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The MRI tissue characterization of vertebral bone marrow includes the measurement of proton density fat fraction (PDFF), T 1 and T 2 * relaxation times of the water and fat components (T 1W , T 1F , T 2 * W , T 2 * F), IVIM diffusion D, perfusion fraction f and pseudo-diffusion coefficient D*. However, the measurement of these vertebral bone marrow biomarkers (VBMBs) is affected with several confounding factors. In the current study, we investigated these confounding factors including the regional variation taking the example of variation between the anterior and posterior area in lumbar vertebrae, B 1 inhomogeneity and the effect of fat suppression on f. A fat suppressed diffusion-weighted sequence and two 3D gradient multi-echo sequences were used for the measurements of the seven VBMBs. A turbo flash B 1 map sequence was used to estimate B 1 inhomogeneities and thus, to correct flip angle for T 1 quantification. We introduced a correction to perfusion fraction f measured with fat suppression, namely f PDFF. A significant difference in the values of PDFF, f and f PDFF , T 1F , T 2 * W and D was observed between the anterior and posterior region. Although, little variations of flip angle were observed in this anterior-posterior direction in one vertebra but larger variations were observed in head-feet direction from L1 to L5 vertebrae. The regional difference in PDFF, f PDFF and T 2 * W can be ascribed to differences in the trabecular bone density and vascular network within vertebrae. The regional variation of VBMBs shows that care should be taken in reproducing the same region-of-interest location along a longitudinal study. The same attention should be taken while measuring f in fatty environment, and measuring T 1. Furthermore, the MRI-protocol presented here allows for measurements of seven VBMBs in less than 6 min and is of interest for longitudinal studies of bone marrow diseases. [ABSTRACT FROM AUTHOR]

Acute eosinophilic pneumonia (AEP) has been reported following chloroquine or mefloquine exposure, both structurally related to piperaquine. We report a case of AEP with typical CT scan patterns, hypereosinophilia in blood (9.8 109/l), and bronchoalveolar lavage (78% of 600 000 cells/ml), 10 days after artenimol-piperaquine exposure in a 26-year-old man. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To characterize the morphological computed tomography (CT) features of pulmonary squamous cell carcinomas (SQCC) submitted to therapeutic resection; to correlate these features with patients’ outcomes; and to compare with pulmonary adenocarcinomas (ADC). Materials and methods: Two chest radiologists retrospectively evaluated CT exams of 123 patients with SQCC resected between 2002 and 2008. Tumors’ size, location (central vs. peripheral), shape, margins, attenuation, enhancement, presence of calcification, cavitation, internal air bronchograms and pleural tags were assigned by consensus. Prevalence of features was compared with patients’ survival data and a previously studied population of ADC surgically resected at the same time period. Results: Cavitation correlated negatively with overall (hazard ratio=3.04), disease-specific (HR=3.67) and disease-free survival (HR=2.69), independent from age, gender, tumor pathological stage, size, and location. In relation to ADC, SQCC presented different shape, margins, attenuation, enhancement, with more cavitation, rare internal air bronchograms, and less pleural tags. Differences were also significant when comparing only the peripheral type of tumors. Conclusions: Cavitation at CT was an independent and negative predictive factor for SQCC. Different CT morphological features were described for SQCC and ADC. Image evaluation of lung lesions should go beyond measuring and addressing adjacent structures invasion. Adequate imaging characterization not only helps to differentiate benign versus malignant disease and to determine malignancy staging, it may also imply the histologic subtype and improve the prognostic assessment of lung cancer patients. [Copyright &y& Elsevier]

Background: Nintedanib is an approved therapy for idiopathic pulmonary fibrosis (IPF). Some patients treated with nintedanib experience weight loss. Exploratory data suggest that low body mass index or weight loss are associated with worse outcomes in patients with IPF. We investigated whether BMI at baseline or weight loss over 52 weeks was associated with FVC decline, or influenced the effect of nintedanib, in patients with IPF.Methods: Using pooled data from the two INPULSIS trials, we analysed the rate of decline in FVC (mL/yr) over 52 weeks in patients treated with nintedanib and placebo in subgroups by baseline BMI (< 25; ≥25 to < 30; ≥30 kg/m2) and by weight loss over 52 weeks (≤5; > 5%) using random coefficient regression.Results: In the placebo group, the mean rate of FVC decline over 52 weeks was numerically greater in patients with lower baseline BMI (- 283.3 [SE 22.4], - 207.9 [20.9] and - 104.5 [21.4] in patients with BMI < 25 kg/m2, ≥25 to < 30 kg/m2 and ≥ 30 kg/m2, respectively). Nintedanib reduced the rate of FVC decline versus placebo in all subgroups by BMI, with a consistent treatment effect across subgroups (interaction p = 0.31). In the placebo group, the mean rate of FVC decline was numerically greater in patients with > 5% than ≤5% weight loss over 52 weeks (- 312.7 [SE 32.2] versus - 199.5 [SE 14.4] mL/year). Nintedanib reduced the rate of FVC decline versus placebo in both subgroups by weight loss, with a greater treatment effect in patients with > 5% weight loss (interaction p = 0.0008). The adverse event profile of nintedanib was similar across subgroups.Conclusions: In patients with IPF, lower BMI and weight loss may be associated with faster decline in FVC. Nintedanib reduces the rate of FVC decline both in patients who lose weight on treatment and those who do not.Trial Registration: ClinicalTrials.gov ; Nos. NCT01335464 and NCT01335477 ; URL: www.clinicaltrials.gov . [ABSTRACT FROM AUTHOR]

Objectives: To assess the role of CT venography (CTV) in the diagnosis of venous thromboembolism (VTE) during the postpartum period., Materials and Methods: This multicenter prospective cohort study was conducted between April 2016 and April 2020 in 14 university hospitals. All women referred for CT pulmonary angiography (CTPA) for suspected pulmonary embolism (PE) within the first 6 weeks postpartum were eligible. All CTPAs were performed on multidetector CT machines with the usual parameters and followed by CTV of the abdomen, pelvis, and proximal lower limbs. On-site reports were compared to expert consensus reading, and the added value of CTV was assessed for both., Results: The final study population consisted of 123 women. On-site CTPA reports mentioned PE in seven women (7/123, 5.7%), all confirmed following expert consensus reading, three involving proximal pulmonary arteries and four limited to distal arteries. Positive CTV was reported on-site in nine women, five of whom had negative and two indeterminate CTPAs, bringing the VTE detection rate to 11.4% (14/123) (95%CI: 6.4-18.4, p = 0.03). Expert consensus reading confirmed all positive on-site CTV results, but detected a periuterine vein thrombosis in an additional woman who had a negative CTPA, increasing the VTE detection rate to 12.2% (15/123) (95%CI: 7.0-19.3, p = 0.008). Follow-up at 3 months revealed no adverse events in this woman, who was left untreated. Median Dose-Length-Product was 117 mGy.cm for CTPA and 675 mGy.cm for CTPA + CTV., Conclusion: Performing CTV in women suspected of postpartum PE doubles the detection of venous thromboembolism, at the cost of increased radiation exposure., Clinical Relevance Statement: CTV can help in the decision-making process concerning curative anticoagulation in women with suspected postpartum PE, particularly those whose CTPA results are indeterminate or whose PE is limited to the subsegmental level., Key Points: Postpartum women are at risk of pulmonary embolism, and CT pulmonary angiography can give equivocal results. CT venography (CTV) positivity increased the venous thromboembolism detection rate from 5.7 to 11.4%. CTV may help clinical decision-making, especially in women with indeterminate CTPA results or subsegmental emboli., (© 2024. The Author(s), under exclusive licence to European Society of Radiology.)

