measured globally. Hyperpolarized 129 Xe gas MRI offers the potential to evaluate lung compliance regionally, allowing for visualization of changes in lung compliance associated with fibrosis., Purpose: To assess global and regional lung compliance in a rat model of pulmonary fibrosis using hyperpolarized 129 Xe gas MRI., Study Type: Prospective., Animal Model: Twenty Sprague-Dawley male rats with bleomycin-induced fibrosis model (N = 10) and saline-treated controls (N = 10)., Field Strength/sequence: 7-T, fast low-angle shot (FLASH) sequence., Assessment: Lung compliance was determined by fitting lung volumes derived from segmented 129 Xe MRI with an iterative selection method, to corresponding airway pressures. Similarly, lung compliance was obtained with computed tomography for cross-validation. Direction-dependencies of lung compliance were characterized by regional lung compliance ratios (R) in different directions. Pulmonary function tests (PFTs) and histological analysis were used to validate the pulmonary fibrosis model and assess its correlation with 129 Xe lung compliance., Statistical Tests: Shapiro-Wilk tests, unpaired and paired t-tests, Mann-Whitney U and Wilcoxon signed-rank tests, and Pearson correlation coefficients. P < 0.05 was considered statistically significant., Results: For the entire lung, the global and regional lung compliance measured with 129 Xe gas MRI showed significant differences between the groups, and correlated with the global lung compliance measured using PFTs (global: r = 0.891; regional: r = 0.873). Additionally, for the control group, significant difference was found in mean regional compliance between areas, eg, 0.37 (0.32, 0.39) × 10 -4  mL/cm H 2 O and 0.47 (0.41, 0.56) × 10 -4  mL/cm H 2 O for apical and basal lung, respectively. The apical-basal direction R was 1.12 ± 0.09 and 1.35 ± 0.13 for fibrosis and control groups, respectively, indicating a significant difference., Data Conclusion: Our findings demonstrate the feasibility of using hyperpolarized gas MRI to assess regional lung compliance., Evidence Level: 2 TECHNICAL EFFICACY: Stage 1., (© 2024 International Society for Magnetic Resonance in Medicine.)

Background: Peripheral artery disease (PAD) and chronic obstructive pulmonary disease (COPD) are inflammatory diseases. These two entities often co-exist, but little is known about the prevalence of this phenomenon in patients with PAD. The objectives of this prospective cross-sectional study were to determine the prevalence of COPD in patients with PAD and to assess the frequency of COPD underdiagnosis in this group of patients. Patients and methods: Consecutive patients admitted to angiology department were evaluated. Measurements of ankle-brachial and toe-brachial index as well as peripheral arteriography were performed in all participants to confirm PAD. In tobacco smokers with PAD spirometry was performed to identified patients with COPD. Clinical information was obtained from the patients on the basis of questionnaires. Results: Eighty-eight out of 300 consecutive patients were included and assessed. COPD was diagnosed in 33 (37.5%) hospitalized smokers with PAD. COPD has not previously been diagnosed in 28 (84.8%) patients who met the criteria of the disease. Conclusions: There was high prevalence of COPD among tobacco smokers hospitalized in the angiology department. Most of them had never had spirometry performed before. The underdiagnosis rate is relatively high; therefore, all patients with PAD who smoke tobacco should have a spirometry performed, as a screening for COPD.

