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Purpose To compare the diagnostic performance of the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax (ATS/JRS/ALAT) versus the American College of Chest Physicians (ACCP) imaging classifications for hypersensitivity pneumonitis (HP). Materials and Methods Patients in the institutional review board-approved Interstitial Lung Disease (ILD) registry referred for multidisciplinary discussion (MDD) at the authors' institution (January 1, 2006-April 1, 2021) were included in this retrospective study when ILD was diagnosed at MDD. MDD diagnoses included HP, connective tissue disease-ILD, and idiopathic pulmonary fibrosis. Retrospective review of thin-section CT images was performed in consensus by two cardiothoracic radiologists blinded to the diagnosis. Diagnostic patterns were determined for thin-section CT images using both classifications. Discordance rates were determined. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were assessed using MDD diagnosis as the reference standard. Results A total of 297 patients were included in the study: 200 (67%) with HP, 49 (16%) with connective tissue disease-ILD, and 48 (16%) with idiopathic pulmonary fibrosis at MDD. The discordance rate between the two classifications was 21%. Assuming low HP prevalence (10%), ATS/JRS/ALAT classification outperformed ACCP classification, with greater accuracy (92.3% vs 87.6%) and greater positive predictive value (60.7% vs 42.9%). Assuming high prevalence (50%), accuracy and negative predictive value were superior using ACCP classification (81.7% vs 79.7% and 77.7% vs 72.6%, respectively), and positive predictive value was superior using ATS/JRS/ALAT classification (93.3% vs 87.1%). Conclusion Accuracy of the ATS/JRS/ALAT and ACCP HP classifications was greater in settings with low and high HP prevalence, respectively. Diagnostic performance of both classifications was discordant in a minority of cases. Keywords: CT, Thorax, Hypersensitivity Pneumonitis, Interstitial Lung Disease Supplemental material is available for this article. © RSNA, 2024.

Purpose: To determine the frequency of malignancy of nonperifissural juxtapleural nodules (JPNs) measuring 6 to < 10 mm in a subset of low-dose chest computed tomographies from the National Lung Cancer Screening Trial and the rate of down-classification of such nodules in Lung-Reporting and Data System (RADS) 2.0 compared with Lung-RADS 1.1., Materials and Methods: A secondary analysis of a subset of the National Lung Screening Trial was performed. An exemption was granted by the Institutional Review Board. The dominant noncalcified nodule measuring 6 to <10 mm was identified on all available prevalence computed tomographies. Nodules were categorized as pleural or nonpleural. Benign or malignant morphology was recorded. Initial and updated categories based on Lung-RADS 1.1 and Lung-RADS 2.0 were assigned, respectively. The impact of the down-classification of JPN was assessed. Both classification schemes were compared using the McNemar test ( P < 0.01)., Results: A total of 2813 patients (62 ± 5 y, 1717 men) with 4408 noncalcified nodules were studied. One thousand seventy-three dominant nodules measuring 6 to <10 mm were identified. Three hundred forty-eight (32.4%) were JPN. The updated scheme allowed down-classification of 310 JPN from categories 3 (n = 198) and 4A (n = 112) to category 2. We, therefore, estimate a 4.8% rate of down-classification to category 2 in the entire National Lung Screening Trial screening group. Two/348 (0.57%) JPN were malignant, both nonbenign in morphology. The false-positive rate decreased in the updated classification ( P < 0.01)., Conclusion: This study demonstrates the low malignant potential of benign morphology JPN measuring 6 mm to <10 mm. The Lung-RADS 2.0 approach to JPN is estimated to reduce short-term follow-ups and false-positive results., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Pack-year smoking history is an imperfect and biased measure of cumulative tobacco exposure. The use of pack-year smoking history to determine lung cancer screening eligibility in the current US Preventive Services Task Force (USPSTF) guideline may unintentionally exclude many high-risk individuals, especially those from racial and ethnic minority groups. It is unclear whether using a smoking duration cutoff instead of a smoking pack-year cutoff would improve the selection of individuals for screening., Methods: We analyzed 49,703 individuals with a smoking history from the Southern Community Cohort Study (SCCS) and 22,126 individuals with a smoking history from the Black Women's Health Study (BWHS) to assess eligibility for screening under the USPSTF guideline versus a proposed guideline that replaces the ≥20-pack-year criterion with a ≥20-year smoking duration criterion., Results: Under the USPSTF guideline, only 57.6% of Black patients with lung cancer in the SCCS would have qualified for screening, whereas a significantly higher percentage of White patients with lung cancer (74.0%) would have qualified ( P < .001). Under the proposed guideline, the percentage of Black and White patients with lung cancer who would have qualified for screening increased to 85.3% and 82.0%, respectively, eradicating the disparity in screening eligibility between the groups. In the BWHS, using a 20-year smoking duration cutoff instead of a 20-pack-year cutoff increased the percentage of Black women with lung cancer who would have qualified for screening from 42.5% to 63.8%., Conclusion: Use of a 20-year smoking duration cutoff instead of a 20-pack-year cutoff greatly increases the proportion of patients with lung cancer who would qualify for screening and eliminates the racial disparity in screening eligibility between Black versus White individuals; smoking duration has the added benefit of being easier to calculate and being a more precise assessment of smoking exposure compared with pack-year smoking history.

