Diana E. Litmanovich

The Pulmonary Embolism Reporting and Data System (PE-RADS) provides a standardized framework for reporting acute pulmonary embolism at CT and MR angiography to guide treatment considerations based on clot location and right heart imaging features.

Purpose Organizing pneumonia is an inflammatory disorder that may co-exist with malignancy in the lung or elsewhere in the body. We aimed to assess patients with a lung biopsy diagnosis of organizing pneumonia for subsequent pathology confirmation of co-existing malignancy. Methods In this retrospective IRB-approved, HIPAA–compliant study, 1314 consecutive patients who underwent CT-guided lung biopsy for suspected lung cancer or metastatic disease from 02/2014 to 04/2022 at a single tertiary referral hospital were identified. In 98/1314 (7.5%) patients, biopsies showed organizing pneumonia, which represented our study cohort. Clinical outcomes, including follow-up imaging and repeat tissue sampling if performed, were evaluated through chart review. Descriptive statistics were calculated. Results There were 43/98 (44%) females, mean age was 66 ± 14 years, mean lesion size 2.9 ± 2.1 cm, and 11/98 (11.2%) had prior history of malignancy. Of 98 patients initially diagnosed with organizing pneumonia on lung biopsy, 11 (11.2%) were subsequently found to have malignancy. Among these, 6 (54.5%) had pulmonary metastases and 5 (45.5%) had primary lung cancer. Malignancies were confirmed through percutaneous re-biopsy in 3/11 (27%) and bronchoscopic, endoscopic, or surgical procedures in 8/11 (73%). Conclusion Malignancy can co-exist with organizing pneumonia in a substantial percentage of initial lung biopsies. Therefore, repeat tissue sampling should be considered when there is high clinical suspicion of malignancy despite an initial histopathological diagnosis of organizing pneumonia. This is especially relevant in lesions that demonstrate FDG avidity on PET/CT or an increase in size on interval imaging, or in instances where the biopsy core sizes are small or where the biopsies have intraprocedural complications.

Purpose: Small left atrial (LA) volume was recently reported to be one of the best predictors of acute pulmonary embolism (PE)-related adverse events (AE). There is currently no data available regarding the impact that body surface area (BSA)-indexing of atrial measurements has on the association with PE-related adverse events. Our aim is to assess the impact of indexing atrial measurements to BSA on the association between computed tomography (CT) atrial measurements and AE. Materials and Methods: Retrospective study (IRB: 2015P000425). A database of hospitalized patients with acute PE diagnosed on CT pulmonary angiography (CTPA) between May 2007 and December 2014 was reviewed. Right and left atrial volume, largest axial area, and axial diameters were measured. Patients undergo both echocardiographies (from which the BSA was extracted) and CTPAs within 48 hours of the procedure. The patient’s body weight was measured during each admission. LA measurements were correlated to AE (defined as the need for advanced therapy or PE-related mortality at 30 days) before and after indexing for BSA. The area under the ROC curve was calculated to determine the predictive value of the atrial measurements in predicting AE. Results: The study included 490 acute PE patients; 62 (12.7%) had AE. There was a significant association of reduced BSA-indexed and non-indexed LA volume (both <0.001), area (<0.001 and 0.001, respectively), and short-axis diameters (both <0.001), and their respective RA/LA ratios (all <0.001) with AE. The AUC values were similar for BSA-indexed and non-indexed LA volume, diameters, and area with LA volume measurements being the best predictor of adverse outcomes (BSA-indexed AUC=0.68 and non-indexed AUC=0.66), followed by non-indexed LA short-axis diameter (indexed AUC=0.65, non-indexed AUC=0.64), and LA area (indexed AUC=0.64, non-indexed AUC=0.63). Conclusion: Adjusting for BSA does not substantially affect the predictive ability of atrial measurements on 30-day PE-related adverse events, and therefore, this adjustment is not necessary in clinical practice. While LA volume is the better predictor of AE, LA short-axis diameter has a similar predictive value and is more practical to perform clinically.

Since the emergence of cardiac computed tomography (Cardiac CT) at the turn of the 21st century, there has been an exponential growth in research and clinical development of the technique, with contributions from investigators and clinicians from varied backgrounds: physics and engineering, informatics, cardiology, and radiology. However, terminology for the field is not unified. As a consequence, there are multiple abbreviations for some terms, multiple terms for some concepts, and some concepts that lack clear definitions and/or usage. In an effort to aid the work of all those who seek to contribute to the literature, clinical practice, and investigation of the field, the Society of Cardiovascular Computed Tomography updates a standard set of medical terms commonly used in clinical and research activities related to cardiac CT.

Approach to imaging ischemia in women Coronary artery disease in women tends to have a worse short- and long-term prognosis relative to men and remains the leading cause of mortality worldwide. Both clinical symptoms and diagnostic approach remain challenging in women due to lesser likelihood of women presenting with classic anginal symptoms on one hand and underperformance of conventional exercise treadmill testing in women on the other. Moreover, a higher proportion of women with signs and symptoms suggestive of ischemia are more likely to have nonobstructive coronary artery disease (CAD) that requires additional imaging and therapeutic considerations. New imaging techniques such as coronary computed tomography (CT) angiography, CT myocardial perfusion imaging, CT functional flow reserve assessment, and cardiac magnetic resonance imaging carry substantially better sensitivity and specificity for the detection of ischemia and coronary artery disease in women. Familiarity with various clinical subtypes of ischemic heart disease in women and with the major advantages and disadvantages of advanced imaging tests to ensure the decision to select one modality over another is one of the keys to successful diagnosis of CAD in women. This review compares the 2 major types of ischemic heart disease in women – obstructive and nonobstructive, while focusing on sex-specific elements of its pathophysiology.

Tracheobronchomalacia and excessive dynamic airway collapse are underdiagnosed distinct clinical entities that require attention with noninvasive imaging to enable prompt diagnosis and guide proper... Tracheobronchomalacia (TBM) and excessive dynamic airway collapse (EDAC) are airway abnormalities that share a common feature of expiratory narrowing but are distinct pathophysiologic entities. Bot...