Study Design: Experimental study., Objective: To create an early-onset scoliosis (EOS) rabbit model and use a design-based stereological method to quantitatively assess lung structure changes at 24 weeks of age., Summary of Background Data: Scoliosis affects thoracic and lung development, impacting children's chest and lung growth., Materials and Methods: EOS was induced via rib tethering in 4-week-old rabbits with ongoing CT scans and weight measures. Lungs were extracted postfixation for volume estimation and tissue sampling, followed by microscopic analysis of lung morphology., Results: The mean Cobb angle increased with the rabbits' growth. The EOS group showed significant decreases in total and right lung volumes. Quantitative lung stereology revealed reduced volumes of lung parenchyma and nonparenchymal tissue in all lobes. Alveolar duct volumes decreased significantly in multiple lobes, and alveolar septal volume was notably reduced in the right upper, middle, and lower lobes. The alveolar septal area decreased, and septal thickness increased in the EOS group. Alveoli numbers dropped, with variable changes in mean alveolar volume across lobes. Vascular lumen volume decreased in the right middle and lower lobes, and blood vessel and perivascular tissue volumes were significantly reduced in the right lung. Vessel diameter changes varied across lobes, with significant decreases in the right middle and lower lobes and increases in the left upper and lower lobes. Vascular endothelial surface area decreased in the left lower, right middle, and right lower lobes, with increased vessel and perivascular tissue thickness in the left upper and lower lobes compared with the right lobes., Conclusion: The EOS rabbit model demonstrated reduced lung volume, impaired alveolarization, septal thickening, and vascular changes, indicating scoliosis's negative impact on thoracic and lung development, especially on the concave lung., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

We aimed to evaluate the image quality and diagnostic performance of chronic lung allograft dysfunction (CLAD) with lung ventilation single-photon emission computed tomography (SPECT) images acquired briefly using a convolutional neural network (CNN) in patients after lung transplantation and to explore the feasibility of short acquisition times. We retrospectively identified 93 consecutive lung-transplant recipients who underwent ventilation SPECT/computed tomography (CT). We employed a CNN to distinguish the images acquired in full time from those acquired in a short time. The image quality was evaluated using the structural similarity index (SSIM) loss and normalized mean square error (NMSE). The correlation between functional volume/morphological volume (F/M) ratios of full-time SPECT images and predicted SPECT images was evaluated. Differences in the F/M ratio were evaluated using Bland-Altman plots, and the diagnostic performance was compared using the area under the curve (AUC). The learning curve, obtained using MSE, converged within 100 epochs. The NMSE was significantly lower (P < 0.001) and the SSIM was significantly higher (P < 0.001) for the CNN-predicted SPECT images compared to the short-time SPECT images. The F/M ratio of full-time SPECT images and predicted SPECT images showed a significant correlation (r = 0.955, P < 0.0001). The Bland-Altman plot revealed a bias of -7.90% in the F/M ratio. The AUC values were 0.942 for full-time SPECT images, 0.934 for predicted SPECT images and 0.872 for short-time SPECT images. Our findings suggest that a deep-learning-based approach can significantly curtail the acquisition time of ventilation SPECT, while preserving the image quality and diagnostic accuracy for CLAD., Competing Interests: Declarations. Conflict of interest: The authors have no competing interests to declare that are relevant to the content of this article. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Bioethics Committee of the Okayama University Hospital (KEN2401-020)., (© 2024. The Author(s), under exclusive licence to Japanese Society of Radiological Technology and Japan Society of Medical Physics.)

Purpose: Acute Kidney Injury (AKI) has an incidence of 20-50 % in patients admitted in Intensive Care Unit. As weaning failure is associated with increased morbidity, its prediction and understanding of its physiological basis holds extreme importance in guided management and prognostication of these patients. We conducted this prospective, observational, single - center study to evaluate the efficacy of transthoracic echocardiography (TTE) and lung ultrasonography (LUS) in predicting weaning failure in patients with AKI requiring mechanical ventilation., Methods: We performed LUS and TTE before and 2 h after initiating spontaneous breathing trials (SBT) in 32 mechanically ventilated critically ill patients with AKI. Extubation was decided by an independent physician. LUS included global and anterior LUS scores. TTE included measurement of E/A and E/e' ratios to determine LV filling pressures., Results: Out of 32 patients included in this study, weaning failure was observed in 17 (n = 17, 53 %) patients (weaning success n = 15, 47%). Demographic and baseline laboratory parameters were comparable between the study groups. Fluid balance [+370 (250-530)] and SOFA score [8 (7-9)] on admission were significantly higher in weaning failure group (p < 0.001, p = 0.049). LUS scores and difference between LUS scores before and at the end of the SBT were significantly higher among the weaning failure group. The model consisting of baseline variables, SOFA score on the day of weaning and SBT induced changes in global lung score showed highest ability to predict weaning failure with AUC of 0.965, R 2  = 61 %, p < 0.001., Conclusion: In mechanically ventilated critically ill patients with AKI, LUS scores can predict weaning failure after SBT., Ctri Number: CTRI/2020/12/029565., Competing Interests: Declaration of competing interest 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 © 2025 Elsevier Ltd. All rights reserved.)