Purpose: We developed a novel patient-radiologist consultation for patients scheduled for lung cancer screening (LCS). We hypothesized that this intervention would improve patient attitudes towards LCS adherence and smoking cessation., Methods: This quality improvement project enrolled 38 LCS patients (a majority were African American) and included 20 current and 18 former smokers. The intervention, a 5-10 min consultation with a radiologist who provided preliminary interpretation of pertinent imaging findings in conjunction with smoking cessation counseling, took place in the radiology reading room immediately after the low dose computed tomography (LDCT) patient scan. Pre- and post-intervention surveys assessed patient attitudes towards LCS and smoking cessation., Results: All recruited patients consented to participate in this project. Regarding viewing their LCS imaging, 86.8% (33/38) expressed general interest initially, with 100.0% (38/38) being more interested afterwards. On LCS logistics, 71.1% (27/38) reported prior knowledge at baseline, while 89.5% (34/38) reported being more informed following the intervention. Among current smokers, 90.0% (18/20) were already motivated towards quitting smoking at baseline, with 100.0% (20/20) exiting the intervention being more interested in doing so. Regarding smoking cessation resources, 95.0% (19/20) were interested in accessing such resources at baseline, and 90.0% (18/20, 2 were same/neutral) were more interested afterwards., Conclusions: Patients' attitudes towards LCS and self-reported interest in quitting smoking were directionally higher after the consultation than at baseline. Incorporating LCS consultations with radiologists as part of patient-centered care provides a resource to educate patients on their own LCS imaging findings while promoting LCS adherence and smoking cessation., 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. Published by Elsevier Inc.)

Progressive pulmonary fibrosis (PPF) and interstitial lung abnormalities (ILA) are relatively new concepts in interstitial lung disease (ILD) imaging and clinical management. Recognition of signs of PPF, as well as identification and classification of ILA, are important tasks during chest high-resolution CT interpretation, to optimize management of patients with ILD and those at risk of developing ILD. However, following professional society guidance, the role of imaging surveillance remains unclear in stable patients with ILD, asymptomatic patients with ILA who are at risk of progression, and asymptomatic patients at risk of developing ILD without imaging abnormalities. In this AJR Expert Panel Narrative Review, we summarize the current knowledge regarding PPF and ILA and describe the range of clinical practice with respect to imaging patients with ILD, those with ILA, and those at risk of developing ILD. In addition, we offer suggestions to help guide surveillance imaging in areas with an absence of published guidelines, where such decisions are currently driven primarily by local pulmonologists' preference.

Competing Interests: Dr Adegunsoye discloses relationships with Genentech, Inogen, Medscape, patientMpower, and Boehringer Ingelheim. Dr Chung discloses relationships with Boehringer Ingelheim, Riverian Technologies, and Roche. Dr Jablonski discloses relationship with AbbVie. Dr Strek discloses relationships with Boehringer Ingelheim, the Pulmonary Fibrosis Foundation, American College of Chest Physicians, and Fibrogen Adjudication. The remaining authors have disclosed no conflicts of interest.

