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Pulmonary artery intimal sarcomas (PAIS) are often misdiagnosed as pulmonary embolisms (PE) as their clinical findings and imaging findings are similar. However, given the clinical outcome of both diseases is different in its prognosis, accurate and rapid diagnosis is mandatory. This is a case report of a histologically-proven PAIS which was initially treated as a PE. The color-coded iodine map using dual-energy computed tomography (dual-energy CT iodine map) well reflected the distribution of the tumor consistent with (18)fluoro-2-deoxyglucose-uptake region using positron emission tomography/CT. This case demonstrates the potential of using dual-energy CT iodine map to differentiate PAIS from PE. LEARNING OBJECTIVE: Use of a dual-energy computed tomography iodine map to visualize a pulmonary artery intimal sarcoma may provide useful diagnostic information.

ObjectivesThis study investigated coronary artery remodeling patterns associated with clinical outcomes.BackgroundIn the prospective, multicenter PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree: An Imaging Study in Patients With Unstable Atherosclerotic Lesions) study, reported predictors of nonculprit lesion (NCL) major adverse cardiac events (MACE) were an intravascular ultrasound (IVUS) minimal lumen area (MLA) ≤4 mm2, a plaque burden ≥70%, and a IVUS–virtual histology (VH) thin-cap fibroatheroma (TCFA), but not lesion site remodeling.MethodsOverall, 697 consecutive patients with an acute coronary syndrome were enrolled and underwent 3-vessel gray-scale and IVUS-VH; 3,223 NCLs were identified by IVUS. The remodeling index (RI) was calculated as the external elastic membrane area at the MLA site divided by the average of the proximal and distal reference external elastic membrane areas. First, one third of the patients were randomly selected to determine RI cutoffs related to NCL MACE (development cohort). Receiver-operating characteristic analysis showed that there were 2 separate cut points that predicted NCL MACE: RI = 0.8789 and RI = 1.0046 (area under the curve = 0.663). These cut points were used to define negative remodeling as an RI 1.00. Second, we used the remaining two-thirds of patients to validate these cut points with respect to lesion morphology and clinical outcomes (validation cohort).ResultsKaplan-Meier curve analysis in the validation cohort showed that NCL MACE occurred more frequent (and equally) in negative and positive remodeling lesions compared with intermediate remodeling lesions. In this cohort, negative remodeling lesions had the smallest MLA, positive remodeling lesions had the largest plaque burden, and VH TCFA, especially VH TCFA with multiple necrotic cores, was most common in negatively remodeling lesions.ConclusionsThe present study showed the novel concept that positive and negative lesion site remodeling was associated with unanticipated NCL MACE in the PROSPECT study. (PROSPECT: An Imaging Study in Patients With Unstable Atherosclerotic Lesions [PROSPECT]; NCT00180466)