Purpose: The purpose of this study was to propose a deep learning-based approach to detect pulmonary embolism and quantify its severity using the Qanadli score and the right-to-left ventricle diameter (RV/LV) ratio on three-dimensional (3D) computed tomography pulmonary angiography (CTPA) examinations with limited annotations., Materials and Methods: Using a database of 3D CTPA examinations of 1268 patients with image-level annotations, and two other public datasets of CTPA examinations from 91 (CAD-PE) and 35 (FUME-PE) patients with pixel-level annotations, a pipeline consisting of: (i), detecting blood clots; (ii), performing PE-positive versus negative classification; (iii), estimating the Qanadli score; and (iv), predicting RV/LV diameter ratio was followed. The method was evaluated on a test set including 378 patients. The performance of PE classification and severity quantification was quantitatively assessed using an area under the curve (AUC) analysis for PE classification and a coefficient of determination (R²) for the Qanadli score and the RV/LV diameter ratio., Results: Quantitative evaluation led to an overall AUC of 0.870 (95% confidence interval [CI]: 0.850-0.900) for PE classification task on the training set and an AUC of 0.852 (95% CI: 0.810-0.890) on the test set. Regression analysis yielded R² value of 0.717 (95% CI: 0.668-0.760) and of 0.723 (95% CI: 0.668-0.766) for the Qanadli score and the RV/LV diameter ratio estimation, respectively on the test set., Conclusion: This study shows the feasibility of utilizing AI-based assistance tools in detecting blood clots and estimating PE severity scores with 3D CTPA examinations. This is achieved by leveraging blood clots and cardiac segmentations. Further studies are needed to assess the effectiveness of these tools in clinical practice., Competing Interests: Disclosure of Interests The authors declare that they have no competing interest., (Copyright © 2023 Société française de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

Background : The response to cardiac resynchronization therapy (CRT) depends on septal viability and correction of abnormal septal motion. This study investigates if cardiac magnetic resonance (CMR) as a single modality can identify CRT responders with combined imaging of pathological septal motion (septal flash) and septal scar. Methods : In a prospective, multicenter, observational study of 136 CRT recipients, septal scar was assessed using late gadolinium enhancement (LGE) ( n = 127) and septal flash visually from cine CMR sequences. The primary endpoint was CRT response, defined as ≥15% reduction in LV end-systolic volume with echocardiography after 6 months. The secondary endpoint was heart transplantation or death of any cause assessed after 39 ± 13 months. Results : Septal scar and septal flash were independent predictors of CRT response in multivariable analysis (both p < 0.001), while QRS duration and morphology were not. The combined approach of septal scar and septal flash predicted CRT response with an area under the curve of 0.86 (95% confidence interval (CI): 0.78-0.94) and was a strong predictor of long-term survival without heart transplantation (hazard ratio 0.27, 95% CI: 0.10-0.79). The accuracy of the approach was similar in the subgroup with intermediate (130-150 ms) QRS duration. The combined approach was superior to septal scar and septal flash alone ( p < 0.01). Conclusions: The combined assessment of septal scar and septal flash using CMR as a single-image modality identifies CRT responders with high accuracy and predicts long-term survival.

Purpose: In 2022, the French Society of Radiology together with the French Society of Thoracic Imaging and CentraleSupelec organized their 13th data challenge. The aim was to aid in the diagnosis of pulmonary embolism, by identifying the presence of pulmonary embolism and by estimating the ratio between right and left ventricular (RV/LV) diameters, and an arterial obstruction index (Qanadli's score) using artificial intelligence., Materials and Methods: The data challenge was composed of three tasks: the detection of pulmonary embolism, the RV/LV diameter ratio, and Qanadli's score. Sixteen centers all over France participated in the inclusion of the cases. A health data hosting certified web platform was established to facilitate the inclusion process of the anonymized CT examinations in compliance with general data protection regulation. CT pulmonary angiography images were collected. Each center provided the CT examinations with their annotations. A randomization process was established to pool the scans from different centers. Each team was required to have at least a radiologist, a data scientist, and an engineer. Data were provided in three batches to the teams, two for training and one for evaluation. The evaluation of the results was determined to rank the participants on the three tasks., Results: A total of 1268 CT examinations were collected from the 16 centers following the inclusion criteria. The dataset was split into three batches of 310, 580 and 378 C T examinations provided to the participants respectively on September 5, 2022, October 7, 2022 and October 9, 2022. Seventy percent of the data from each center were used for training, and 30% for the evaluation. Seven teams with a total of 48 participants including data scientists, researchers, radiologists and engineering students were registered for participation. The metrics chosen for evaluation included areas under receiver operating characteristic curves, specificity and sensitivity for the classification task, and the coefficient of determination r 2 for the regression tasks. The winning team achieved an overall score of 0.784., Conclusion: This multicenter study suggests that the use of artificial intelligence for the diagnosis of pulmonary embolism is possible on real data. Moreover, providing quantitative measures is mandatory for the interpretability of the results, and is of great aid to the radiologists especially in emergency settings., Competing Interests: Disclosure of Interests The authors declare that they have no known competing financial or personal relationships that could be viewed as influencing the work reported in this paper., (Copyright © 2023 Société française de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

