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Objectives Pulmonary perfusion abnormalities are prevalent in patients with chronic obstructive pulmonary disease (COPD), are potentially reversible, and may be associated with emphysema development. Therefore, we aimed to evaluate the clinical meaningfulness of perfusion defects in percent (QDP) using DCE-MRI. Methods We investigated a subset of baseline DCE-MRIs, paired inspiratory/expiratory CTs, and pulmonary function testing (PFT) of 83 subjects (age = 65.7 ± 9.0 years, patients-at-risk, and all GOLD groups) from one center of the “COSYCONET” COPD cohort. QDP was computed from DCE-MRI using an in-house developed quantification pipeline, including four different approaches: Otsu’s method, k-means clustering, texture analysis, and 80th percentile threshold. QDP was compared with visual MRI perfusion scoring, CT parametric response mapping (PRM) indices of emphysema (PRMEmph) and functional small airway disease (PRMfSAD), and FEV1/FVC from PFT. Results All QDP approaches showed high correlations with the MRI perfusion score (r = 0.67 to 0.72, p r = 0.72, p p Emph (r = 0.70 to 0.75, p Emph (mean difference = 35.85 to 40.40) and PRMfSAD (mean difference = 15.12 to 19.68), but in close agreement when combining both PRM indices (mean difference = 1.47 to 6.03) for all QDP approaches. QDP correlated moderately with FEV1/FVC (r = − 0.54 to − 0.41, p Conclusion QDP is associated with established markers of disease severity and the extent corresponds to the CT-derived combined extent of PRMEmph and PRMfSAD. We propose to use QDP based on Otsu’s method for future clinical studies in COPD. Key Points • QDP quantified from DCE-MRI is associated with visual MRI perfusion score, CT PRM indices, and PFT. • The extent of QDP from DCE-MRI corresponds to the combined extent of PRMEmph and PRMfSAD from CT. • Assessing pulmonary perfusion abnormalities using DCE-MRI with QDP improved the correlations with CT PRM indices and PFT compared to the quantification of pulmonary blood flow and volume.

Background Lung emphysema is an important phenotype of chronic obstructive pulmonary disease (COPD), and CT scanning is strongly recommended to establish the diagnosis. This study aimed to identify criteria by which physicians with limited technical resources can improve the diagnosis of emphysema. Methods We studied 436 COPD patients with prospective CT scans from the COSYCONET cohort. All items of the COPD Assessment Test (CAT) and the St George’s Respiratory Questionnaire (SGRQ), the modified Medical Research Council (mMRC) scale, as well as data from spirometry and CO diffusing capacity, were used to construct binary decision trees. The importance of parameters was checked by the Random Forest and AdaBoost machine learning algorithms. Results When relying on questionnaires only, items CAT 1 & 7 and SGRQ 8 & 12 sub-item 3 were most important for the emphysema- versus airway-dominated phenotype, and among the spirometric measures FEV1/FVC. The combination of CAT item 1 (≤ 2) with mMRC (> 1) and FEV1/FVC, could raise the odds for emphysema by factor 7.7. About 50% of patients showed combinations of values that did not markedly alter the likelihood for the phenotypes, and these could be easily identified in the trees. Inclusion of CO diffusing capacity revealed the transfer coefficient as dominant measure. The results of machine learning were consistent with those of the single trees. Conclusions Selected items (cough, sleep, breathlessness, chest condition, slow walking) from comprehensive COPD questionnaires in combination with FEV1/FVC could raise or lower the likelihood for lung emphysema in patients with COPD. The simple, parsimonious approach proposed by us might help if diagnostic resources regarding respiratory diseases are limited. Trial registration ClinicalTrials.gov, Identifier: NCT01245933, registered 18 November 2010, https://clinicaltrials.gov/ct2/show/record/NCT01245933. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01837-2.

