Magnetic resonance angiography for the primary diagnosis of pulmonary embolism: A review from the international workshop for pulmonary functional imaging

Pulmonary contrast enhanced magnetic resonance angiography (CE-MRA) is useful for the primary diagnosis of pulmonary embolism (PE). Many sites have chosen not to use CE-MRA as a first line of diagnostic tool for PE because of the speed and higher efficacy of computerized tomographic angiography (CTA). In this review, we discuss the strengths and weaknesses of CE-MRA and the appropriate imaging scenarios for the primary diagnosis of PE derived from our unique multi-institutional experience in this area. The optimal patient for this test has a low to intermediate suspicion for PE based on clinical decision rules. Patients in extremis are not candidates for this test. Younger women (< 35 years of age) and patients with iodinated contrast allergies are best served by using this modality We discuss the history of the use of this test, recent technical innovations, artifacts, direct and indirect findings for PE, ancillary findings, and the effectiveness (patient outcomes) of CE-MRA for the exclusion of PE. Current outcomes data shows that CE-MRA and NM V/Q scans are effective alternative tests to CTA for the primary diagnosis of PE

Computed tomography examinations of the surface and internal morphologies of the upper face in Ryukyu Islanders and mainland Japanese population

Using computed tomography, we examined the surface and internal morphologies of the upper face of people living on the Ryukyu Islands and mainland Japanese, focusing on the nasal root protrusion and eyeball position. The results showed that the nasal root protrusion on the surface was influenced by a combination of changes in both hard and soft tissues, such as skeletal nasal protrusion, eyeball recession, and skin thickness. The eyeball position became more posterior as the orbital cavity height and depth increased. Compared with people originating from mainland Japan, Ryukyu Islanders had a more prominent nasal root at both surface and skeletal levels, and a lower orbital rim relative to its internal height. However, a significant difference in the eyeball position and skin thickness was not detected. Therefore, the skeletal nasal root protrusion, not soft tissue configuration, is likely to account for the difference in the surface nasal root protrusion between the two populations. These findings will contribute to a better understanding of the association between hard and soft tissue configurations and the diversification of human facial features at the individual and population levels

Reproducibility of pulmonary blood flow measurements by phase-contrast MRI using different 1.5 T MR scanners at two institutions

Background Magnetic resonance imaging (MRI) can be beneficial for diagnosis of disease by offering quantitative information. However, reproducibility can be a major problem when there is a numerical threshold in multi-institution, multi-vendor situations. Purpose To measure pulmonary blood flow with phase-contrast (PC) imaging using two different MR scanners (1.5 T) at different institutions in the same participants and to examine the reproducibility of the measurements. Material and Methods Participants were 10 healthy volunteers (5 men; age range, 27–36 years). The measurements included the mean and maximal blood velocities, the mean blood flow volume, and the acceleration time and volume (AT and AV), derived from the time-flow curve of the PC-MRI. Simultaneously obtained maximal, minimal, and mean areas from regions of interest set in the pulmonary artery were also calculated. In order to calculate the reproducibility of the quantitative variables, intra-class correlation coefficients (ICCs) were employed. When an adequate ICC was obtained, Bland–Altman analysis was conducted to identify any systematic bias. Results The ICCs were almost perfect for the mean blood flow volume and the AV (r = 0.82 and 0.80), and were substantial in the mean and maximal areas, and the AT (r = 0.63, 0.74, and 0.64, respectively). However, there was a fixed bias in the area measurement between the two scanners. Also, the AV had a proportional bias. Conclusion Our results reveal that various indices derived from PC-MRI on different MR scanners are promising as common indices for pulmonary flow assessment. Research and clinical use of PC-MRI for the pulmonary artery is expected to extend to multi-institution situations

An Okhotsk adult female human skeleton (11th/12th century AD) with possible SAPHO syndrome from Hamanaka 2 site, Rebun Island, northern Japan

We present the oldest human skeletal case yet identified with possible SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis), a chronic disease involving the skin, bone, and joints. A human skeleton with a severe pathological condition was recovered from a shell mound of the prehistoric Okhotsk culture at the Hamanaka 2 site, Rebun Island, Hokkaido, Japan in 2013. Morphological and Amelogenin gene analyses determined the sex as female, and the age at time of death was estimated to be in the forties using analysis of the auricular surface of the ilium. The stable isotope ratios of this individual (NAT002) and other Hamanaka 2 samples indicated a heavy dependence on marine mammals and fish for dietary protein intake. Radiocarbon age on collagen from the bone of NAT002 was 1689 ± 20 BP, or 1060–1155 (68.2%) calAD. Macroscopic and computed tomography (CT) findings indicated diffuse hyperostosis in the axial and appendicular skeleton, including the mandible, vertebrae, clavicles, sternum, scapulae, humeri, radii, ulnae, and ilium, caused by osteitis and synovitis. The bilateral clavicles were most affected, in which CT imaging revealed irregular cortical thickening, termed ‘grotesque periostitis.’ The case was diagnosed as most likely having SAPHO syndrome, although dermatological findings could not be detected. Although SAPHO syndrome is a fairly new concept in autoimmune diseases, this case suggests the syndrome originated much earlier in human history

Computed tomography measured tissue density of pectoral muscle and liver predicts outcomes in heart transplant recipients