Pulmonary hypertensive changes are commonly seen by the surgical pathologist, but the majority represents secondary changes due to some process extrinsic to the lung. Some primary, or idiopathic, vascular diseases result in unique pathologic changes including the plexiform lesion and venous hypertensive changes. Thromboembolic disease also shows unique pathologic features. Diffuse alveolar hemorrhage, vasculitis, and capillaritis often overlap, but may represent separate, distinct pathologic processes. Lastly, alveolar capillary dysplasia with misalignment of pulmonary veins, as well as chronic lung allograft vasculopathy, present as unique pathologies in the neonate and posttransplant recipient, respectively., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Mucus plugs identified through chest computed tomography (CT) scans have emerged as potential prognostic factors in chronic obstructive pulmonary disease (COPD). This 5-year longitudinal study investigated their impact on exacerbations and FEV 1 decline., Methods: COPD patients with baseline chest CT and spirometric assessments were categorized based on mucus plug presence. Propensity-score matching yielded balanced groups. Exacerbation rates, time to exacerbation events, hazard ratio (HR) for exacerbations, and annual rates of FEV 1 decline were evaluated. Sensitivity analysis was performed with stratification according to mucus plug scores of 0, 1-2, and ≥3., Results: Among 623 eligible patients, the mucus plug group was 44.3%. Through 1:1 propensity-score matching, each group was comprised of 187 individuals with balanced covariates. The mucus plug group showed higher rates of moderate-to-severe (0.51/year vs. 0.58/year, P=0.035), severe exacerbations (0.21/year vs. 0.24/year, P=0.032), and non-eosinophilic exacerbations (0.45/year vs. 0.52/year, P=0.008). Mucus plugs were associated with increased hazard of moderate-to-severe (adjusted HR=1.502 [95% CI 1.116-2.020]), severe (adjusted HR=2.106 [95% CI, 1.429-3.103]), and non-eosinophilic exacerbations (adjusted HR=1.551 [95% CI, 1.132-2.125]). Annual FEV 1 decline was accelerated in the mucus plug group (β-coefficient=-62 [95% CI, -120 to -5], P=0.035). Sensitivity analysis showed higher risk of exacerbations and accelerated FEV 1 decline in mucus plug score ≥3 compared to score 0., Conclusions: Mucus plugs are associated with increased risks of exacerbations, particularly non-eosinophilic, and accelerated FEV 1 declines over 5 years. Our study identified the potential prognostic value of mucus plugs on future exacerbation risks and lung function decline trajectories., (Copyright © 2024 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: We sought to assess whether the presence and extent of lung ultrasound (LUS) findings were associated with asthma exacerbation severity in children., Methods: We enrolled a convenience sample of patients aged 5-18 years presenting with acute asthma exacerbation to a tertiary care pediatric emergency department. Severity of an asthma exacerbation (mild, moderate, severe) was assessed within 1 hour of the LUS using the Hospital Asthma Severity Score, a validated asthma assessment tool. LUS was performed by trained pediatric emergency providers. The presence of LUS findings (B-lines, consolidations, pleural effusion, and pleural line abnormalities) was assessed using a standardized criterion based on consensus guidelines., Results: A total of 111 patients with a median age of 8 years (interquartile range 6-12) were enrolled. LUS was positive in 57% of patients. Pleural line abnormalities were observed in 34%, B-lines in 29%, consolidations <1 cm in 24%, and consolidations ≥1 cm in 7%. Patients with moderate and severe asthma exacerbations were more likely to have any B-lines (31% and 43%, respectively) than patients with mild exacerbations (12%; P = .021); however, the presence of ≥3 B-lines or confluent B-lines did not differ across severity groups. The presence of other findings did not differ based on asthma severity., Conclusions: LUS findings are observed in a substantial portion of children presenting with asthma exacerbations. B-lines were the only LUS finding significantly associated with asthma severity, while lung consolidations <1 cm and >1 cm were not correlated with severity. These findings provide valuable information for the diagnostic use of LUS in pediatric patients with asthma exacerbation., (© 2024 American Institute of Ultrasound in Medicine.)

There are reports of successful lung transplants using SARS-CoV-2+ donors, but the data on their overall outcome is limited. We used the United Network for Organ Sharing Database (UNOS) to identify all lung transplant patients who received lungs from SARS-CoV-2+ donors between 2020 and 2023. There was no difference in survival between those who received lungs from SARS-CoV-2- and SARS-CoV-2+ donors (P = .60). In addition, the timing of the SARS-CoV-2 test for donors did not affect the outcomes among recipients. Among all SARS-CoV-2+ donors identified since 2020, the lungs used came from younger donors, had better chest x-ray findings, and had a higher P/F ratio. Our data suggest that organ function may be more important than SARS-CoV-2 status when using lungs from SARS-CoV-2+ donors. Further research and follow-up are still needed to adequately address the use of lungs from SARS-CoV-2+ donors, thus further increasing the donor pool., Competing Interests: Declaration of competing interest 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 Elsevier Inc. All rights reserved.)