Interstitial lung disease (ILD) has been reported with many cancer drugs including some recent antibody-drug conjugates (ADCs). The mechanisms of ILD induced by many chemotherapy drugs, other drug classes and ADCs used in cancer, including breast cancer, are not clearly elucidated. In the absence of specific clinical or radiological signs, the diagnosis of drug-induced ILD is often a diagnosis of exclusion. When present, the most frequent symptoms are respiratory signs (cough, dyspnea, chest pain) and general signs (fatigue, fever). Any suspicion of ILD should be evaluated by imaging and, if in doubt, the CT scan should be evaluated by a pulmonologist and a radiologist. A network of multidisciplinary experts for proactive early management of ILD is important, including oncologist, radiologist, pulmonologist, infectious disease specialist and nurses. Patient education is essential to report new or exacerbated lung symptoms and prevent high-grade ILD. Study drug is discontinued temporarily or permanently according to ILD severity and type of ADC. For asymptomatic cases (Grade 1), the efficacy of corticosteroids is not clearly established; for higher grades, the benefit/risk balance of long-term corticosteroid therapy should be considered for the dose and treatment duration. Hospitalization and oxygen supplementation are required for severe cases (Grades 3-4). For patient follow-up, the expertise of a pulmonologist is necessary with repeated chest scans, spirometry and DLCO. Preventing ADC-induced ILDs and evolution to high grade rests on a network of multidisciplinary experts for assessment of individual risk factors, early management, close follow-up and patient education., (Copyright © 2023 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Background: ONCOS-102, an oncolytic adenovirus expressing granulocyte-macrophage colony-stimulating factor, can alter the tumor microenvironment to an immunostimulatory state. Combining ONCOS-102 with standard-of-care chemotherapy for malignant pleural mesothelioma (MPM) may improve treatment outcomes., Methods: In this open-label, randomized study, patients with unresectable MPM received intratumoral ONCOS-102 (3×10 11 virus particles on days 1, 4, 8, 36, 78, and 120) and pemetrexed plus cisplatin/carboplatin (from day 22), or pemetrexed plus cisplatin/carboplatin alone. The primary endpoint was safety. Overall survival (OS), progression-free survival, objective response rate, and tumor immunologic activation (baseline and day 36 biopsies) were also assessed., Results: In total, 31 patients (safety lead-in: n=6, randomized: n=25) were enrolled. Anemia (15.0% and 27.3%) and neutropenia (40.0% and 45.5%) were the most frequent grade ≥3 adverse events (AEs) in the ONCOS-102 (n=20) and chemotherapy-alone (n=11) cohorts. No patients discontinued ONCOS-102 due to AEs. No statistically significant difference in efficacy endpoints was observed. There was a numerical improvement in OS (30-month OS rate 34.1% vs 0; median OS 20.3 vs 13.5 months) with ONCOS-102 versus chemotherapy alone in chemotherapy-naïve patients (n=17). By day 36, ONCOS-102 was associated with increased T-cell infiltration and immune-related gene expression that was not observed in the control cohort. Substantial immune activation in the tumor microenvironment was associated with survival at month 18 in the ONCOS-102 cohort., Conclusions: ONCOS-102 plus pemetrexed and cisplatin/carboplatin was well tolerated by patients with MPM. In injected tumors, ONCOS-102 promoted a proinflammatory environment, including T-cell infiltration, which showed association with survival at month 18., Competing Interests: Competing interests: SP reports leadership/fiduciary role for Pegasys, and patent for lurbinectidin plus atezolizumab. CR reports personal payments from Bristol Meyers Squibb, MSD, and Takeda. NI reports honoraria from Amgen, Bristol Meyers Squibb, Daiichi Sankyo, Eisai, Glaxo Smith Klein, and Lilly; support for meeting attendance from Gilead, Novartis, Pfizer, PharmaMar, and Roche Genentech; and Data Safety Monitoring Board/Advisory Board participation for Transgene. SViteri reports fees from Abbvie, AstraZeneca, Bristol Meyers Squibb, Merck, Ipsen, MSD, OSE Immunotherapeutics, Puma Biotech, Roche, and Takeda. MH-J reports honoraria from AstraZeneca and support for meeting attendance from Roche and Takeda. AM-M reports honoraria from AstraZeneca/MedImmune, Bristol Myers Squibb, F. Hoffmann La Roche AG, MSD, MSD oncology, and Pfizer. AN reports consulting fees/honoraria from Amgen, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Pfizer, Roche, Takeda; fees for expert testimony from Medsir and Oryzon; Data Safety Monitoring Board participation for Hengenix, and support for meeting attendance from Boehringer Ingelheim, Pfizer, and Roche. SC, ML and XS report no potential conflicts of interest to disclose. JZ reports research grants from AstraZeneca, Bristol Myers Squibb, and Roche; consulting fees from Bristol Myers Squibb, Novartis and Sanofi, honoraria from AstraZeneca, Bristol Myers Squibb, MSD, NanoString, Roche, and Sanofi; and support for meeting attendance from AstraZeneca, Bristol Myers Squibb, Roche, and Sanofi. SVetrhus and MJ report prior employment by Circio Holding ASA and stock in Circio Holding ASA. TBH reports employment by Circio Holding ASA and stock in Circio Holding ASA. VL reports employment with Servier, consultancy fees from Athebio AG, CatalYm, and Circio Holding ASA; and stock in Circio Holding ASA. LP-A reports grants/contracts from AstraZeneca, Bristol Meyers Squibb, MSD, and Pfizer; consulting fees from Amgen, AstraZeneca, Bayer, Bristol Meyers Squibb, GSK, Janssen, Lilly, Mirati Therapeutics, Novartis, Merck, MSD, Pfizer, Pharmamar, Roche, Daiichi Sankyo, Sanofi, Servier, and Takeda, and honoraria from AstraZeneca, Janssen, Merck, and Mirati Therapeutics., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: The objective was to define a safe strategy to exclude pulmonary embolism (PE) in COVID-19 outpatients, without performing CT pulmonary angiogram (CTPA)., Methods: COVID-19 outpatients from 15 university hospitals who underwent a CTPA were retrospectively evaluated. D-Dimers, variables of the revised Geneva and Wells scores, as well as laboratory findings and clinical characteristics related to COVID-19 pneumonia, were collected. CTPA reports were reviewed for the presence of PE and the extent of COVID-19 disease. PE rule-out strategies were based solely on D-Dimer tests using different thresholds, the revised Geneva and Wells scores, and a COVID-19 PE prediction model built on our dataset were compared. The area under the receiver operating characteristics curve (AUC), failure rate, and efficiency were calculated., Results: In total, 1369 patients were included of whom 124 were PE positive (9.1%). Failure rate and efficiency of D-Dimer > 500 µg/l were 0.9% (95%CI, 0.2-4.8%) and 10.1% (8.5-11.9%), respectively, increasing to 1.0% (0.2-5.3%) and 16.4% (14.4-18.7%), respectively, for an age-adjusted D-Dimer level. D-dimer > 1000 µg/l led to an unacceptable failure rate to 8.1% (4.4-14.5%). The best performances of the revised Geneva and Wells scores were obtained using the age-adjusted D-Dimer level. They had the same failure rate of 1.0% (0.2-5.3%) for efficiency of 16.8% (14.7-19.1%), and 16.9% (14.8-19.2%) respectively. The developed COVID-19 PE prediction model had an AUC of 0.609 (0.594-0.623) with an efficiency of 20.5% (18.4-22.8%) when its failure was set to 0.8%., Conclusions: The strategy to safely exclude PE in COVID-19 outpatients should not differ from that used in non-COVID-19 patients. The added value of the COVID-19 PE prediction model is minor., Key Points: • D-dimer level remains the most important predictor of pulmonary embolism in COVID-19 patients. • The AUCs of the revised Geneva and Wells scores using an age-adjusted D-dimer threshold were 0.587 (95%CI, 0.572 to 0.603) and 0.588 (95%CI, 0.572 to 0.603). • The AUC of COVID-19-specific strategy to rule out pulmonary embolism ranged from 0.513 (95%CI: 0.503 to 0.522) to 0.609 (95%CI: 0.594 to 0.623)., (© 2023. The Author(s), under exclusive licence to European Society of Radiology.)