Chronic obstructive pulmonary disease (COPD) is frequently associated with coronary artery disease (CAD). When considering computed tomography (CT) for COPD phenotyping, coronary vessel wall calcification would be a potential marker of cardiac disease. However, non-ECG gated scans as used in COPD monitoring do not comply with established quantitative approaches using ECG-triggered CT and the Agatston score. We studied the diagnostic potential of Agatston scores from non-triggered scans for cardiac disease. The study population was a sub-group of the COPD cohort COSYCONET that underwent CT scanning in addition to comprehensive clinical assessments, echocardiographic data and physician-based diagnoses of comorbidities. Agatston scores from non-contrast enhanced, non-triggered CT were used to identify a cut-off value for CAD via ROC analysis. 399 patients were included (152 female, mean age 66.0 ± 8.2 y). In terms of CAD, an Agatston score ≥1500 AU performed best (AUC 0.765; 95% CI: 0.700, 0.831) and was superior to the conventional cut-off value (400 AU). Using this value for defining groups, there were differences (p lt; 0.05) in lung function, left atrial diameter and left ventricular end-systolic diameter as well as CT-determined central airway wall thickness pointing towards a bronchitis phenotype. In multivariate analysis, BMI, hyperlipidemia, arterial hypertension, GOLD D (p lt; 0.05) but particularly Agatston score ≥1500 AU (Odds ratio 10.5; 95% CI: 4.8; 22.6)) were predictors of CAD. We conclude that in COPD patients, Agatston scores derived from non-ECG gated CT showed a much higher cut-off value (1500 AU) for actionable coronary artery disease than the score derived from ECG-triggered CT in cardiology patients.

Background There is a clinical need for imaging-derived biomarkers for the management of chronic obstructive pulmonary disease (COPD). Observed pulmonary T1 (T1 (TE)) depends on the echo-time (TE) and reflects regional pulmonary function. Purpose To investigate the potential diagnostic value of T1 (TE) for the assessment of lung disease in COPD patients by determining correlations with clinical parameters and quantitative CT. Study type Prospective non-randomized diagnostic study. Population Thirty COPD patients (67.7 ± 6.6 years). Data from a previous study (15 healthy volunteers [26.2 ± 3.9 years) were used as reference. Field strength/sequence Study participants were examined at 1.5 T using dynamic contrast-enhanced three-dimensional gradient echo keyhole perfusion sequence and a multi-echo inversion recovery two-dimensional UTE (ultra-short TE) sequence for T1 (TE) mapping at TE1-5 = 70 μsec, 500 μsec, 1200 μsec, 1650 μsec, and 2300 μsec. Assessment Perfusion images were scored by three radiologists. T1 (TE) was automatically quantified. Computed tomography (CT) images were quantified in software (qCT). Clinical parameters including pulmonary function testing were also acquired. Statistical tests Spearman rank correlation coefficients (ρ) were calculated between T1 (TE) and perfusion scores, clinical parameters and qCT. A P-value Results Median values were T1 (TE1-5 ) = 644 ± 78 msec, 835 ± 92 msec, 835 ± 87 msec, 831 ± 131 msec, 893 ± 220 msec, all significantly shorter than previously reported in healthy subjects. A significant increase of T1 was observed from TE1 to TE2 , with no changes from TE2 to TE3 (P = 0.48), TE3 to TE4 (P = 0.94) or TE4 to TE5 (P = 0.02) which demonstrates an increase at shorter TEs than in healthy subjects. Moderate to strong Spearman's correlations between T1 and parameters including the predicted diffusing capacity for carbon monoxide (DLCO, ρ -0.69) were found. Overall, correlations were strongest at TE2 , weaker at TE1 and rarely significant at TE4 -TE5 . Data conclusion In COPD patients, the increase of T1 (TE) with TE occurred at shorter TEs than previously found in healthy subjects. Together with the lack of correlation between T1 and clinical parameters of disease at longer TEs, this suggests that T1 (TE) quantification in COPD patients requires shorter TEs. The TE-dependence of correlations implies that T1 (TE) mapping might be developed further to provide diagnostic information beyond T1 at a single TE. Level of evidence 2 TECHNICAL EFFICACY: Stage 1.