Rationale: Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive disease characterized by dyspnea and loss of lung function. Transforming growth factor-β (TGF-β) activation mediated by α v integrins is central to the pathogenesis of IPF. Bexotegrast (PLN-74809) is an oral, once-daily, dual-selective inhibitor of α v β 6 and α v β 1 integrins under investigation for the treatment of IPF. Positron emission tomography (PET) using an α v β 6 -specific PET tracer could confirm target engagement of bexotegrast in the lungs of participants with IPF. Objectives: This Phase 2 study evaluated α v β 6 receptor occupancy in the lung as assessed by changes from baseline in α v β 6 PET tracer uptake, after single-dose administration of bexotegrast to participants with IPF. Methods: In this open-label, single-center study, adults with IPF received up to two single doses of bexotegrast, ranging from 60 to 320 mg with or without background IPF therapy (pirfenidone or nintedanib). At baseline and approximately 4 hours after each orally administered bexotegrast dose, a 60-minute dynamic PET-computed tomography scan was conducted after administration of an α v β 6 -specific PET probe ([ 18 F]FP-R 0 1-MG-F2). α v β 6 receptor occupancy by bexotegrast was estimated from the changes in PET tracer uptake after bexotegrast administration. Pharmacokinetics, safety, and tolerability of bexotegrast were also assessed. Results: Eight participants completed the study. Total and unbound plasma bexotegrast concentrations increased in a dose-dependent manner, and regional PET volume of distribution values decreased in a dose- and concentration-dependent manner. The data for volume of distribution fit a simple saturation model, producing an unbound bexotegrast half maximal effective concentration estimate of 3.32 ng/ml. Estimated maximum receptor occupancy was 35%, 53%, 71%, 88%, and 92% after single 60-, 80-, 120-, 240-, and 320-mg doses of bexotegrast, respectively. No treatment-emergent adverse events related to bexotegrast were reported. Conclusions: Dose and concentration-dependent α v β 6 receptor occupancy by bexotegrast was observed by PET imaging, supporting once-daily 160- to 320-mg dosing to evaluate efficacy in clinical trials of IPF. Clinical trial registered with www.clinicaltrials.gov (NCT04072315).

Purpose: To compare pulmonary function metrics obtained with hyperpolarized xenon-129 (HXe) MRS, using chemical shift saturation recovery (CSSR) and CSI-CSSR, in healthy rats and a rat model of radiation-induced lung injury., Methods: HXe-MR data were acquired in two healthy rats and one rat with radiation-induced lung injury using whole-lung spectroscopy and CSI-CSSR techniques. The CSI-CSSR acquisitions were performed with both fixed TE and variable TE. Apparent alveolar septal wall thickness, gas transfer dynamics, and regional lung function were quantified and compared across acquisition methods. Spectral analysis included alignment of dissolved-phase frequency spectra using the membrane resonance as reference, segmentation of gas-phase (GP) frequency distribution, and characterization of gas uptake in the vasculature., Results: Complex GP line shapes were observed in rat lungs, necessitating pixel-wise CSI analysis and membrane resonance alignment for improved quantification. Notable differences in alveolar septal wall thickness, dissolved-phase GP ratios, and GP and red blood cell frequencies were found between acquisition techniques and lung conditions. CSI-CSSR provided unique insights into regional lung function, including the identification of distinct GP frequency zones potentially corresponding to different airway structures, and the ability to map relative xenon gas transport. Metrics from fixed-TE and variable-TE acquisitions usually differed by less than 10%, but the latter yielded a 20% SNR gain., Conclusion: HXe-MRS and CSI-CSSR techniques provide similar but not universally interchangeable insights into lung function, particularly in the presence of pathology., (© 2024 International Society for Magnetic Resonance in Medicine.)