Background: Because chest CT scan has largely supplanted surgical lung biopsy for diagnosing most cases of interstitial lung disease (ILD), tools to standardize CT scan interpretation are urgently needed., Research Question: Does a deep learning (DL)-based classifier for usual interstitial pneumonia (UIP) derived using CT scan features accurately discriminate radiologist-determined visual UIP?, Study Design and Methods: A retrospective cohort study was performed. Chest CT scans acquired in individuals with and without ILD were drawn from a variety of public and private data sources. Using radiologist-determined visual UIP as ground truth, a convolutional neural network was used to learn discrete CT scan features of UIP, with outputs used to predict the likelihood of UIP using a linear support vector machine. Test performance characteristics were assessed in an independent performance cohort and multicenter ILD clinical cohort. Transplant-free survival was compared between UIP classification approaches using the Kaplan-Meier estimator and Cox proportional hazards regression., Results: A total of 2,907 chest CT scans were included in the training (n = 1,934), validation (n = 408), and performance (n = 565) data sets. The prevalence of radiologist-determined visual UIP was 12.4% and 37.1% in the performance and ILD clinical cohorts, respectively. The DL-based UIP classifier predicted visual UIP in the performance cohort with sensitivity and specificity of 93% and 86%, respectively, and in the multicenter ILD clinical cohort with 81% and 77%, respectively. DL-based and visual UIP classification similarly discriminated survival, and outcomes were consistent among cases with positive DL-based UIP classification irrespective of visual classification., Interpretation: A DL-based classifier for UIP demonstrated good test performance across a wide range of UIP prevalence and similarly discriminated survival when compared with radiologist-determined UIP. This automated tool could efficiently screen for UIP in patients undergoing chest CT scan and identify a high-risk phenotype among those with known ILD., Competing Interests: Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: L. K., K. L., S. Z., and C. H. are employees of Imbio, Inc. H. G., E. S., S. L., and C. S. are paid consultants for Imbio, Inc. J. H. C., A. A., and J. M. O. report consulting fees from Genentech unrelated to this investigation. None declared (L. C., J. V. P., J. M. W., A. W. M., S. G., A. G.)., (Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study is to bring attention to an atypical form of metastatic pulmonary calcification, which is conventionally described as a metabolic process with upper lobe predominance in patients with a specific clinical history, which has not been reported as a distinct entity., Methods: Patients with metastatic pulmonary calcification (MPC) were first identified with mPower keyword search, including MPC or metastatic calcifications on computed tomography chest radiological reports. Patients were then filtered on likelihood of MPC based off imaging reports. Images were then reviewed by three senior radiologists for pertinent characteristics such as location of MPC, degree of calcifications and pleural effusions. Based on the predominant location of MPC, cases were labeled as either typical or atypical. Clinical and imaging characteristics relevant to MPC were noted and compared across typical and atypical cases., Results: In our study, we describe 25 patients with MPC, 13 defined as typical MPC and 12 with atypical MPC. Through consensus of senior radiologists, MPC was deemed to be mild (52%), moderate (44%), or severe (4%). Twenty-three patients (92%) had underlying renal disease including 21 requiring dialysis at the time of diagnosis. Outside of age at diagnosis, there was no significant clinical difference between the two groups. Evaluation of imaging characteristics (average HU attenuation, 267; range, 186-295), pattern and distribution of calcification, and clinical history strongly supported a diagnosis of atypical MPC., Conclusion: This study presents several cases of lower lobe subpleural MPC associated with pleural effusions, which has not been reported as a distinct entity, despite comprising a significant portion of MPC cases at our institution., Competing Interests: There are no financial conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Occupational lung diseases (OLD) are a group of preventable conditions caused by noxious inhalation exposure in the workplace. Workers in various industries are at a higher risk of developing OLD. Despite regulations contributing to a decreased incidence, OLD remain among the most frequently diagnosed work-related conditions, contributing to significant morbidity and mortality. A multidisciplinary discussion (MDD) is necessary for a timely diagnosis. Imaging, particularly computed tomography, plays a central role in diagnosing OLD and excluding other inhalational lung diseases. OLD can be broadly classified into fibrotic and non-fibrotic forms. Imaging reflects variable degrees of inflammation and fibrosis involving the airways, parenchyma, and pleura. Common manifestations include classical pneumoconioses, chronic granulomatous diseases (CGD), and small and large airway diseases. Imaging is influenced by the type of inciting exposure. The findings of airway disease may be subtle or solely uncovered upon expiration. High-resolution chest CT, including expiratory-phase imaging, should be performed in all patients with suspected OLD. Radiologists should familiarize themselves with these imaging features to improve diagnostic accuracy., Competing Interests: The authors have no potential conflicts of interest to disclose., (Copyright © 2023 The Korean Society of Radiology.)