Even after more than 100 years, the chest X‑ray is still an important technique to detect important pathological changes of lungs, heart and vessels in a fast and low-dose manner. For the German-speaking regions, there are only recommendations available published by the "Ständigen Strahlenschutzkommission (SSK)" regarding the indication. These recommendations are not updated on a regular basis and more recent developments are only integrated with delayed.The chest division of the German Radiological Society has summarized their expertise for the usage and indication of the chest X‑ray. Especially within the field of oncology the usage of chest X‑ray is evaluated differently to the aforementioned recommendations; here chest computed tomography (CT) is much more sensitive for evaluation of metastasis and local invasion of tumors. Also, within the area of infectious diseases in non-immunocompetent patients, CT is the method of choice. Based on the structure of the current recommendations, many current guidelines and indications are summarized and presented within the context of the usage of chest X‑ray.HINTERGRUND: Die Röntgenübersichtsaufnahme des Thorax ist ungeachtet ihrer mehr als 100-jährigen Geschichte immer noch eine wichtige Technik, um wesentliche Pathologien von Lunge, Herz und Gefäßen schnell und dosissparend zu untersuchen. Für den deutschsprachigen Raum existieren aktuell nur Empfehlungen der Ständigen Strahlenschutzkommission (SSK) zur Indikation. Diese Empfehlungen werden allerdings nicht regelmäßig überarbeitet, und aktuelle Entwicklungen fließen verzögert ein.Die AG Thorax der Deutschen Röntgengesellschaft hat ihre Einschätzungen zum Einsatz und Indikationsspektrum der Röntgenübersichtsaufnahme dargelegt. Vor allem im Bereich der Onkologie wird der Einsatz der Röntgenübersichtsaufnahme divergent zu den bestehenden Empfehlungen gesehen – hier ist die Computertomographie (CT) deutlich sensitiver, um Metastasten oder die lokale Invasion von Tumoren zu beurteilen. Im Bereich der Infektionen bei immuninkompetenten Patienten steht ebenfalls die CT im Vordergrund. Neben diesen genannten Aspekten werden die aktuellen Leitlinien für eine Vielzahl von Indikationen aufgeführt und übersichtlich dargestellt.

There is a clinical need for imaging-derived biomarkers for the management of chronic obstructive pulmonary disease (COPD). Observed pulmonary TTo investigate the potential diagnostic value of TProspective non-randomized diagnostic study.Thirty COPD patients (67.7 ± 6.6 years). Data from a previous study (15 healthy volunteers [26.2 ± 3.9 years) were used as reference.Study participants were examined at 1.5 T using dynamic contrast-enhanced three-dimensional gradient echo keyhole perfusion sequence and a multi-echo inversion recovery two-dimensional UTE (ultra-short TE) sequence for TPerfusion images were scored by three radiologists. TSpearman rank correlation coefficients (ρ) were calculated between TMedian values were TIn COPD patients, the increase of T2 TECHNICAL EFFICACY: Stage 1.

ZusammenfassungSeit dem letzten gemeinsamen Positionspapier der Deutschen Röntgengesellschaft und der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin im Jahr 2011 hat sich die Datenlage zur Lungenkrebsfrüherkennung mit Niedrigdosis-CT deutlich erweitert und in der 2018 revidierten S3-Leitlinie Lungenkarzinom wird eine schwache Empfehlung zur Lungenkrebsfrüherkennung mit Niedrigdosis-CT in einem qualitätsgesicherten Früherkennungsprogramm ausgesprochen. Diese neuen Entwicklungen erforderten eine Neupositionierung der beteiligten Fachgesellschaften. Das vorliegende Positionspapier beschreibt Grundzüge eines qualitätsgesicherten Früherkennungsprogramms für Lungenkrebs in Deutschland.

Despite recent advances in our knowledge about the pathophysiology and treatment of cystic fibrosis (CF), pulmonary involvement remains the most important determinant of morbidity and mortality in patients with CF. Since lung function testing may not be sensitive enough for subclinical disease progression, and because young children may have normal spirometry results over a longer period of time, imaging today plays an increasingly important role in clinical routine and research for the monitoring of CF lung disease. In this regard, chest magnetic resonance imaging (MRI) could serve as a radiation-free modality for structural and functional lung imaging. Our research agenda encompassed the entire process of development, implementation, and validation of appropriate chest MRI protocols for use with infant and adult CF patients alike. After establishing a general MRI protocol for state-of-the-art clinical 1.5-T scanners based on the available sequence technology, a semiquantitative scoring system was developed followed by cross-validation of the method against the established modalities of computed tomography, radiography, and lung function testing. Cross-sectional studies were then set up to determine the sensitivity of the method for the interindividual variation of the disease and for changes in disease severity after treatment. Finally, the MRI protocol was implemented at multiple sites to be validated in a multicenter setting. After more than a decade, lung MRI has become a valuable tool for monitoring CF in clinical routine application and as an endpoint for clinical studies.