Background: The present article is an English-language version of the French National Diagnostic and Care Protocol, a pragmatic tool to optimize and harmonize the diagnosis, care pathway, management and follow-up of lymphangioleiomyomatosis in France., Methods: Practical recommendations were developed in accordance with the method for developing a National Diagnosis and Care Protocol for rare diseases of the Haute Autorité de Santé and following international guidelines and literature on lymphangioleiomyomatosis. It was developed by a multidisciplinary group, with the help of patient representatives and of RespiFIL, the rare disease network on respiratory diseases., Results: Lymphangioleiomyomatosis is a rare lung disease characterised by a proliferation of smooth muscle cells that leads to the formation of multiple lung cysts. It occurs sporadically or as part of a genetic disease called tuberous sclerosis complex (TSC). The document addresses multiple aspects of the disease, to guide the clinicians regarding when to suspect a diagnosis of lymphangioleiomyomatosis, what to do in case of recurrent pneumothorax or angiomyolipomas, what investigations are needed to make the diagnosis of lymphangioleiomyomatosis, what the diagnostic criteria are for lymphangioleiomyomatosis, what the principles of management are, and how follow-up can be organised. Recommendations are made regarding the use of pharmaceutical specialties and treatment other than medications., Conclusion: These recommendations are intended to guide the diagnosis and practical management of pulmonary lymphangioleiomyomatosis., Competing Interests: Declaration of Competing Interest Vincent COTTIN has no conflict of interest to disclose in relation with the content of the manuscript. Elodie BLANCHARD has no conflict of interest to disclose in relation with the content of the manuscript. Mallorie KERJOUAN declares research fees paid by Pfizer and Novartis to her institution. Romain LAZOR has no conflict of interest to disclose in relation with the content of the manuscript. Martine REYNAUD-GAUBERT has no conflict of interest to disclose in relation with the content of the manuscript. Romain LAZOR has no conflict of interest to disclose in relation with the content of the manuscript. Camille TAILLE declares consulting fees paid to her by Novartis. Yurdagül UZUNHAN has no conflict of interest to disclose in relation with the content of the manuscript. Lidwine WEMEAU has no conflict of interest to disclose in relation with the content of the manuscript. Claire ANDREJAK has no conflict of interest to disclose in relation with the content of the manuscript. Dany BAUD has no conflict of interest to disclose in relation with the content of the manuscript. Philippe BONNIAUD has no conflict of interest to disclose in relation with the content of the manuscript. Pierre-Yves BRILLET has no conflict of interest to disclose in relation with the content of the manuscript. Alain CALENDER has no conflict of interest to disclose in relation with the content of the manuscript. Lara CHALABREYSSE has no conflict of interest to disclose in relation with the content of the manuscript. Isabelle COURT-FORTUNE has no conflict of interest to disclose in relation with the content of the manuscript. Nicolas DESBAILLETS has no conflict of interest to disclose in relation with the content of the manuscript. Gilbert FERRETTI has no conflict of interest to disclose in relation with the content of the manuscript. Anne GUILLEMOT has no conflict of interest to disclose in relation with the content of the manuscript. Laurane HARDELIN has no conflict of interest to disclose in relation with the content of the manuscript. Marianne KAMBOUCHNER has no conflict of interest to disclose in relation with the content of the manuscript. Violette LECLERC (deceased). Mathieu LEDERLIN has no conflict of interest to disclose in relation with the content of the manuscript. Marie-Claire MALINGE has no conflict of interest to disclose in relation with the content of the manuscript. Alain MANCEL has no conflict of interest to disclose in relation with the content of the manuscript. Sylvain MARCHAND-ADAM declares consulting fees paid by Novartis. Jean-Michel MAURY has no conflict of interest to disclose in relation with the content of the manuscript. Jean-Marc NACCACHE has no conflict of interest to disclose in relation with the content of the manuscript. Mouhamad NASSER has no conflict of interest to disclose in relation with the content of the manuscript. Hilario NUNES has no conflict of interest to disclose in relation with the content of the manuscript. Gaële PAGNOUX has no conflict of interest to disclose in relation with the content of the manuscript. Grégoire PRÉVOT has no conflict of interest to disclose in relation with the content of the manuscript. Christine ROUSSET-JABLONSKI has no conflict of interest to disclose in relation with the content of the manuscript. Olivier ROUVIERE has no conflict of interest to disclose in relation with the content of the manuscript. Salim SI-MOHAMED has no conflict of interest to disclose in relation with the content of the manuscript. Renaud TOURAINE has no conflict of interest to disclose in relation with the content of the manuscript. Julie TRACLET has no conflict of interest to disclose in relation with the content of the manuscript. Ségolène TURQUIER has no conflict of interest to disclose in relation with the content of the manuscript. Stéphane VAGNARELLI has no conflict of interest to disclose in relation with the content of the manuscript. Kaïs AHMAD has no conflict of interest to disclose in relation with the content of the manuscript., (Copyright © 2023 SPLF and Elsevier Masson SAS. All rights reserved.)

Introduction: Screening for neoplasms and vascular calcifications is a key step before kidney transplantation. American, European and French recommendations diverge on the imaging assessment to be carried out in this context., Method: We carried out a retrospective single-center study including patients who underwent imaging for kidney transplantation between the 01/01/2011 and the 12/31/2018. The neoplastic pathologies and vascular calcifications discovered on this assessment were noted., Results: We included 579 patients: 293 performed a thoracic CT scan, 579 an abdominopelvic CT scan. The imaging work-up revealed 5 malignant thoracic tumors, 14 malignant abdominal tumors and 140 significant calcifications of the external iliac axes. All malignant chest tumors were found in patients with estimated smoking greater than or equal to 30 PY., Discussion: Like the American recommendations, our results are in favor of performing a chest computed tomography in patients with smoking greater than or equal to 30 PY. Contrary to American and European recommendations, our results are in favor of performing an abdominopelvic tomodensitometry in all patients., Conclusion: Screening for vascular calcifications and neoplasms in kidney transplant candidates should include routine abdominopelvic CT and chest CT for smoking greater than or equal to 30 PY., (Copyright © 2022 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)

Introduction and Aims: Malnutrition is frequent in patients with idiopathic pulmonary fibrosis (IPF). We examined the relationship between malnutrition at diagnosis and all-cause hospitalization, survival, and acute exacerbation in newly diagnosed IPF patients., Methods: In this prospective cohort study, the nutritional status of 153 consecutive newly-diagnosed IPF outpatients was evaluated by measuring body mass index (BMI), fat-free mass index (FFMI) with bioelectrical impedance analysis, and food intake with the Self Evaluation of Food Intake (SEFI)®. Diagnosis was taken as the baseline date and malnutrition was defined as an FFMI below 17 (men) or 15 kg/m 2 (women). To determine the factors associated with all-cause hospitalization and mortality, univariate Cox regression analyses were performed and variables with P < 0.2 were included in a stepwise multivariable analysis., Results: A quarter (26%; 40/153) of the patients were suffering from malnutrition at baseline, which was more frequent (62%) in patients whose BMI was <25 kg/m 2 . Patients whose baseline FFMI was low were more likely to be hospitalized (Hazard Ratio (HR) = 1.98 [95% confidence interval, 1.15; 3.41], P = 0.0139) and/or die (HR = 1.79 [1.11; 2.89], P = 0.0165), but their acute exacerbation rate was similar to that of patients with normal FFMIs. Decreased food intake (SEFI®<7) at baseline was associated with all-cause hospitalization (P = 0.003) and mortality (P < 0.0001) during follow-up. Baseline higher gender-age-physiology (GAP) scores (HR = 1.24 [1.01; 1.52], P = 0.0434; HR = 1.71 [1.37; 2.14], P < 0.0001, respectively), lower BMI (HR = 0.89 [0.83; 0.96], P = 0.003; HR = 0.89 [0.82; 0.96], P = 0.003), and decreased food intake (SEFI® score) (HR = 0.81 [0.71; 0.93], P = 0.003; HR = 0.72 [0.64; 0.81], P < 0.0001), but not FFMI, were independently associated with all-cause hospitalization and mortality rates during follow-up., Conclusions: Malnutrition and decreased food intake at IPF diagnosis are associated with all-cause hospitalization and mortality. Future studies will determine whether dedicated interventions to improve food intake and nutritional status could improve outcomes for IPF patients., Competing Interests: Conflicts of interest Stéphane Jouneau has received fees, funding or reimbursement for national and international conferences, boards, expert or opinion groups, and research projects over the past 5 years from Actelion, AIRB, Astra Zeneca, Bellorophon Therapeutics, Biogen, BMS, Boehringer, Chiesi, Fibrogen, Gilead, GSK, LVL, Mundipharma, Novartis, Olam Pharm, Pfizer, Pliant Therapeutics, Roche, Savara-Serendex. Mathieu Lederlin has received fees, funding or reimbursement for national and international conferences, boards, expert or opinion groups and research projects over the past 5 years from Astra Zeneca, Boehringer, Fresenius-Kabi, Roche, and Siemens Healthcare. Laurent Vernhet has received funding from Boehringer-Ingelheim for research projects. Ronan Thibault has received royalties for designing the Simple Evaluation of Food Intake® (SEFI®) (Knoë, le Kremlin Bicêtre, France) tool, and consulting fees from Roche. The other authors disclose no conflict of interest., (Copyright © 2022 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