Hypersensitivity pneumonia (HP) refers to a heterogeneous group of interstitial lung diseases resulting from a non-IgE immune-mediated reaction to inhaled pathogens in susceptible and sensitized hosts. Environmental and genetic factors are important substrates of disease pathogenesis. A recurrent or ongoing airborne exposure results in activation of humoral and cellular immune responses. This article discusses key clinical, radiologic, and histopathologic features of HP and reviews current recommendations., (Copyright © 2022 Elsevier Inc. All rights reserved.)

BACKGROUND. A possible association has been reported between COVID-19 messenger RNA (mRNA) vaccination and myocarditis. OBJECTIVE. The purpose of our study was to describe cardiac MRI findings in patients with myocarditis after COVID-19 mRNA vaccination. METHODS. This retrospective study included patients without known prior SARS-CoV-2 infection who underwent cardiac MRI between May 14, 2021, and June 14, 2021, for suspected myocarditis within 2 weeks of COVID-19 mRNA vaccination. Information regarding clinical presentation, hospital course, and events after hospital discharge were recorded. A cardiothoracic imaging fellow and cardiothoracic radiologist reviewed cardiac MRI examinations in consensus. Data were summarized descriptively. RESULTS. Of 52 patients without known prior SARS-CoV-2 infection who underwent cardiac MRI during the study period, five underwent MRI for suspected myocarditis after recent COVID-19 mRNA vaccination. All five patients were male patients ranging in age from 16 to 19 years (mean, 17.2 ± 1.0 [SD] years) who presented within 4 days of receiving the second dose of a COVID-19 mRNA vaccine. Troponin levels were elevated in all patients (mean peak troponin I value, 6.82 ± 4.13 ng/mL). Alternate possible causes of myocarditis were deemed clinically unlikely on the basis of medical history, physical examination findings, myocarditis viral panel, and toxicology screening. Cardiac MRI findings were consistent with myocarditis in all five patients on the basis of the Lake Louise criteria, including early gadolinium enhancement and late gadolinium enhancement (LGE) in all patients and corresponding myocardial edema in four patients. All five patients had a favorable hospital course and were discharged from the hospital in stable condition with improved or resolved symptoms after hospitalization (mean length of hospital stay, 4.8 days). Two patients underwent repeat cardiac MRI that showed persistent, although decreased, LGE. Three patients reported mild intermittent self-resolving chest pain after hospital discharge, and two patients had no recurrent symptoms after discharge. CONCLUSION. In this small case series, all patients with myocarditis after COVID-19 vaccination were male adolescents and had a favorable initial clinical course. All patients showed cardiac MRI findings typical of myocarditis from other causes. LGE persisted in two patients who underwent repeat MRI. These observations do not establish causality. CLINICAL IMPACT. Radiologists should be aware of a possible association of COVID-19 mRNA vaccination and myocarditis and recognize the role of cardiac MRI in the assessment of suspected myocarditis after COVID-19 vaccination.

Urbanization transforms environments in ways that alter biological evolution. We examined whether urban environmental change drives parallel evolution by sampling 110,019 white clover plants from 6169 populations in 160 cities globally. Plants were assayed for a Mendelian antiherbivore defense that also affects tolerance to abiotic stressors. Urban-rural gradients were associated with the evolution of clines in defense in 47% of cities throughout the world. Variation in the strength of clines was explained by environmental changes in drought stress and vegetation cover that varied among cities. Sequencing 2074 genomes from 26 cities revealed that the evolution of urban-rural clines was best explained by adaptive evolution, but the degree of parallel adaptation varied among cities. Our results demonstrate that urbanization leads to adaptation at a global scale.