Background: Bronchiectasis is known to be associated with COPD. We studied which degree of radiological alterations was associated with clinical signs of bronchiectasis in COPD. Methods: Visit 4 data (GOLD grades 1-4) of the COSYCONET cohort was analysed. Chest CT scans were evaluated for bronchiectasis in 6 lobes using a 3-point scale (0-2), resulting in a total score of 0-12. We also included data from disease-specific questionnaires, medication, and lung function. Results: 1176 patients were included (mean age 67.3y, 61.1% males), among them 38 (3.2%) with patient-reported physicians’ diagnosis of bronchiectasis and 76 (6.5%) with alpha1-antitrypsin deficiency (AA1D). 429 patients had CT scans, with any signs of bronchiectasis in 46.6%, less than 50% bronchiectasis in ≤2 lobes in 18.6%, in 3-4 lobes in 10.0%, in 5-6 lobes in 15.9%, and more than 50% bronchiectasis in at least 1 lobe in 2.1%. Scores ≥4 were linked to elevated FRC/RV. Links to sputum production, composition (n=105) or inflammatory indices were borderline or absent. Triple therapy was associated with symptoms, but not radiological signs of bronchiectasis. The clinical diagnosis of bronchiectasis correlated with phlegm and cough and with radiological scores of at least 3, optimally ≥5. AA1D was associated with radiological signs of bronchiectasis and only borderline with the clinical diagnosis. Conclusion: Clinical diagnosis and radiological signs of bronchiectasis showed only weak correlations in COPD patients. For a significant correspondence to symptoms and diagnosis, a threshold CT score implying radiological alterations in several lobes was needed, which was about one third of the maximum score.

Introduction: Morphologic changes in the COPD lung also affect the lung vasculature. Most insights stem from pathologic examinations of end-stage disease and there is only limited data for milder COPD. Aims: To analyse the lung vasculature from thoracic CT images in a large cohort of patients with different grades of chronic airway obstruction from GOLD 0 (only symptoms) to GOLD 1&2 (FEV1≥50%) and GOLD 3&4 ( Methods: The COSYCONET study acquired CT images in inspiration and expiration. An algorithm identified the lung vessels with diameters of 2-10mm and labelled them as arteries and veins. All segmentations were inspected by a radiologist to exclude failed results. Morphologic readouts were analysed with respect to GOLD stage. Results: Normalized inspiratory vessel volume decreased with disease severity (p Conclusion: Vessel morphology changes with severity of chronic airway obstruction and may reflect interactions between lung volume, loss of elasticity, and intrathoracic pressure.

This information provided by the Thoracic Imaging Section of the German Radiological Society is intended to give physicians recommendations on the use of thoracic imaging procedures in the context of the current COVID-19 pandemic. It represents the consensus of the authors based on the previous scientific knowledge and is intended to provide guidance for unified, structured CT reporting if COVID-19 pneumonia is suspected. The recommendations presented correspond to state of knowledge at the time of print and will be updated according to the results of ongoing and future scientific studies. KEY POINTS:: · COVID-19. · chest imaging. · German Radiological Society. CITATION FORMAT: · Vogel-Claussen J, Ley-Zaporozhan J, Agarwal P et al. Recommendations of the Thoracic Imaging Section of the German Radiological Society for clinical application of chest imaging and structured CT reporting in the COVID-19 pandemic. Fortschr Röntgenstr 2020; DOI: 10.1055/a-1174-8378.Diese Information der AG Thoraxdiagnostik der Deutschen Röntgengesellschaft soll Ärztinnen und Ärzten Empfehlungen zur Anwendung thoraxradiologischer Verfahren im Rahmen der aktuellen COVID-19-Pandemie geben. Sie repräsentiert den Konsensus der Autoren basierend auf den bisherigen wissenschaftlichen Erkenntnissen und soll zur einheitlichen und strukturierten CT-Befundung bei COVID-19 anleiten. Die vorgestellten Empfehlungen entsprechen dem Wissensstand zum Zeitpunkt der Drucklegung und werden entsprechend den Ergebnissen laufender und zukünftiger wissenschaftlicher Untersuchungen bei Bedarf aktualisiert. KERNAUSSAGEN:: · COVID-19. · Thoraxbildgebung. · Deutsche Röntgengesellschaft. ZITIERWEISE: · Vogel-Claussen J, Ley-Zaporozhan J, Agarwal P et al. Recommendations of the Thoracic Imaging Section of the German Radiological Society for clinical application of chest imaging and structured CT reporting in the COVID-19 pandemic. Fortschr Röntgenstr 2020; DOI: 10.1055/a-1174-8378.