Pulmonary vascular diseases, particularly when accompanied by pulmonary hypertension, are complex disorders often requiring multimodal imaging for diagnosis and monitoring. Echocardiography is the primary screening tool for pulmonary hypertension, while cardiac MR imaging (CMR) is used for more detailed characterization and risk stratification in right ventricular failure. Chest computed tomography (CT) is used to detect vascular anomalies and parenchymal lung diseases. While CT angiography is preferred for the detection of acute pulmonary embolus, dual-energy CT, single photon emission CT, and ventilation/perfusion scintigraphy are recommended for the detection of chronic thromboembolic disease. Application of these modalities will be reviewed here., Competing Interests: Disclosure K.N. Goss is supported by research funding provided by Southwestern Health Resources Academic Affiliation Committee, and by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number R01HL164853. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have no relevant conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This review will describe various disease processes resulting in pulmonary vasculitis. The clinical and imaging findings in these diseases often overlap with diffuse alveolar hemorrhage secondary to pulmonary capillaritis, a common manifestation in many of these diseases. A multidisciplinary approach is important for the correct diagnosis of these diseases, and this review will highlight the important imaging findings that radiologists need to be aware of to aid in this diagnostic process., Competing Interests: Disclosure The author has nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: ARDS is a heterogeneous syndrome involving different subphenotypes with different clinical features and different responses to treatment strategies. The prone position (PP) is an effective treatment for ARDS; however, whether the effects of prone positioning vary among ARDS patients with different subphenotypes remains unknown., Objectives: To evaluated the impact of PP on ventilation-perfusion matching(VQ matching) by contrast-enhanced Electrical impedance tomography (EIT) in ARDS patients with different subphenotypes., Methods: This was a prospective, observational study at the medical ICU of Zhongda Hospital, Southeast University. ARDS patients undergoing mechanical ventilation were screened and allocated to different subphenotypes based on lung morphology (focal/non-focal) and D-dimer level (low/high D-dimer). EIT was used in the supine position and 3 h, 6 h, and 12 h after the PP during the first PP session., Results: From July 1, 2021, to July 1, 2022, 25 patients were included in this study. 10 patients (40%) were focal ARDS, and 15 were non-focal ARDS based on baseline morphology. 12 patients (48%) were high D-dimer ARDS, and 13 were low D-dimer ARDS based on baseline D-dimer levels. PaO2/FiO2 increased significantly 3 h after prone positioning in focal ARDS patients (130.30[109.94-147.30] vs. 213.50[176.00-256.50] mmHg, p < 0.001), while the effect of improved oxygenation was not apparent until 6 h after prone positioning in non-focal ARDS patients (104.60[95.20-127.00] vs. 190.20[160.10-213.20] mm Hg, p < 0.001). VQ matching improved after 3 h in the prone position in the focal ARDS group (69.93 ± 6.69 vs. 78.22 ± 5.07, p = 0.006) but improved after only 6 h in the prone position in the non-focal ARDS group (67.32 ± 4.78 vs. 78.70 ± 5.93, p < 0.001). In ARDS patients with varying levels of D-dimer, increased PaO2/FiO2 (126.60[99.30-146.20] vs. 185.20[112.10-236.00] mmHg, p = 0.013) and improved VQ matching (67.60 ± 4.60 vs. 72.97 ± 6.48, p = 0.023) were observed at 3 h in the PP in patients with low D-dimer ARDS. In contrast, increased PaO2/FiO2(105.20[95.20-124.10] vs. 195.2[183.20-213.20], p < 0.001) and improved VQ matching (67.19 ± 6.70 vs. 72.50 ± 6.37, p < 0.001) were revealed only after 6 h in the prone position in high D-dimer ARDS patients., Conclusions: For moderate to severe ARDS patients, non-focal and high D-dimer ARDS patients need longer PP to improve oxygenation and VQmatching than the focal and low D-dimer patients., Clinical Trial Registration: This was a prospective, observational study registered in the Chinese Clinical Trial Registry (ChiCTR2200055442, https://www.chictr.org.cn/ ), on June 30, 2021., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the local ethics committee(2021ZDSYLL171-P01) and written informed consent was obtained from all participants before enrollment. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: While the presence of distinct imaging abnormalities by high-resolution CT (HRCT) defines interstitial lung disease (ILD), there is a relative lack of validated methods to quantify these abnormalities in clinical practice, limiting ILD severity and progression assessments. We aimed to validate a semi-quantitative method for lung fibrosis assessment in patients with systemic sclerosis associated ILD (SSc-ILD) by standard and low-dose HRCT, considering lung structure and function as integral components of ILD evaluation., Methods: SSc patients from Oslo and Zurich with HRCT images, pulmonary function tests, including forced vital capacity (FVC), diffusing capacity for carbon monoxide (DLCO) and the 6-minute walk test with oxygen (O 2 ) desaturation were enrolled. We validated the semi-quantitative fibrosis extent method by HRCT using criteria for content and construct validity, discrimination, sensitivity to change and feasibility, as well as inter- and intra-rater variability., Results: 65 SSc patients from Zurich and 90 from Oslo were included. Significant correlations were observed between the extent of fibrosis on HRCT and FVC (r=-0.517, p<0.001), DLCO (r=-0.400, p<0.001) and O 2 desaturation (r=-0.500, p<0.001), indicating content, construct and criterion validity. Discrimination and sensitivity to change assessments showed moderate correlation with DLCO (r=-0.377, p=0.003) but not with FVC or O 2 desaturation. Inter- and intra-rater variability demonstrated excellent reliability (κ=0.891 and κ=0.996, respectively), with HRCT quantification averaging 9-15 min, indicating high feasibility., Conclusion: This study confirms that semi-quantitative fibrosis assessment of HRCT for SSc-ILD meets most validation criteria, supporting its use in clinical practice and showing additive value of structural to functional ILD assessment., Competing Interests: Competing interests: LT, SJ and TMA report no conflicts. MB reports research funding, consultancy fees and/or speaker fees from GSK, Amgen, Novartis and Vifor. CB reports no conflicts. CC reports consulting fees and speaker fees from GSK, Novartis, Vifor, Boehringer, Astra Zeneca and Sanofi; speaker fees from Daiichi Sankyo; received support for attending meetings from Boehringer and Astra Zeneca. RD reports grants from the Iten-Kohaut Foundation; received support for attending meetings from Otsuka and Amgen; participated on an advisory board for Boehringer Ingelheim. MTD reports grants from Boehringer Ingelheim and Roche; received support for attending meetings and participated on an advisory board for Boehringer Ingelheim. ME received support for attending meetings from Janssen and Astra Zeneca. TF reports speaker fees from Bracco, Bayer and Boehringer; participated on an advisory board for AGFA; holds leadership or fiduciary roles with European Society of Thoracic Imaging and Swiss Society of Radiology. HF reports consulting fees from Bayer; speaker fees from Boehringer Ingelheim. GT and ØMolberg report no conflicts. CM reports speaker fees from MEDtalks Switzerland, Mepha, PlayToKnow AG, Medbase AG, Romanian Society of Rheumatology and Boehringer Ingelheim; support for attending meetings from Boehringer Ingelheim and Roche; participated on an advisory board for Boehringer Ingelheim and Janssen. OMidtvedt reports no conflicts. OD reports grants from Kymera, Mitsubishi Tanabe and Boehringer Ingelheim; consulting fees from 4P-Pharma, Abbvie, Acceleron, Alcimed, Altavant Sciences, Amgen, AnaMar, Arxx, Astra Zeneca, Blade Therapeutics, Bayer, Boehringer Ingelheim, Corbus Pharmaceuticals, CSL Behring, Galapagos, Glenmark, Horizon, Gossamer, Janssen, Kymera, Lupin, Medscape, Merck, Miltenyi Biotec, Mitsubishi Tanabe, Novartis, Orion, Prometheus Biosciences, Redxpharma, Roivant and Topadur; speaker fees from Bayer, Boehringer Ingelheim, Janssen and Medscape; has a patent issued for 'mir-29 for treatment of systemic sclerosis'; hold leadership or fiduciary roles with FOREUM foundation, ERS/EULAR Guidelines, EUSTAR, SCQM (Swiss Clinical Quality Management in Rheumatic Disease), SAMW (Swiss Academy of Medical Sciences) and Hartmann Müller Foundation; and reports other interest with Citus AG. A-MH-V reports grants from BI and Janssen; speakers fees from: Boehringer Ingelheim, Janssen, Medscape, Merck Sharp & Dohme, Novartis and Roche; consultancy fees of: ARXX, Boehringer Ingelheim, Genentech, Janssen, Medscape, Merck Sharp & Dohme, Pliant therapeutics, Roche and Werfen; and holds leadership or fiduciary roles with EULAR, and the Nordic PH vision group., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objective . The study aims to systematically characterize the effect of CT parameter variations on images and lung radiomic and deep features, and to evaluate the ability of different image harmonization methods to mitigate the observed variations. Approach . A retrospective in-house sinogram dataset of 100 low-dose chest CT scans was reconstructed by varying radiation dose (100%, 25%, 