In 2014, the American College of Radiology (ACR) created Lung-RADS 1.0. The system was updated to Lung-RADS 1.1 in 2019, and further updates are anticipated as additional data become available. Lung-RADS provides a common lexicon and standardized nodule follow-up management paradigm for use when reporting lung cancer screening (LCS) low-dose CT (LDCT) chest examinations and serves as a quality assurance and outcome monitoring tool. The use of Lung-RADS is intended to improve LCS performance and lead to better patient outcomes. To date, the ACR's Lung Cancer Screening Registry is the only LCS registry approved by the Centers for Medicare & Medicaid Services and requires the use of Lung-RADS categories for reimbursement. Numerous challenges have emerged regarding the use of Lung-RADS in clinical practice, including the timing of return to LCS after planned follow-up diagnostic evaluation; potential substitution of interval diagnostic CT for future LDCT; role of volumetric analysis in assessing nodule size; assessment of nodule growth; assessment of cavitary, subpleural, and category 4X nodules; and variability in reporting of the S modifier. This article highlights the major updates between versions 1.0 and 1.1 of Lung-RADS, describes the system's ongoing challenges, and summarizes current evidence and recommendations.

Background: Multidisciplinary discussion (MDD) is widely recommended for patients with interstitial lung disease (ILD), but published primary data from MDD has been scarce, and factors influencing MDD other than chest computed tomography (CT) and lung histopathology interpretations have not been well-described., Methods: Single institution MDD of 179 patients with ILD., Results: MDD consensus clinical diagnoses included autoimmune-related ILD, chronic hypersensitivity pneumonitis, smoking-related ILD, idiopathic pulmonary fibrosis, medication-induced ILD, occupation-related ILD, unclassifiable ILD, and a few less common pulmonary disorders. In 168 of 179 patients, one or more environmental exposures or pertinent features of the medical history were identified, including recreational/avocational, residential, and occupational exposures, systemic autoimmune disease, malignancy, medication use, and family history. The MDD process demonstrated the importance of comprehensively assessing these exposures and features, beyond merely noting their presence, for rendering consensus clinical diagnoses. Precise, well-defined chest CT and lung histopathology interpretations were rendered at MDD, including usual interstitial pneumonia, nonspecific interstitial pneumonia, and organizing pneumonia, but these interpretations were associated with a variety of MDD consensus clinical diagnoses, demonstrating their nonspecific nature in many instances. In 77 patients in which MDD consensus diagnosis differed from referring diagnosis, assessment of environmental exposures and medical history was found retrospectively to be the most impactful factor., Conclusions: A comprehensive assessment of environmental exposures and pertinent features of the medical history guided MDD. In addition to rendering consensus clinical diagnoses, MDD presented clinicians with opportunities to initiate environmental remediation, behavior modification, or medication alteration likely to benefit individual patients with ILD., (Published by Elsevier Ltd.)

Objective: The purpose of this study is to determine whether imaging features of right heart failure seen on CT performed before transcatheter aorta valve replacement (TAVR) predict poor outcomes after the procedure., Materials and Methods: We retrospectively evaluated findings on CT performed before TAVR for 505 consecutive patients seen from 2014 to 2018. Of these patients, 300 underwent TAVR. Patient demographic characteristics and clinical and procedural data were recorded. Imaging features, including signs of right heart failure, left heart failure, lung disease, coronary artery disease, and concomitant mitral valve and apparatus calcifications were evaluated. The primary outcome was all-cause mortality at 1 year after TAVR. Patients were divided into two groups: those who were alive (group 1) and those who had died (group 2) by 1 year after TAVR. These groups were compared using the Mann-Whitney U test and the Pearson chi-square and Fisher exact tests when applicable. Multivariate logistic regression with a backward stepwise approach was performed. Results were correlated with echo-cardiography findings., Results: A total of 31 patients (10.3%) died within 1 year of TAVR. The presence and size of pericardial effusions were strongly associated with mortality within 1 year after TAVR ( p = 0.002). Pericardial effusion was noted in 25 patients in group 1 (9.3%) and eight patients in group 2 (25.8%). Increased size of the main pulmonary artery was associated with death ( p = 0.024), with a median main pulmonary artery size of 2.9 cm (interquartile range, 2.6-3.3 cm) in group 1 and 3.2 cm (interquartile range, 2.9-3.5 cm) in group 2. In multivariate analysis, pericardial effusion size and pulmonary artery size, both of which are indicative of right heart failure, were predictors of death, independent of the routinely used clinical Society of Thoracic Surgeons score (AUC, 0.758; 95% CI, 0.671-0.845). Depressed right ventricular ejection fraction, as identified on echocardiography, was associated with mortality within 1 year after TAVR ( p = 0.034), further corroborating the CT findings., Conclusion: Features related to right heart failure on pre-TAVR CT were associated with increased all-cause mortality within the first year after TAVR, even after adjustment for the Society of Thoracic Surgeons score. Such imaging findings can help in further risk stratification of patients before TAVR.