Bronchiectasis (BE) might be frequently present in COPD but masked by COPD symptoms. We studied the relationship of clinical signs of bronchiectasis to the presence and extent of its radiological signs in patients of different COPD severity. Visit 4 data (GOLD grades 1-4) of the COSYCONET cohort was used. Chest CT scans were evaluated for bronchiectasis in 6 lobes using a 3-point scale (0: absence, 1: ≤50%, 2: >50% BE-involvement for each lobe). 1176 patients were included (61%male, age 67.3y), among them 38 (3.2%) with reported physicians' diagnosis of bronchiectasis and 76 (6.5%) with alpha1-antitrypsin deficiency (AA1D). CT scans were obtained in 429 patients. Within this group, any signs of bronchiectasis were found in 46.6% of patients, whereby ≤50% BE occurred in 18.6% in ≤2 lobes, in 10.0% in 3-4 lobes, in 15.9% in 5-6 lobes; >50% bronchiectasis in at least 1 lobe was observed in 2.1%. Scores ≥4 correlated with an elevated ratio FRC/RV. The clinical diagnosis of bronchiectasis correlated with phlegm and cough and with radiological scores of at least 3, optimally ≥5. In COPD patients, clinical diagnosis and radiological signs of BE showed only weak correlations. Correlations became significant with increasing BE-severity implying radiological alterations in several lobes. This indicates the importance of reporting both presence and extent of bronchiectasis on CT. Further research is warranted to refine the criteria for CT scoring of bronchiectasis and to determine the relevance of radiologically but not clinically detectible bronchiectasis and their possible implications for therapy in COPD patients.

In-line free propagation phase-contrast synchrotron tomography of the lungs has been shown to provide superior image quality compared with attenuation-based computed tomography (CT) in small-animal studies. The present study was performed to prove the applicability on a human-patient scale using a chest phantom with ventilated fresh porcine lungs. Local areas of interest were imaged with a pixel size of 100 µm, yielding a high-resolution depiction of anatomical hallmarks of healthy lungs and artificial lung nodules. Details like fine spiculations into surrounding alveolar spaces were shown on a micrometre scale. Minor differences in artificial lung nodule density were detected by phase retrieval. Since we only applied a fraction of the X-ray dose used for clinical high-resolution CT scans, it is believed that this approach may become applicable to the detailed assessment of focal lung lesions in patients in the future.

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

Substantial new data on the early detection of lung cancer with low-dose CT has become available since the last joint statement of the German Radiological Society and the German Respiratory Society was published in 2011. The German S3 guideline on lung cancer was revised in 2018 and now contains a weak recommendation regarding the early detection of lung cancer with low-dose CT in a quality-assured early detection program. These new developments required a change in the position of the involved professional societies. This joint statement describes the main features of a quality-assured program for the early detection of lung cancer with low-dose CT in Germany. KEY POINTS:: · New study data on early detection of lung cancer with low-dose CT and the new German S3 guideline on lung cancer required a new positioning of the involved professional societies.. · The involved professional societies strongly recommend that low-dose CT examinations for early detection of lung cancer should only be performed within a quality-assured program.. · The article describes some fundamentals of such a quality-assured early detection program.. CITATION FORMAT: · Wormanns D, Kauczor H, Antoch G et al. Joint Statement of the German Radiological Society and the German Respiratory Society on a Quality-Assured Early Detection Program for Lung Cancer with Low-Dose CT. Fortschr Röntgenstr 2019; 191: 993 - 997.Seit dem letzten gemeinsamen Positionspapier der Deutschen Röntgengesellschaft und der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin im Jahr 2011 hat sich die Datenlage zur Lungenkrebsfrüherkennung mit Niedrigdosis-CT deutlich erweitert, und in der 2018 revidierten S3-Leitlinie Lungenkarzinom wird eine schwache Empfehlung zur Lungenkrebsfrüherkennung mit Niedrigdosis-CT in einem qualitätsgesicherten Früherkennungsprogramm ausgesprochen. Diese neuen Entwicklungen erforderten eine Neupositionierung der beteiligten Fachgesellschaften. Das vorliegende Positionspapier beschreibt Grundzüge eines qualitätsgesicherten Früherkennungsprogramms für Lungenkrebs in Deutschland. KERNAUSSAGEN:: · Neue Studiendaten zur Lungenkrebsfrüherkennung mit Niedrigdosis-CT und die neue S3-Leitlinie Lungenkarzinom machten eine Neupositionierung der Fachgesellschaften erforderlich.. · Untersuchungen zur Früherkennung von Lungenkrebs mittels Niedrigdosis-CT sollten nach Einschätzung der beteiligten Fachgesellschaften nur innerhalb eines qualitätsgesicherten Früherkennungsprogramms durchgeführt werden.. · Im Artikel werden Eckpunkte eines solchen qualitätsgesicherten Früherkennungsprogramms dargestellt.. ZITIERWEISE: · Wormanns D, Kauczor H, Antoch G et al. Joint Statement of the German Radiological Society and the German Respiratory Society on a Quality-Assured Early Detection Program for Lung Cancer with Low-Dose CT. Fortschr Röntgenstr 2019; 191: 993 – 997.