The aim of this study is to develop an automated deep-learning-based whole heart segmentation of ECG-gated computed tomography data. After 21 exclusions, CT acquired before transcatheter aortic valve implantation in 71 patients were reviewed and randomly split in a training (n = 55 patients), validation (n = 8 patients), and a test set (n = 8 patients). A fully automatic deep-learning method combining two convolutional neural networks performed segmentation of 10 cardiovascular structures, which was compared with the manually segmented reference by the Dice index. Correlations and agreement between myocardial volumes and mass were assessed. The algorithm demonstrated high accuracy (Dice score = 0.920; interquartile range: 0.906-0.925) and a low computing time (13.4 s, range 11.9-14.9). Correlations and agreement of volumes and mass were satisfactory for most structures. Six of ten structures were well segmented. Deep-learning-based method allowed automated WHS from ECG-gated CT data with a high accuracy. Challenges remain to improve right-sided structures segmentation and achieve daily clinical application., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: To evaluate different approaches for generating a cardiorespiratory ITV for cardiac radioablation., Methods: Four patients with ventricular tachycardia were included in this study. For each patient, cardiac-gated and respiration-correlated 4D-CT scans were acquired. The cardiorespiratory ITV was defined using registrations of the cardiac and respiratory 4D-CT images. Five different approaches, which differed in the number of incorporated cardiac phases (1, 2, 10, or 1 with a fixed 3 mm margin (FM) expansion) and respiratory phases (2 or 10), were evaluated. For each approach, a VMAT treatment plan was simulated. Target coverage (TC) and spill were evaluated geometrically and dosimetrically for each approach., Results: When employing one cardiac phase, the TC did not exceed 85%. Using the two extreme phases of the cardiac and respiratory cycles resulted in a geometric TC < 88% for two patients, with a dosimetric TC of 83% for one patient. An acceptable TC for all patients (geometric TC > 89%, dosimetric TC > 92%) was only achieved when combining 10 respiratory phases with either 2 or 10 cardiac phases or a single cardiac phase with FM. The use of a single cardiac phase with FM combined with 10 respiratory phases lead to a mean geometric and dosimetric spill of 43% and 35%, respectively., Conclusion: For cardiac radioablation, the use of two extreme cardiac phases combined with 10 respiratory phases is a robust approach to generate a cardiorespiratory ITV. The use of a single cardiac phase with or without fixed margin expansion is not recommended based on this study., (Copyright © 2022 Associazione Italiana di Fisica Medica e Sanitaria. Published by Elsevier Ltd. All rights reserved.)

Purpose: To evaluate the feasibility of a chest CT-based body composition analysis in idiopathic pulmonary fibrosis (IPF), and to investigate the respective contribution of lung and muscle CT quantitative analyses to the prognosis of IPF., Method: A total of 71 IPF patients were recruited at diagnosis. All patients underwent a standard chest CT-scan and a bioelectrical impedance analysis considered as reference standard for estimating malnutrition through the use of the fat-free mass index (FFMI). The skeletal muscle index (SMI) was measured on chest-CT at the level of the first lumbar vertebra by two radiologists. Lung fibrosis extent was quantified by three radiologists in consensus. The extent of emphysema, the pulmonary artery to aorta (PA/AO) diameter ratio and lymph node enlargement were also reported. Mortality and hospitalization over a 14-month follow-up were recorded., Results: A low FFMI defining malnutrition was identified in 26.8% of patients. SMI was significantly lower in these patients (p<0.001) and was correlated with FFMI (r=0.637, p<0.001). Interobserver agreement of SMI measurement was very good (ICC=0.91). For diagnosing malnutrition, SMI showed a 0.79 sensitivity, a 0.69 specificity, a 0.48 PPV and a 0.90 NPV. In univariate analysis, fibrosis extent was significantly associated with death, while SMI did not reach significance. In multivariate analysis, fibrosis extent and PA/AO ratio were independently associated with hospitalization., Conclusions: SMI measured on chest CT could be a reliable tool to exclude malnutrition in IPF. A quantitative analysis of both fibrosis and skeletal muscle may allow holistic management of IPF patients., (Copyright © 2021 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Objective: MRI is a reliable and accurate technique to characterize rheumatoid arthritis. The aim of this study was to provide voxel-by-voxel 3D maps of the proton density fat fraction (PDFF), the T 1 of water (T 1W ), the T 1 of fat (T 1F ), the T 2 * of water (T 2 * W ), the T 2 * of fat (T 2 * F ) in the wrist bone marrow., Materials and Methods: The experiments were conducted on 14 healthy volunteers (mean age: 24 ± 4). The data were acquired at 1.5 T using two optimized four-echo 3D 1.2 × 1.2 × 1.2 mm 3 -isotropic spoiled gradient sequences. A repeatability study was carried out. The measurements were done using a homemade parametric viewer software., Results: The inter-volunteer results were, on average: PDFF = 86 ± 3%, T 1W  = 441 ± 113 ms, T 1F  = 245 ± 19 ms, T 2 * W  = 6 ± 1 ms and T 2 * F  = 16 ± 3 ms. The coefficients of variation were for fat based biomarkers CV PDFF  < 5%, CV T1F  < 15% and CV T2*F  < 10% in the repeatability study., Discussion: The protocol and quantification tool proposed in this study provide high-resolution voxel-by-voxel 3D maps of five biomarkers in the wrist in less than 4 min of acquisition., (© 2021. European Society for Magnetic Resonance in Medicine and Biology (ESMRMB).)

Radiologists, and doctors in general, need relevant information for the quantification and characterization of pulmonary structures damaged by severe diseases, such as the Coronavirus disease 2019 (COVID-19). Texture-based analysis in scope of other pulmonary diseases has been used to screen, monitor, and provide valuable information for several kinds of diagnoses. To differentiate COVID-19 patients from healthy subjects and patients with other pulmonary diseases is crucial. Our goal is to quantify lung modifications in two pulmonary pathologies: COVID-19 and idiopathic pulmonary fibrosis (IPF). For this purpose, we propose the use of a three-dimensional multiscale fuzzy entropy (MFE3D) algorithm. The three groups tested (COVID-19 patients, IPF, and healthy subjects) were found to be statistically different for 9 scale factors ( p < 0.01 ). A complexity index (CI) based on the sum of entropy values is used to classify healthy subjects and COVID-19 patients showing an accuracy of 89.6 % , a sensitivity of 96.1 % , and a specificity of 76.9 % . Moreover, 4 different machine-learning models were also used to classify the same COVID-19 dataset for comparison purposes., (© 2021 Elsevier Ltd. All rights reserved.)

Purpose: The SARS-CoV-2 infection can lead to a severe acute respiratory distress syndrome (ARDS) with prolonged mechanical ventilation and high mortality rate. Interestingly, COVID-19-associated ARDS share biological and clinical features with sepsis-associated immunosuppression since lymphopenia and acquired infections associated with late mortality are frequently encountered. Mechanisms responsible for COVID-19-associated lymphopenia need to be explored since they could be responsible for delayed virus clearance and increased mortality rate among intensive care unit (ICU) patients., Methods: A series of 26 clinically annotated COVID-19 patients were analyzed by thorough phenotypic and functional investigations at days 0, 4, and 7 after ICU admission., Results: We revealed that, in the absence of any difference in demographic parameters nor medical history between the two groups, ARDS patients presented with an increased number of myeloid-derived suppressor cells (MDSC) and a decreased number of CD8 pos effector memory cell compared to patients hospitalized for COVID-19 moderate pneumonia. Interestingly, COVID-19-related MDSC expansion was directly correlated to lymphopenia and enhanced arginase activity. Lastly, T cell proliferative capacity in vitro was significantly reduced among COVID-19 patients and could be restored through arginine supplementation., Conclusions: The present study reports a critical role for MDSC in COVID-19-associated ARDS. Our findings open the possibility of arginine supplementation as an adjuvant therapy for these ICU patients, aiming to reduce immunosuppression and help virus clearance, thereby decreasing the duration of mechanical ventilation, nosocomial infection acquisition, and mortality.