Rationale and Objectives: The coronavirus disease of 2019 (COVID-19) pandemic has challenged the educational missions of academic radiology departments nationwide. We describe a novel cloud-based HIPAA compliant and accessible education platform which simulates a live radiology workstation for continued education of first year radiology (R1) residents, with an emphasis on call preparation and peer to peer resident learning., Materials and Methods: Three tools were used in our education model: Pacsbin (Orion Medical Technologies, Baltimore, MD, pacsbin.com), Zoom (Zoom Video Communications, San Jose, CA, zoom.us), and Google Classroom (Google, Mountain View, CA, classroom.google.com). A senior radiology resident (R2-R4) (n = 7) driven workflow was established to provide scrollable Digital Imaging and Communications in Medicine (DICOM) based case collections to the R1 residents (n = 9) via Pacsbin. A centralized classroom was created using Google Classroom for assignments, reports, and discussion where attending radiologists could review content for accuracy. Daily case collections over an 8-week period from March to May were reviewed via Zoom video conference readout in small groups consisting of a R2-R4 teacher and R1 residents. Surveys were administered to R1 residents, R2-4 residents, and attending radiologist participants., Results: Hundred percent of R1 residents felt this model improved their confidence and knowledge to take independent call. Seventy-eight percent of the R1 residents (n = 7/9) demonstrated strong interest in continuing the project after pandemic related restrictions are lifted. Based on a Likert "helpfulness" scale of 1-5 with 5 being most helpful, the project earned an overall average rating of 4.9. Two R2-R4 teachers demonstrated increased interest in pursuing academic radiology., Conclusion: In response to unique pandemic circumstances, our institution implemented a novel cloud-based distance learning solution to simulate the radiology workstation. This platform helped continue the program's educational mission, offered first year residents increased call preparation, and promoted peer to peer learning. This approach to case-based learning could be used at other institutions to educate residents., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Background: Numerous studies have used magnetic resonance spectroscopy (MRS) neurometabolite measurements to study HIV infection effects. While many have reported differences in total N-Acetylaspartate (tNAA), myo-Inositol (mI), and total Choline (tCho), there have been no meta-analyses performed to evaluate concordance across studies., Purpose: To evaluate the consistency of HIV serostatus effects on brain metabolites., Study Selection: The sample included studies conducted between 1993 and 2019 reporting HIV infection effects measured using proton MRS. tNAA/tCr ratios (21 papers), tCho/tCr ratios (21 papers), mI/tCr ratios (17 papers) and quantitative tCr (9 papers), sampling from basal ganglia (BG), gray matter (GM), and white matter (WM) were included., Data Analysis: Random effects meta-analysis using inverse variance weighting and bias corrected standardized mean differences (SMDs) was used. Meta-regression examined effects of publication year and data acquisition technique differences., Data Synthesis: BG SMDs related to positive serostatus were -0.10 [-0.39; 0.18] tNAA/tCr, 0.27 [0.05; 0.49] tCho/tCr, 0.60 [0.31; 0.90] mI/tCr, and -0.26 [-0.59; 0.06] tCr. GM SMDs related to serostatus were -0.29 [-0.49; -0.09] tNAA/tCr, 0.37 [0.19; 0.54] tCho/tCr, 0.41 [0.15; 0.68] mI/tCr, and -0.24 [-0.45; -0.03] tCr. WM SMDs related to serostatus were -0.52 [-0.79; -0.25] tNAA/tCr, 0.41 [0.21; 0.61] tCho/tCr, 0.59 [0.24; 0.94] mI/tCr, and -0.03 [-0.25; 0.19] tCr. WM regions showed larger serostatus effect sizes than BG and GM. I 2 ranged from 52 to 88% for the metabolite ratios. Both GM and WM tNAA/tCr SMDs were lower with increasing calendar year., Limitations: Many studies pooled participants with varying treatment, infection, and comorbidity durations., Conclusions: HIV neurometabolite studies showed consistently lower tNAA/tCr, higher tCho/tCr and higher mI/tCr ratios associated with chronic HIV infection. Substantial between-study variation may have resulted from measurement technique variations, study population differences and HIV treatment changes over time. Higher WM tCho/tCr and mI/tCr may reflect reactive gliosis or myelin turnover. Neurometabolite measurements can reliably detect chronic HIV infection effects and may be useful in understanding the pathophysiology of cognitive and sensorimotor decline following HIV infection., Classification of Evidence: This study provides Class II evidence of neurometabolite differences in chronic HIV infection., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: A few case reports of intracavitary coronary arteries (ICCA) have been reported and only a single case series on the coronary computed tomography angiography (CCTA) prevalence rate of ICCA of the right coronary artery (RCA). We describe several cases of ICCA that were noted incidentally and also determine the overall prevalence rate of anomalous ICCA., Materials and Methods: A retrospective analysis of ICCA was performed consisting of consecutive CCTA cases as well as a group of ICCA from teaching files. To establish a prevalence rate, we reviewed 464 consecutive CCTA referred to our center for transcatheter aortic valve replacement. The presence of ICCA and several imaging features were evaluated., Results: Our cohort comprises a total of 12 patients with ICCA, with 1 patient containing 2 anomalous ICCA. 83.3% of affected patients were adult males, with an average age of 69.8 years. The RCA was the most commonly affected vessel (53.8%). The mean length of the intracavitary segment was 33.4 mm for the RCA and 27 mm for the LAD. No cases involved the left circumflex coronary artery. Six of the cases were identified routinely as part of clinical practice and therefore not included in the prevalence analysis. On review of our transcatheter aortic valve replacement database, there was a 1.3% prevalence rate of ICCA. RCA had a prevalence of 0.4%, whereas LAD had a prevalence of 0.9%., Conclusions: Although rare, our study suggests that ICCA may be more common than previously described. Its presence is important to communicate to clinicians prior to invasive cardiac procedures to prevent potentially catastrophic outcomes.