Zusammenfassung: Hintergrund: Mit den technischen Weiterentwicklungen in den vergangenen Jahren hat sich die MRT zu einem methodisch ausgereiften und für spezifische pulmonale Fragestellungen bereits auch klinisch bewährten Untersuchungsverfahren entwickelt. Ohne Strahlenexposition kombiniert sie morphologische und funktionelle Diagnostik und ergänzt das Spektrum der etablierten Verfahren für die bildgebende Diagnostik der Lunge. Ziel der Arbeit und Methoden: Diese Arbeit gibt einen Überblick über die aktuell verwendeten Sequenzen und Techniken zur Darstellung pulmonaler Rundherde und analysiert deren klinischen Stellenwert anhand der aktuellen Studienlage. In Zentrum stehen dabei die Detektion pulmonaler Metastasen, die Detektion primär pulmonaler Malignome bei Personen mit Risikoprofil und die Abklärung pulmonaler Rundherde hinsichtlich ihrer Dignität. Ergebnisse und Diskussion: Die MRT besitzt im Vergleich zum Referenzstandard Niedrigdosis-CT eine Sensitivität von ca. 80 % für die Detektion maligner pulmonaler Rundherde und ist der CT damit etwas unterlegen. Vorteile der MRT gegenüber der Niedrigdosis-CT sind andererseits die höhere Spezifität bei der Differenzierung maligner und benigner pulmonaler Rundherde sowie die fehlende Strahlenexposition. Außerhalb von Studien kann ein breiter Einsatz der MRT als Screeningverfahren zur Detektion und Abklärung pulmonaler Rundherde aufgrund der noch ungenügenden Datenlage derzeit noch nicht empfohlen werden. Das diagnostische Potenzial der MRT für die Früherkennung und das Staging pulmonaler Malignome rechtfertigt aber die weitere Evaluation der MRT als sekundäre Modalität im Rahmen von Studien.