10%) and reconstruction kernels (smooth, medium, sharp). A set of image processing, convolutional neural network (CNNs), and generative adversarial network-based (GANs) methods were trained to harmonize all image conditions to a reference condition (100% dose, medium kernel). Harmonized scans were evaluated for image similarity using peak signal-to-noise ratio (PSNR), structural similarity index measure (SSIM), and learned perceptual image patch similarity (LPIPS), and for the reproducibility of radiomic and deep features using concordance correlation coefficient (CCC). Main Results . CNNs consistently yielded higher image similarity metrics amongst others; for Sharp/10%, which exhibited the poorest visual similarity, PSNR increased from a mean ± CI of 17.763 ± 0.492 to 31.925 ± 0.571, SSIM from 0.219 ± 0.009 to 0.754 ± 0.017, and LPIPS decreased from 0.490 ± 0.005 to 0.275 ± 0.016. Texture-based radiomic features exhibited a greater degree of variability across conditions, i.e. a CCC of 0.500 ± 0.332, compared to intensity-based features (0.972 ± 0.045). GANs achieved the highest CCC (0.969 ± 0.009 for radiomic and 0.841 ± 0.070 for deep features) amongst others. CNNs are suitable if downstream applications necessitate visual interpretation of images, whereas GANs are better alternatives for generating reproducible quantitative image features needed for machine learning applications. Significance . Understanding the efficacy of harmonization in addressing multi-parameter variability is crucial for optimizing diagnostic accuracy and a critical step toward building generalizable models suitable for clinical use., (Creative Commons Attribution license.)

Background: Lung ultrasound has been extensively used to assess the etiology of respiratory failure. Additionally, lung ultrasound-based scoring systems have been proposed to semi-quantify the loss of lung aeration in the ICU. The one most frequently used distinguishes four steps of progressive loss of aeration (scores from 0 to 3) and 3 scores mean tissue-like pattern. However, the burden of consolidation is not considered as tissue-like pattern is defined as 3 scores independently of its dimension. In this study, we present an ultrasound method for quantitative measurement of consolidation size and investigate the relationship between consolidation size and outcome in ICU patients with respiratory failure., Methods: A total of 124 patients in ICU were prospectively enrolled and 13 patients were excluded due to failure to obtain LUS measurements. Among the remaining 111 patients, 17 patients were non-intubated, and 94 patients under sedation and analgesia were intubated. All patients underwent lung ultrasound examination for the measurement of lung consolidation size between 24 and 48 h after ICU admission. Lung consolidation size was assessed by consolidation area index (CA), which was determined by tracing the maximum cross-sectional area of the region of consolidation. The Cox-regression model was constructed for 28- and 90-day mortality., Results: Consolidation size was successfully evaluated in all patients. The CA was 24.2cm 2 [15.9-36.6] (median [25th -75th percentiles]). CA was negatively correlated with PaO 2 /FiO 2 ratio (r=-0.26, P < 0.0001). Upon univariate and multivariate analysis, only CA [Odds ratio (OR) 1.04, 95% CI 1.01-1.08, P = 0.004] and APACHEII (OR 1.14, 95% CI 1.05-1.25, P = 0.002) were the risk factors for ICU mortality. Patients with substantial CA (> 29.4cm 2 ) had a higher risk of death in 28-day [Hazard ratio (HR) 4.35, 95%CI 1.70-11.11; Log-rank P = 0.017] and 90-day mortality (HR 4.10, 95%CI 1.62-10.39; Log-rank P < 0.01)., Conclusions: The proposed CA parameter, determined by lung ultrasound, was readily accessible at the bedside. It is noteworthy that a larger CA was correlated with impaired oxygenation and increased mortality rates among ICU patients. Further investigation is required to establish the merits of incorporating CA into lung ultrasound assessments in the ICU., Trial Registration: ClinicalTrial.gov, Identifier NCT05647967, Date: Dec 13, 2022, retrospectively registered., Competing Interests: Declarations. Ethics approval and consent to participate: This was a single-center prospective cohort study in the intensive care unit (ICU) of the Perking Union Medical College Hospital in Beijing, China. This study was strictly carried out in accordance with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Peking Union Medical College Hospital (Approved date: Aug 2, 2022; No. I-22PJ140). In our study, seventeen non-intubated patients signed informed consent themselves, while the remaining intubated patients, under sedation and analgesia, had their informed consent signed by their next of kin. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)