Aims: Fifteen to thirty percentage of patients with severe aortic stenosis (AS) have preserved left ventricular ejection fraction (LVEF) and a discordant AS pattern at Doppler echocardiography, which is characterized by a small (<1 cm2) aortic area and low mean aortic gradient (<40 mmHg). The 'Randomized study for the Optimal Treatment of symptomatic patients with low-gradient severe Aortic Stenosis and preserved left ventricular ejection fraction' (ROTAS trial) aims at demonstrating the superiority of aortic valve replacement vs. a 'watchful waiting strategy' in symptomatic patients with low-gradient (LS), severe AS, and preserved LVEF, stratified according to indexed stroke volume, in terms of all-cause mortality or cardiovascular-related hospitalization during follow-up (FU)., Methods and Results: The ROTAS trial will be a multicentre randomized non-blinded study involving 16 reference centres. AS severity will be confirmed by a multimodality approach (rest and stress echocardiography, calcium scoring, and cardiac magnetic resonance imaging for optimally characterize the population), which could provide important inputs to improve the pathophysiological understanding of this complex disease. Well-characterized patients will be randomized according to the management strategy. The primary endpoint will be the occurrence of all-cause mortality or cardiac related-hospitalizations during 2-year FU. One hundred and eighty subjects per group will be included., Conclusion: The management of patients with LS severe AS and preserved LVEF is largely debated. ROTAS trial will allow a comprehensive evaluation of this particular pattern of AS and will establish which is the most appropriate management of these patients., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)

Background: Cryoballoon ablation is widely used for pulmonary vein isolation in patients with atrial fibrillation. There are no data regarding the clinical efficacy of cryoballoon ablation in patients with atypical right pulmonary vein anatomy., Aim: We aimed to evaluate the impact of right pulmonary vein anatomy on the safety and efficacy of cryoballoon ablation., Methods: Patients referred for cryoballoon ablation of paroxysmal atrial fibrillation were enrolled prospectively. Left atrial computed tomography was performed before cryoballoon ablation to determine whether the right pulmonary vein anatomy was "normal" or "atypical". For patients with atypical anatomy, cryoballoon ablation was only performed for right superior and right inferior pulmonary veins, neglecting accessory pulmonary veins., Results: Overall, 303 patients were included: 254 (83.8%) with normal and 49 (16.2%) with atypical right pulmonary vein anatomy. First-freeze isolation for right superior and right inferior pulmonary veins occurred in 44 (89.8%) and 37 (75.5%) patients with atypical pulmonary vein anatomy, and in 218 (85.8%) and 217 (85.4%) patients with typical pulmonary vein anatomy, respectively (P not significant). Phrenic nerve palsies were only observed in patients with normal anatomy (0 vs. 26 [8.6%]; P=0.039). Mid-term survival free from atrial arrhythmia was similar, regardless of right pulmonary vein anatomy., Conclusions: A significant proportion of patients have atypical right pulmonary vein anatomy. Procedural characteristics, acute pulmonary vein isolation success and mid-term procedural efficacy were similar, regardless of right pulmonary vein anatomy. In addition to left-side pulmonary vein isolation, cryoballoon ablation of right superior and right inferior pulmonary veins only, neglecting accessory pulmonary veins, is sufficient to obtain acute right-side pulmonary vein isolation and mid-term sinus rhythm maintenance in patients with atypical anatomy., (Copyright © 2020. Published by Elsevier Masson SAS.)

Purpose: This paper presents a novel 3D multimodal registration strategy to fuse 3D real-time echocardiography images with cardiac cine MRI images. This alignment is performed in a saliency space, which is designed to maximize similarity between the two imaging modalities. This fusion improves the quality of the available information., Methods: The method performs in two steps: temporal and spatial registrations. A temporal alignment is firstly achieved by nonlinearly matching pairs of correspondences between the two modalities using a dynamic time warping. A temporal registration is then carried out by applying nonrigid transformations in a common saliency space where normalized cross correlation between temporal pairs of salient volumes is maximized., Results: The alignment performance was evaluated with a set of 18 subjects, 3 with cardiomyopathies and 15 healthy, by computing the Dice score and Hausdorff distance with respect to manual delineations of the left ventricle cavity in both modalities. A Dice score and Hausdorff distance of [Formula: see text] and [Formula: see text], respectively, were obtained. In addition, the deformation field was estimated by quantifying its foldings, obtaining a 98% of regularity in the deformation field., Conclusions: The 3D multimodal registration strategy presented is performed in a saliency space. Unlike state-of-the-art methods, the presented one takes advantage of the temporal information of the heart to construct this common space, ending up with two well-aligned modalities and regular deformation fields. This preliminary study was evaluated on heterogeneous data composed of two different datasets, healthy and pathological cases, showing similar performances in both cases. Future work will focus on testing the presented strategy in a larger dataset with a balanced number of classes.