High diagnostic accuracy, increasing clinical experience and technical improvements are good reasons to consider lung ultrasound (US) for the assessment of pleural and pulmonary diseases. In the emergency room and in intensive care, it is well acknowledged, but application in other settings is rare. The aim of this review is to update potential users in general radiology about the diagnostic scope of lung US and to encourage more frequent use of this generally underestimated lung imaging modality. Literature review was done independently by the two authors in MEDLINE (via PubMed) covering a time span from 2002 until 2017 using free text and Medical Subject Headings/MeSH. Article selection for the bibliography was based on consensus according to relevance and evidence. The technical prerequisites include a standard ultrasound unit with a suitable transducer. Pleural effusion and pneumothorax, atelectasis, interstitial edema, pneumonia, exacerbated chronic obstructive pulmonary disease/asthma and pulmonary embolism can be distinguished by particular ultrasound signs, artifacts and their combinations. A highly standardized selection of access points and terminology for the description of imaging findings contributes to high diagnostic accuracy even in challenging patients and settings. Besides the assessment of acute respiratory failure in the emergency room, lung US may be used for monitoring interstitial fluid accumulation in volume therapy and for the diagnosis of pneumonia or the assessment of pleural effusion and pleurisy in a routine outpatient setting. Last but not least, the increasing concerns about medical radiation exposure warrant a more extensive use of this sometimes underestimated modality as a cost-, time- and radiation-saving alternative or valuable adjunct to the standard imaging modalities. · Lung US is a safe, quick and readily available method with options for dynamic imaging of respiratory function.. · Proper selection of technical parameters customized to the clinical question and standardized terminology for the precise description and interpretation of the imaging signs regarding patient history determine its diagnostic accuracy.. · In dyspnea lung US differentiates pneumothorax, lung edema, pneumonia, pulmonary embolism, atelectasis and pleural effusion.. · In intensive care, lung US allows monitoring of lung ventilation and fluid administration.. · It saves radiation exposure in serial follow-up, in pregnancy and pediatric radiology..· Radzina M, Biederer J, Ultrasonography of the Lung. Fortschr Röntgenstr 2019; 191: 909 - 923. Eine hohe diagnostische Treffsicherheit, zunehmende klinische Erfahrung und technische Verbesserungen machen den Ultraschall der Lunge zu einer interessanten Alternative für die Untersuchung pleuraler und pulmonaler Erkrankungen. Im Schockraum und auf der Intensivstation ist der Ultraschall etabliert. Ziel dieses Artikels ist, weitere potenzielle Anwender in der Radiologie mit der diagnostischen Reichweite der Methode vertraut zu machen und zu einer breiteren Anwendung dieses in der thorakalen Bildgebung häufig unterschätzten Verfahrens anzuregen. Die Literaturrecherche erfolgte in der Datenbank MEDLINE (via PubMed) im Suchzeitraum von 2002 bis 2017 mittels Freitext- und Schlagwortsuche (Medical Subject Headings/MeSH) durch 2 unabhängige Reviewer. Die Auswahl der Artikel erfolgte im Konsensus entsprechend Relevanz und Evidenzgrad. Die technischen Voraussetzungen sind mit einem modernen Ultraschallgerät und einem geeigneten Schallkopf erfüllt. Während Pathologien der Thoraxwand und der Pleura (z. B. Pleuraerguss) im B-Bild gut erkennbar sind, erfolgt die Beurteilung der pulmonalen Pathologie jenseits der Pleuralinie meist indirekt anhand typischer Artefakte und Zeichen. Diese erlauben z. B. die Unterscheidung von hämodynamischem Lungenödem, Pneumonie, Lungenembolie, exazerbierter COPD/Asthma oder Pneumothorax. Standardisierte Zugangswege und eine exakte Terminologie tragen wesentlich zur diagnostischen Genauigkeit und Reproduzierbarkeit der Methode auch in anspruchsvollen Situationen und bei erschwerten Untersuchungsbedingungen bei. Im Schockraum erlaubt der Lungen-Ultraschall eine sichere und schnelle Identifizierung des interstitiellen Lungenödems bei Patienten in Atemnot. Beim ambulanten Einsatz erlaubt die Sonografie eine schnelle und sichere Differenzierung von Pleuraerguss, Pleuritis und Pneumonie. Nicht zuletzt die Reduzierung der diagnostischen Strahlenexposition spricht für einen breiteren Einsatz dieser häufig unterschätzten Methode als kosten-, zeit- und strahlensparende Alternative oder als wertvolle Ergänzung zu den etablierten Standardverfahren. · Der Lungen-US ist eine einfach verfügbare, sichere Methodik mit Optionen zur dynamischen Beurteilung der Atemmechanik.. · Eine an die Fragestellung angepasste Untersuchungstechnik und die standardisierte Beschreibung und Interpretation typischer Zeichen und Artefakte in Zusammenschau mit der klinischen Fragestellung bestimmen die diagnostische Sicherheit.. · Bei Dyspnoe lassen sich Pneumothorax, Lungenödem, Pneumonie, Lungenembolie, Atelektasen und Pleuraergüsse differenzieren.. · Lungenventilation und Infusionstherapie lassen sich mittels Lungen-US steuern.. · Bei Verlaufskontrollen, Schwangerschaft und Kindern wird eine Strahlenexposition vermieden..

Although some of the associations between chronic obstructive pulmonary disease (COPD) and atherosclerosis are based on shared risk factors such as smoking, recent epidemiological evidence suggests that COPD is a risk factor for vascular disease due to systemic inflammation. The present study assessed the hypothesis that disease severity (as expressed by the GOLD stage) independently predicts the extent of vascular calcifications. A total of 160 smokers diagnosed with COPD (GOLD I–IV, 40 subjects of each GOLD stage) and 40 smokers at risk (GOLD 0; median age of 60 years old; Q1:56;Q3:65; 135 males and 65 females) underwent non-contrast, non-electrocardiography synchronized chest computerised tomography. The volume of thoracic aortic calcifications was quantified semi-automatically within a region from T1 through T12. Multiparametric associations with GOLD stage, smoking history, sex, age, body mass index and emphysema index were evaluated using generalized linear regression analysis. Thoracic aortic calcifications were highly prevalent in this cohort (187/200 subjects, 709 (Q1:109;Q3:2163) mm3). Analysis of variance on ranks demonstrated a significant difference in calcium between different GOLD-stages as well as patients at risk of COPD (F=36.8, P