Purpose: The purpose of this study was to calculate the positive predictive value (PPV) of lumbar spine magnetic resonance imaging (MRI) findings for a painful disc using provocative discography., Materials and Methods: Lumbar spine discography records and prediscography MRIs of 736 patients (2457 discs) who underwent discography for diagnostic purposes from 2003 to 2007 were retrospectively reviewed in an Institutional Review Board-exempt and Health Insurance Portability and Accountability Act-compliant protocol. Each level was identified as having high-intensity zone (HIZ) disc, disc protrusion, disc extrusion, or combination (any herniation type), disc bulge, disc degeneration, and spondylolisthesis. Statistical analysis used a 2 × 2 contingency table of significant discography results for each of the MRI variables to calculate P value and PPV with a confidence interval from a binomial distribution., Results: An HIZ disc has a PPV of 0.71 (0.65-0.76, P = 4.31E - 44) for a provocative discography. A disc protrusion has a PPV of 0.79 (0.73-0.83, P = 2.68E - 53). A disc extrusion has a PPV of 0.93 (0.79-0.98, P = 1.34E - 14), a bulge of 0.43 (0.37-0.48, P = 0.002), and a degenerative disc of 0.32 (0.28-0.35, P = 0.08), and spondylolisthesis has a PPV of 0.67 (0.59-0.73, P = 1.70E - 20). A herniation of either type (extrusion or protrusion) has a PPV of 0.80 (0.75-0.84, P = 5.86E - 69)., Conclusions: Disc herniations and HIZ discs have high predictive value in identifying a pain generator. An extruded disc herniation has the highest PPV for discogenic pain.