Background: Pulmonary vein isolation (PVI) using cryoballoon ablation is widely used for rhythm control in patients with paroxysmal atrial fibrillation. This technique has a steep learning curve, and PVI can be achieved quickly in most patients. However, the right inferior pulmonary vein (RIPV) is often challenging to occlude and isolate., Aim: We aimed to analyse the efficacy of RIPV ablation using a systematic approach., Methods: Consecutive patients referred for cryoballoon ablation of paroxysmal atrial fibrillation were enrolled prospectively. A systematic approach was used for RIPV cryoablation. The primary endpoint was acute RIPV isolation during initial freeze., Results: A total of 214 patients were included. RIPV isolation during initial freeze occurred in 179 patients (82.2%). Real-time PVI could be observed in 72 patients (33.6%), whereas cryoballoon stability required pushing the Achieve™ catheter inside the RIPVs in the remaining patients. The rate of unsuccessful or aborted first freeze as a result of insufficient minimal temperature was significantly higher in patients with real-time pulmonary vein potential recording (16.7% vs. 6.3%; P=0.031). To overcome this issue and obtain both stability and real-time PVI, a dedicated "whip technique" was developed. Twelve patients (5.6%) required a redo ablation; only two of these had a reconnected RIPV., Conclusions: A systematic approach to RIPV cryoablation can lead to a high rate of first freeze application. Operators should not struggle to visualize pulmonary vein potentials before ablation, as this may decrease cryoapplication efficacy. Thus, stability should be preferred over real-time PVI for RIPV ablation. Both stability and real-time PVI can be obtained using a "whip technique"., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objectives: Little is known about the indicators to assess malnutrition in patients with idiopathic pulmonary fibrosis (IPF). This study aimed to determine the following: 1) the prevalence of malnutrition in IPF patients; 2) the nutritional indicators predictive of low fat-free mass (FFM) as measured by bioimpedance analysis; 3) the IPF patients' characteristics associated with low FFM., Methods: The IPF patients were consecutively recruited in a referral center for rare pulmonary diseases. Malnutrition was defined as a fat-free mass index (FFMI) = FFM (kg) / (height [m] 2 ) <17 (men) or <15 (women). Nutritional assessment included body mass index (BMI), mid-arm circumference (MAC), triceps skinfold thickness, analogue food intake scale, and serum albumin and transthyretin. The primary endpoint was FFMI. Area under the receiver operating characteristic curve (AUC) assessed low FFMI prediction from nutritional indicators. Multivariable logistic regression determined variables associated with low FFMI., Results: Eighty-one patients were consecutively recruited. Low FFMI prevalence was 28% (23 of 81). BMI AUC was 0.91 (95% confidence interval [CI], 0.84‒0.97) and MAC AUC was 0.85 (0.76‒0.94). Multivariable analysis associated BMI (odds ratio [OR] 0.26 [95% CI, 0.12-0.54], P = 0.0003), male sex (OR 0.02 [0.00-0.33], P = 0.005), and smoking (OR 0.10 [0.01-0.75], P = 0.024) with a lower risk of malnutrition., Conclusions: Malnutrition occurred in nearly one-third of IPF patients. Malnutrition screening should become systematic based on BMI and MAC, which are good clinical indicators of low FFMI. We propose a practical approach to screen malnutrition in IPF patients., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Cone-beam computed tomography (CBCT) acquisition during endovascular aneurysm repair is an emergent technology with more and more applications. It may provide 3-D information to achieve guidance of intervention. However, there is growing concern on the overall radiation doses delivered to patients, thus a low dose protocol is called when scanning. But CBCT images with a low dose protocol are degraded, resulting in streak artifacts and decreased contrast-to-noise ratio (CNR). In this paper, a Laplacian pyramid-based nonlinear diffusion is proposed to improve the quality of CBCT images., Method: We first transform the CBCT image into its pyramid domain, then a modified nonlinear diffusion is performed in each level to remove noise across edges while keeping edges as far as possible. The improved diffusion coefficient is a function of the gradient magnitude image; the threshold in the modified diffusion function is estimated using the median absolute deviation (MAD) estimator; the time step is automatically determined by iterative image changes and the iteration is stopped according to mean absolute error between two adjacent diffusions. Finally, we reconstruct the Laplacian pyramid using the processed pyramid images in each level., Result: Results from simulation show that the filtered image from the proposed method has the highest peak signal-noise ratio (81.92), the highest correlation coefficient (99.77%) and the lowest mean square error (27.61), compared with the other four methods. In addition, it has highest contrast-to-noise ratio and sharpness in ROIs. Results from real CBCT images show that the proposed method shows better smoothness in homogeneous regions meanwhile keeps bony structures clear., Conclusion: Simulation and patient studies show that the proposed method has a good tradeoff between noise/artifacts suppression and edge preservation.

C-arm cone-beam computed tomography (CBCT) acquisition during endovascular aneurysm repair (EVAR) is an emergent technology with more and more applications. It offers real time imaging with a stationary patient and provides 3-D information to achieve guidance of intervention. However, there is growing concern on the overall radiation doses delivered to patients all along the endovascular management due to pre-, intra-, and post-operative X-ray imaging. Manufactures may have their low dose protocols to realize reduction of radiation dose, but CBCT with a low dose protocol has too many artifacts, particularly streak artifacts, and decreased contrast-to-noise ratio (CNR). To reduce noise and artifacts, a penalized weighted least-squares (PWLS) algorithm with an edge-preserving penalty is proposed. The proposed method is evaluated by quantitative parameters including a defined signal-to-noise ratio (SNR), CNR, and modulation transfer function (MTF) on clinical CBCT. Comparisons with PWLS algorithms with isotropic, TV, Huber, anisotropic penalties demonstrate that the proposed edge-preserving penalty performs well not only on edge preservation, but also on streak artifacts suppression, which may be crucial for observing guidewire and stentgraft in EVAR., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Left ventricular non-compaction (LV NC) is characterized by abnormal trabeculations that are mainly at the LV apex. Distinction between LV NC and non-specific dilated cardiomyopathies (DCMs) remains often challenging. We sought to find additive tools comparing the longitudinal strain characteristics of LVNC versus idiopathic DCM in a cohort of patients. 48 cases of LVNC (derivation cohort) were compared with 45 cases of DCM. Global and regional multi-layer (sub-endocardial, mid-wall, and sub-epicardial) LV longitudinal strain analysis was performed. Results were compared to define the best tool for distinguishing LVNC from DCM. A validation cohort (41 LVNC patients) was then used to assess the performance of the proposed diagnostic tools. In the derivation cohort, longitudinal deformation (strain) was greater in LVNC than in DCM patients. Longitudinal shortening was greater in the non-compacted segments than in the compacted ones. A mid-wall strain base-apex gradient had 88.4 % sensitivity and 66.7 % specificity in distinguishing LVNC from DCM (AUC = 0.83; cut-off of -23 or |0.23|%). In a multivariable model, the base-apex mid-wall gradient in an apical 4-chamber view was the only independent echocardiographic criteria (OR = 0.76, CI 95 % [0.66; 0.90], p = 0.0010) allowing the distinction between LVNC and DCM. In the validation cohort, the base-apex mid-wall gradient of strain had 88.4 % sensitivity, 85.7 % negative predictive values for the diagnosis of LVNC. Longitudinal strain, especially the base-apex longitudinal gradient of strain, appears as an additive valuable tool for distinguishing LVNC from DCM.

Atrial fibrillation (AF) is the commonest cardiac rhythm disorder. Evaluation of patients with AF requires an electrocardiogram, but imaging techniques should be considered for defining management and driving treatment. The present document is an expert consensus from the European Association of Cardiovascular Imaging (EACVI) and the European Heart Rhythm Association. The clinical value of echocardiography, cardiac magnetic resonance (CMR), computed tomography (CT), and nuclear imaging in AF patients are challenged. Left atrial (LA) volume and strain in echocardiography as well as assessment of LA fibrosis in CMR are discussed. The value of CT, especially in planning interventions, is highlighted. Fourteen consensus statements have been reached. These may serve as a guide for both imagers and electrophysiologists for best selecting the imaging technique and for best interpreting its results in AF patients., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.)

Objectives: To evaluate the influence of exposure parameters and raw-data based iterative reconstruction (IR) on the performance of computer-aided detection (CAD) of pulmonary nodules on chest multidetector computed tomography (MDCT)., Material and Methods: Seven porcine lung explants were inflated in a dedicated ex vivo phantom shell and prepared with n=162 artificial nodules of a clinically relevant volume and maximum diameter (46-1063 μl, and 6.2-21.5 mm). n=118 nodules were solid and n=44 part-solid. MDCT was performed with different combinations of 120 and 80 kV with 120, 60, 30 and 12 mA*s, and reconstructed with both filtered back projection (FBP) and IR. Subsequently, 16 datasets per lung were subjected to dedicated CAD software. The rate of true positive, false negative and false positive CAD marks was measured for each reconstruction., Results: The rate of true positive findings ranged between 88.9-91.4% for FBP and 88.3-90.1% for IR (n.s.) with most exposure settings, but was significantly lower with the combination of 80 kV and 12 mA*s (80.9% and 81.5%, respectively, p<0.05). False positive findings ranged between 2.3-8.1 annotations per lung. For nodule volumes <200 μl the rate of true positives was significantly lower than for >300 μl (p<0.05). Similarly, it was significantly lower for diameters <12 mm compared to ≥12 mm (p<0.05). The rate of true positives for solid and part-solid nodules was similar., Conclusions: Nodule CAD on chest MDCT is robust over a wide range of exposure settings. Noise reduction by IR is not detrimental for CAD, and may be used to improve image quality in the setting of low-dose MDCT for lung cancer screening., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objective: Little is known about the effectiveness of dose reduction options according to breast thickness. The purpose of this phantom study was to compare the effects on dose and noise of bismuth shielding versus a low kilovoltage for different breast thicknesses., Materials and Methods: CT acquisitions were performed first at 120 kVp (reference acquisition), then at 120 kVp with shielding and at 100 kVp without shielding on a phantom with three different prosthetic breast thicknesses, corresponding to the minimum, median, and maximum values first measured in a sample of 30 female thoracic CT examinations, which were randomly selected. Breast doses were measured with optically stimulated luminescence dosimeters placed on and beneath the prosthetic breast. For noise evaluation, the CT number SDs were measured within six ROIs at increasing depths., Results: Taking into account all breast thicknesses, the average breast dose was reduced by 42.1% with shielding and by 33.0% at 100 kVp (p=0.009). In-depth noise increased less with shielding (19.0% vs 32.1%, p<0.0001). For 1-cm breast thickness, the breast dose fell by 46.5% and 29.7% with shielding and 100 kVp, respectively (p=0.01), and in-depth noise increased by 19.5% and 33.9% (p=0.01). The corresponding values for 2-cm breast thickness were -38.5% and -30.1%, (p=0.02) and 16.5% and 33.5% (p=0.001), whereas those for 4-cm thickness were -40.6% and -40.5% (p=0.95) and 20.7 and 29.2% (p=0.02)., Conclusion: Greater breast dose reduction is achieved by shielding for breast thicknesses less than 4 cm. Regardless of breast thickness, shielding leads to a smaller increase in in-depth noise.