Background The German COPD cohort study COSYCONET (" CO PD and SY stemic consequences- CO morbidities NET work") investigates the interaction of lung disease, comorbidities and systemic inflammation. Recruitment took place from 2010 to 2013 in 31 study centers. In addition to the baseline visit, follow-up visits are scheduled at 6, 18, 36 and 54 months after baseline. The study also comprises a biobank, image bank, and includes health economic data. Here we describe the study design of COSYCONET and present baseline data of our COPD cohort. Methods Inclusion criteria were broad in order to cover a wide range of patterns of the disease. In each visit, patients undergo a large panel of assessments including e.g. clinical history, spirometry, body plethysmography, diffusing capacity, blood samples, 6-min walk-distance, electrocardiogram and echocardiography. Chest CTs are collected if available and CTs and MRIs are performed in a subcohort. Data are entered into eCRFs and subjected to several stages of quality control. Results Overall, 2741 subjects with a clinical diagnosis of COPD were included (59% male; mean age 65 ± 8.6 years (range 40–90)). Of these, 8/35/32/9% presented with GOLD stages I–IV; 16% were uncategorized, including the former GOLD-0 category. 24% were active smokers, 68% ex-smokers and 8% never-smokers. Data completeness was 96% for the baseline items. Conclusion The German COPD cohort comprises patients with advanced and less advanced COPD. This is particularly useful for studying the time course of COPD in relation to comorbidities. Baseline data indicate that COSYCONET offers the opportunity to investigate our research questions in a large-scale, high-quality dataset.

Progressive lung disease in cystic fibrosis (CF) is the life-limiting factor of this autosomal recessive genetic disorder. Increasing implementation of CF newborn screening allows for a diagnosis even in pre-symptomatic stages. Improvements in therapy have led to a significant improvement in survival, the majority now being of adult age. Imaging provides detailed information on the regional distribution of CF lung disease, hence longitudinal imaging is recommended for disease monitoring in the clinical routine. Chest X-ray (CXR), computed tomography (CT) and magnetic resonance imaging (MRI) are now available as routine modalities, each with individual strengths and drawbacks, which need to be considered when choosing the optimal modality adapted to the clinical situation of the patient. CT stands out with the highest morphological detail and has often been a substitute for CXR for regular severity monitoring at specialized centers. Multidetector CT data can be post-processed with dedicated software for a detailed measurement of airway dimensions and bronchiectasis and potentially a more objective and precise grading of disease severity. However, changing to CT was inseparably accompanied by an increase in radiation exposure of CF patients, a young population with high sensitivity to ionizing radiation and lifetime accumulation of dose. MRI as a cross-sectional imaging modality free of ionizing radiation can depict morphological hallmarks of CF lung disease at lower spatial resolution but excels with comprehensive functional lung imaging, with time-resolved perfusion imaging currently being most valuable. Key Points: • Hallmarks are bronchiectasis, mucus plugging, air trapping, perfusion abnormalities, and emphysema. • Imaging is more sensitive to disease progression than lung function testing. • CT provides the highest morphological detail but is associated with radiation exposure. • MRI shows comparable sensitivity for morphology but excels with additional functional information. • MRI sensitively depicts reversible abnormalities such as mucus plugging and perfusion abnormalities. Citation Format: • Wielputz MO, Eichinger M, Biederer J et al. Imaging of Cystic Fibrosis Lung Disease and Clinical Interpretation. Fortschr Rontgenstr 2016; 188: 834 – 845

Magnetic resonance imaging (MRI) has recently been introduced into clinical practice as a diagnostic lung imaging modality. After chest radiography and computed tomography (CT), which is regarded as the standard and most comprehensive three-dimensional (3D) imaging techniques of the lung, MRI is increasingly used as an alternative and supplementary method, albeit in selected cases. Once broadly available and suf- ciently robust, it will likely become a modality of choice for cases in which exposure to ionizing radiation should be strictly avoided. This would comprise children, pregnant women, and disorders requiring repeated followup examinations over prolonged periods in which MRI could contribute signicantly to lowering the cumulative radiation dose and therapy burden.

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).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.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, p0.05). False positive findings ranged between 2.3-8.1 annotations per lung. For nodule volumes200 μl the rate of true positives was significantly lower than for300 μl (p0.05). Similarly, it was significantly lower for diameters12 mm compared to ≥12 mm (p0.05). The rate of true positives for solid and part-solid nodules was similar.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.