Abstract Background Computed tomography (CT)‐derived measures of tissue quality can add to frailty assessment and improve selection of candidates for heart transplant. We investigated the prognostic value of CT measures of tissue density for predicting hospital length of stay (LOS) and mortality post‐transplant. Methods All patients at a quaternary care hospital between 1999 to 2018 with preheart transplant CT scans and available data on transplant outcomes were eligible (n = 189), including a subset within the total cohort with scans 6‐month pretransplant (n = 103). Axial chest CT scans were analysed for liver and muscle density at the 12th thoracic vertebrae and aortic arch landmarks, respectively. Cox and linear regression models examined the risk of death and LOS, respectively, according to median (above or below) pectoral muscle density. Low‐density muscle (LDM) area and liver density were analysed as continuous variables. Results Out of 157 patients with readable CT scans (median age 55 years, interquartile range [50–60] 10% women), 31 died on 1‐year follow up. Patients with higher than and at median pectoral muscle density (39.5 Hounsfield Unit [HU]) had better 1‐year survival in the overall cohort (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.673, 0.989; p = 0.039), with the 6‐month cohort showing a trend (HR 0.79, 95% CI 0.603, 1.023; p = 0.074) towards improved survival. Conversely, every 5‐cm2 increase in pectoral LDM area was associated with 2.4‐day lower LOS (p = 0.045) in the overall cohort, and a 2.6‐day lower LOS in the 6‐month cohort (p = 0.05). Patients with higher ratio of normal‐density muscle to LDM had higher LOS (p < 0.01). Every 5‐HU increase in liver density at a region of interest was associated with 0.24‐day higher post‐transplant LOS in the overall cohort, and a 0.41 higher LOS in the 6‐month cohort (p ≤ 0.05). Conclusions Patients with higher preheart transplant pectoral muscle density had greater 1‐year survival. Higher pectoral LDM area was associated with decreased LOS post‐transplant and higher liver density was associated with increased LOS. These findings raise possibilities that measures of muscle density as they reflect to quality of muscle may have prognostic implications. Future studies with prospective design are needed to confirm these findings

Survey on chest CT findings in COVID-19 patients in Okinawa, Japan: differences between the delta and omicron variants

Abstract To investigate the frequency of pneumonia and chest computed tomography (CT) findings in patients with coronavirus disease 2019 (COVID-19) during the fifth Delta variant-predominant and sixth Omicron variant-predominant waves of the COVID-19 pandemic in Okinawa, Japan. A survey on chest CT examinations for patients with COVID-19 was conducted byhospitals with board-certified radiologists who provided treatment for COVID-19 pneumonia in Okinawa Prefecture. Data from 11 facilities were investigated. Indications for chest CT; number of COVID-19 patients undergoing chest CT; number of patients with late-onset pneumonia, tracheal intubation, and number of deaths; and COVID-19 Reporting and Data System classifications of initial chest CT scans were compared by the chi-squared test between the two pandemic waves (Delta vs. Omicron variants). A total of 1944 CT scans were performed during the fifth wave, and 1178 were performed during the sixth wave. CT implementation rates, which were the number of patients with COVID-19 undergoing CT examinations divided by the total number of COVID-19 cases in Okinawa Prefecture during the waves, were 7.1% for the fifth wave and 2.1% for the sixth wave. The rates of tracheal intubation and mortality were higher in the fifth wave. Differences between the distributions of the CO-RADS classifications were statistically significant for the fifth and sixth waves (p < 0.0001). In the fifth wave, CO-RADS 5 (typical of COVID-19) was most common (65%); in the sixth wave, CO-RADS 1 (no findings of pneumonia) was most common (50%). The finding of “typical for other infection but not COVID-19” was more frequent in the sixth than in the fifth wave (13.6% vs. 1.9%, respectively). The frequencies of pneumonia and typical CT findings were higher in the fifth Delta variant-predominant wave, and nontypical CT findings were more frequent in the sixth Omicron variant-predominant wave of the COVID-19 pandemic in Okinawa, Japan

Skeletal Muscle Adiposity and Lung Function Trajectory in the Severe Asthma Research Program.

Rationale: Extrapulmonary manifestations of asthma, including fatty infiltration in tissues, may reflect systemic inflammation and influence lung function and disease severity. Objectives: To determine if skeletal muscle adiposity predicts lung function trajectory in asthma. Methods: Adult SARP III (Severe Asthma Research Program III) participants with baseline computed tomography imaging and longitudinal postbronchodilator FEV1% predicted (median follow-up 5 years [1,132 person-years]) were evaluated. The mean of left and right paraspinous muscle density (PSMD) at the 12th thoracic vertebral body was calculated (Hounsfield units [HU]). Lower PSMD reflects higher muscle adiposity. We derived PSMD reference ranges from healthy control subjects without asthma. A linear multivariable mixed-effects model was constructed to evaluate associations of baseline PSMD and lung function trajectory stratified by sex. Measurements and Main Results: Participants included 219 with asthma (67% women; mean [SD] body mass index, 32.3 [8.8] kg/m2) and 37 control subjects (51% women; mean [SD] body mass index, 26.3 [4.7] kg/m2). Participants with asthma had lower adjusted PSMD than control subjects (42.2 vs. 55.8 HU; P &lt; 0.001). In adjusted models, PSMD predicted lung function trajectory in women with asthma (β = -0.47 Δ slope per 10-HU decrease; P = 0.03) but not men (β = 0.11 Δ slope per 10-HU decrease; P = 0.77). The highest PSMD tertile predicted a 2.9% improvement whereas the lowest tertile predicted a 1.8% decline in FEV1% predicted among women with asthma over 5 years. Conclusions: Participants with asthma have lower PSMD, reflecting greater muscle fat infiltration. Baseline PSMD predicted lung function decline among women with asthma but not men. These data support an important role of metabolic dysfunction in lung function decline