Patients who underwent myocardial perfusion PET/CT and showed evidence of nonalcoholic fatty liver disease at CT showed a higher risk of coronary microvascular dysfunction, which is an independent risk factor for major adverse cardiac events. Background Cardiovascular disease is a major cause of mortality in patients with nonalcoholic fatty liver disease (NAFLD). However, the association of NAFLD with coronary microvascular dysfunction is, to our knowledge, unknown. Purpose To determine whether coronary microvascular dysfunction is more prevalent in patients with NAFLD and to determine whether coronary microvascular dysfunction predicts major adverse cardiac events (MACE) independently of NAFLD. Materials and Methods This retrospective study (2006–2014) included patients without evidence of obstructive epicardial coronary artery disease and healthy left ventricular ejection fraction (≥40%) at a clinical rest and stress myocardial perfusion PET/CT. NAFLD was defined by a mean hepatic attenuation of less than 40 HU at CT and coronary microvascular dysfunction as a coronary flow reserve (CFR) of less than 2.0. A composite of all-cause mortality, myocardial infarction, coronary revascularization, and hospitalization because of heart failure compri...

Diffuse cystic lung diseases (DCLDs) represent a group of pathophysiologically heterogeneous entities that share a common radiological phenotype of multiple thin-walled pulmonary cysts. DCLDs differ from the typical fibroinflammatory interstitial lung diseases in their epidemiology, clinical presentation, molecular pathogenesis, and therapeutic approaches, making them worthy of a distinct classification. The importance of timely and accurate identification of DCLDs is heightened by the impact on patient management including recent discoveries of targeted therapeutic approaches for some disorders. This article offers a practical framework for evaluating patients with DCLD indicating the most appropriate and current diagnostic and management approaches. We focus on the DCLDs that are most likely to be encountered by practicing pulmonologists: lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis, Birt-Hogg-Dubé syndrome, and lymphoid interstitial pneumonia. Chest computed tomography is the most informative non-invasive diagnostic modality to identify DCLDs. Thereafter, instituting a structured approach to high-yield associated factors such as medical, social and family history, as well as renal and dermatological findings increases the likelihood of identifying DCLDs and achieving a diagnosis. While the individual diseases that comprise the DCLD family are rare, taken together DCLDs can be encountered more frequently in clinical practice than commonly perceived. An increased eagerness among general pulmonary physicians to recognise these entities, coupled with a practical and systematic clinical approach to examinations and investigations is required to improve case finding, allow earlier intervention, and reduce morbidity and mortality.

Cardiac imaging plays an increasingly central role in the diagnosis and prognostication of cardiovascular disease. This review focuses on three key noninvasive cardiac imaging modalities—cardiac CT angiography (CTA), MRI, and PET/CT—and summarizes key publications in 2021 relevant to radiologists in clinical pr...

Compared with qualitative assessment, quantitative assessment performed by using an optimized MRI protocol has low interobserver variability independent of radiologist experience and measurement cr... Purpose To evaluate the interobserver variability associated with quantitative and qualitative MRI assessments of malignant pleural mesothelioma (MPM). Materials and Methods Patients with MPM who u...

Fluoro-2-deoxyglucose-18 (FDG) positron emission tomography (PET/CT) has utility in identifying sites of active sarcoidosis. However, the role of FDG-PET/CT in predicting treatment response and guiding therapy outside of cardiac disease is yet to be completely understood. Do physicians agree on the utility of FDG-PET/CT in sarcoid cases, and do they agree on the appropriate treatment response, based on the associated reports? Physicians respondents were presented with a series of anonymised sarcoidosis case vignettes. The perceived utility of FDG-PET/CT in each case, as well as the ultimate treatment decision following provision of FDG-PET/CT results was assessed. Inter-rater agreement was assessed overall and per case vignette specialty using Gwet's Agreeability Coefficient (AC1). Respondents (n=215) were predominantly respiratory physicians (86.78%) experienced in sarcoidosis management (94.39%), and a third of whom had >20 years' experience (32.66%). Pulmonary sarcoidosis case vignettes had the lowest rates of FDG-PET/CT endorsement among surveyed subspecialties (38 - 64%). Overall inter-rater agreement was assessed among physicians who positively endorsed an FDG-PET/CT. Treatment rationalisation based on FDG-PET/CT report was near-chance agreement for pulmonary AC1=0.178 (N=217, 95% CI 0.125- 0.234, p=0.07) and multisystem AC1=0.296 (N=168, 95% CI 0.066 - 0.477, p=0.41) cases, while agreement was highest for cases of cardiac sarcoidosis AC1=0.797 (N=374, 95% CI 0.759 - 0.838, p=<0.05). Our results indicate a low agreement between physicians regarding their management of pulmonary sarcoidosis following FDG-PET/CT. This highlights a need for further research and clarity over the role of FDG-PET/CT in the therapeutic management of pulmonary sarcoidosis.