Objective: To retrospectively investigate the diagnostic value of pre-operative CT-features between pre/minimally invasive and invasive lesions in part-solid persistent pulmonary ground glass nodules in a Caucasian population., Materials and Methods: Retrospective review of two pre-operative CTs for 31 nodules in 30 patients. There were 10 adenocarcinomas in situ, 1 minimally invasive adenocarcinoma, 20 invasive adenocarcinomas. We analyzed the correlation between histopathology and the following CT-features: maximal axial diameter, maximal orthogonal axial diameter, height, density, size of solid component, air bronchogram, pleural retraction, nodule mass, disappearance rate and their evolution during follow-up., Results: In univariate analysis, invasive adenocarcinomas had a higher maximal height, density, solid component size, mass, a lower disappearance rate and presented more often with pleural retraction (p<0.05). After logistic regression performed with the uncorrelated parameters using a method of selection of variables, only the size of solid component remained significant, with 100% sensitivity for invasive adenocarcinoma when larger than 5mm., Conclusion: Preoperative CT-features can help differentiating in situ and minimally invasive adenocarcinomas from invasive adenocarcinomas in Caucasian patients. A solid component larger than 5mm in diameter had 100% sensitivity for the diagnosis of invasive adenocarcinoma., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Cardiac Resynchronization Therapy (CRT) has been validated as an efficient treatment for selected patients suffering from heart failure with cardiac dyssynchrony. In case of bi-ventricular stimulation, the response to the therapy may be improved by an optimal choice of the left ventricle (LV) pacing sites. The characterization of LV properties to select the best candidate sites and to precise their access modes would be useful for the clinician in pre- and per-operative stages. For that purpose, we propose a new pre-operative analysis solution integrating previously developed multi-modal data registration methods and a new segmentation process of their coronary venous access. Moreover, a novel visualization interface is proposed to help the clinician to visualize the most relevant pacing sites and their access during the implantation in the operating room. This work is illustrated on real CRT data patients.

Recently, a novel classification system based on tumour architecture and with high prognostic impact has been proposed for pulmonary adenocarcinomas (ADCs). For imaging-based prediction of histological ADC subtypes and, thus, prognosis, it is of paramount importance to investigate the correlations of radio- and histomorphological parameters. Associations between histomorphological ADC growth patterns (lepidic, acinar, papillary, micropapillary and solid) and data from pre-operative assessment by computed tomography (CT) imaging of 174 resected pulmonary ADCs were analysed. Margin configuration as well as solidity/ground glass opacity of an ADC was associated with distinct histomorphological ADC growth patterns. Solid-predominant ADCs usually had smooth margins and were also solid in CT scans, while lepidic-predominant ADCs had no predominant margin pattern, were located in the periphery, showed a positive bronchogram and were frequently associated with solidity/ground glass opacity. In addition, nonspherical tumour growth was a negative predictor of overall and disease-specific patient survival. We defined CT morphological parameters that were associated with histomorphological growth patterns of pulmonary ADCs. These data may form the basis for the development of future prognostic algorithms in the palliative setting, which include an integrated evaluation of biopsy histomorphology and CT scan morphology of nonresectable pulmonary ADC.

Objective: The purposes of this study were to compare airway wall attenuation in subjects with asthma and subjects without asthma; to correlate this value with pulmonary function test results, standard bronchial CT parameters, and immunohistologic data; and to identify CT parameters that influence obstructive indexes., Subjects and Methods: Bronchial airway wall attenuation was averaged over four bronchi in 27 subjects with asthma and 15 control subjects without asthma. The following five standard bronchial parameters also were assessed: lumen area, wall area, wall thickness, wall-to-lumen area ratio, and wall-to-total area ratio (wall area percentage). These parameters were compared between groups and correlated with functional data. Ability to predict patient group with these parameters was determined by comparison of receiver operating characteristic curves and areas under the curve. The influence of the parameters on obstructive indexes was assessed by multivariate analysis. Correlations between wall attenuation value and histologic data were studied in 11 patients with asthma., Results: Wall attenuation value was greater in patients with asthma (-322 ± 79 HU) than in control subjects (-463 ± 69 HU). Correlation coefficients of wall attenuation value with functional obstructive parameters were significant and greater than those obtained for any other CT parameter. The area under the curve of wall attenuation value was greater than that of bronchial lumen area and bronchial wall area. In the model of multiple regression that included wall attenuation value and wall-to-total area ratio, wall attenuation value was the only measurement that significantly influenced obstructive indexes (R(2) = 0.39-0.43). Wall attenuation value correlated with mast cell infiltration., Conclusion: Compared with the usual bronchial CT parameters, airway wall attenuation better differentiates patients with asthma from control subjects and better correlates with obstruction.

Objective: The objective of our study was to evaluate bronchial wall attenuation values quantified using CT in patients with chronic obstructive pulmonary disease (COPD)., Subjects and Methods: Ninety patients (81 men, nine women; age range, 21-80 years; mean age, 56 years) underwent CT and pulmonary function tests (PFTs). Bronchial wall attenuation value, wall area, and lumen area were averaged over four segmental bronchi in control subjects (n = 30), smokers with COPD (n = 30), and smokers without COPD (n = 30). The bronchial wall thickness, wall area-to-lumen area ratio, and wall area-to-total area ratio were computed. The extent of emphysema was measured as the percentage of area with an attenuation of less than -950 HU. Parameters were compared among groups and were correlated with PFT results. Receiver operating characteristic curves were obtained for each parameter and areas under the curve were compared. Variables responsible for changes in wall attenuation values and those accounting for obstructive indexes were assessed using multiple regressions., Results: The wall attenuation value was the only parameter discriminating between each pair of groups (mean ± SD, -293 ± 71 HU in COPD patients, -387 ± 70 HU in smokers, and -457 ± 69 HU in control subjects). The area under the curve of the wall attenuation value was greater than that of any other CT bronchial parameter to separate smokers from COPD patients. Wall attenuation value correlated with PFT results and was influenced by the wall area-to-lumen area ratio. The wall attenuation value, extent of emphysema, and standard bronchial parameters independently influenced obstructive indexes., Conclusion: The bronchial wall attenuation value is a powerful index for assessing tobacco-related bronchial wall changes in patients with COPD.