Background and Purpose: Carotid webs are intraluminal filling defects at the carotid bulb which are considered rare, though possibly underappreciated entities with recent studies demonstrating a likely casual association with ischemic stroke. The purpose of the study is to describe our recent experience with clinical and imaging manifestations of carotid webs., Materials and Methods: A retrospective review of CTA neck studies in all adult patients presenting to our institution during the 19-month study interval was performed to determine the presence of carotid webs. Subsequent chart review of these patients with webs was performed to assess their clinical history and to obtain demographic detail., Results: A total of 14 patients were identified with carotid webs in the study population. The mean age of patients with webs was 42.1 years (range: 28-54), consisting mostly of African Americans (86%) and females (64%). Ten (71%) of web patients had a history of ischemic stroke, each ipsilateral to the side of web, and at least four of these patients had recurrent ischemic stroke., Conclusion: We provide one of the largest sample sizes of webs gathered in a single study. Given its association with ischemic stroke, carotid webs should be assessed for in all patients presenting with ischemic stroke, especially younger African Americans., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Introduction: MRI is often used to determine the presence of residual disease following unplanned excisions (UPE) of soft tissue sarcomas (STS). We sought to identify MRI features associated with histologic evidence of residual disease after TBE., Materials and Methods: This was an IRB-approved retrospective review of 27 patients with R1-type UPE of STS over a 32-month period, with subsequent MRI and TBE. MRI studies were retrospectively evaluated to determine depth of tissue involvement, presence of nodular enhancement, and maximum length of soft tissue edema normalized to extremity size. MRI findings were correlated with histology from unplanned excision and TBE., Results: Among the 21 subjects, there were 13 males and 8 females, mean age 58. Eighteen of 21 STS were grade 2 or 3. Deep compartments were involved in 5/21 cases. Original margins were positive in 17/21 UPE, with inadequate margin assessment in the remaining 4 cases. Residual tumor was present at TBE in 11/21 cases; it was found in 4/6 cases with nodular enhancement and 7/15 cases without nodular enhancement (sensitivity = 0.36; specificity = 0.80; PPV = 0.67; NPV = 0.53). Increased extent of soft tissue edema increased the likelihood of residual tumor at TBE (OR = 35.0; 95% CI = 1.6 to 752.7; p = 0.023)., Conclusion: Nodular enhancement is neither sensitive nor specific in predicting residual microscopic tumor in TBE following UPE. Extensive soft tissue edema on MRI after UPE increases the likelihood of finding a residual microscopic tumor, justifying ample margins at TBE and consideration of adjuvant therapy.

Arginine vasopressin (AVP) is often used as an alternative pressor to catecholamines (CATs). However, unlike CATs, AVP is a powerful antidiuretic that could promote edema. We tested the hypothesis that AVP promoted cerebral edema and/or increased requirements for osmotherapy, relative to those who received CATs, for cerebral perfusion pressure (CPP) management after traumatic brain injury (TBI). This is a retrospective review of 286 consecutive TBI patients with intracranial pressure monitoring at a single institution from September 2008 to January 2015. Cerebral edema was quantitated using CT attenuation in prespecified areas of gray and white matter., Results: To maintain CPP >60 mm Hg, 205 patients required no vasopressors, 41 received a single CAT, 12 received AVP, and 28 required both. Those who required no pressors were generally less injured; required less hyperosmolar therapy and less total fluid; and had lower plasma Na, lower intracranial pressure, less edema, and lower mortality (all P < 0.05). Edema; daily mean, minimum, and maximum Na levels; and mortality were similar with AVP versus CATs, but the daily requirement of mannitol and 3 per cent NaCl were reduced by 45 and 35 per cent (both P < 0.05). In patients with TBI who required CPP therapy, AVP reduced the requirements for hyperosmolar therapy and did not delay resolution or increase cerebral edema compared with CATs.

Major improvements in the care of liver transplant recipients have mitigated but not eliminated the risk of potentially life-threatening infectious complications. This review provides general information about risk factors, prophylactic strategies, diagnostic workup, and therapy for some of the most commonly encountered infections after liver transplant., (Copyright © 2015 Cleveland Clinic.)