To evaluate the natural course of coronary-to-pulmonary artery fistula (CPAF) detected on coronary computed tomography angiography (CCTA) and to propose potential treatment strategies. In this retrospective multicenter study, we assessed the CCTA reports of 188 CPAF patients evaluated between March 2009 and June 2016. Fifty-seven patients were excluded because their follow-up (FU) periods were less than 2 years. Information regarding demographic characteristics, past history, treatment method, and the occurrence of major adverse cardiac events (MACE) during the FU period was collected. We analyzed the morphologic features of CPAF and the various factors associated with surgical treatment. Patients who had undergone FU CCTA after being diagnosed with CPAF were assessed for the presence of morphological changes on FU imaging. The median age of the study population was 63.0 years (range, 57.0-72.0 years), and the median FU period was 5.72 years (range, 4.08-6.96 years). The most common origin of the CPAF was both coronary arteries in 76 (58.0%) cases. An aneurysm or aneurysms was/were present in 41 (31.3%) cases. Fifty-four (41.2%) fistulas were less than 2 mm in size. Eight patients underwent surgery, and 123 (93.9%) patients received optimal medical treatment (OMT). The fistula size was significantly different between the two treatment groups (p = 0.013) and was the only factor associated with surgical treatment (odds ratio = 1.14, p = 0.021). Only one patient in the OMT group reported MACE during the FU period due to preexisting coronary artery disease. Twenty-nine patients (22.1%) underwent FU CCTA after CPAF diagnosis, with a median FU period of 3.81 years. None of the patients in the OMT group demonstrated morphological changes in the CPAF on FU imaging. Most CPAFs identified on CCTA have a favorable prognosis. Observation with OMT is usually an appropriate strategy. Fistula size is a possible determinant for surgical treatment.

The Korean Society of Abdominal Radiology consensus recommendation for extrahepatic bile duct cancer preoperative multiphasic CT evaluation provided acceptable performance in predicting negative-ma... Background In extrahepatic bile duct (EHD) cancer, accurate assessment of resectability is essential for curative surgery, but pertinent guidelines from the perspectives of radiologists are yet to ...

Kim H, et al. Korean J Radiol. 2024 Jan;25(1):43-54. https://doi.org/10.3348/kjr.2023.0760

We aimed to determine the histopathological characteristics and prognosis of curatively resected pancreatic ductal adenocarcinoma (PDAC) showing intratumoral necrosis on preoperative CT or MRI. This study consecutively included 102 patients who underwent upfront surgery with margin-negative resection from 2012 to 2020. All patients underwent both pancreatic CT and MRI within 1 month before surgery. Two radiologists independently assessed CT/MRI findings, including the presence of CT- and MRI-detected necrosis. Histopathological characteristics of PDACs according to CT or MRI detection of necrosis were evaluated. Disease-free survival (DFS) and overall survival (OS) were assessed by the Kaplan–Meier method and the Cox proportional hazards model. Among the 102 PDAC patients, 14 patients (13.7%) had CT-detected necrosis, and 16 patients (15.7%) had MRI-detected necrosis, of which 9 showed both CT- and MRI-detected necrosis. PDACs with CT- or MRI-detected necrosis demonstrated a significantly higher degree of histopathological necrosis than those without (p < 0.001). Multivariable analysis revealed that tumor size (hazard ratio [HR], 1.19; p = 0.040), tumor location (HR, 0.46; p = 0.009), and MRI-detected necrosis (HR, 2.64; p = 0.002) had independent associations with DFS. Only MRI-detected necrosis was significantly associated with OS (HR, 2.59; p = 0.004). Therefore, MRI-detected necrosis might be a potential imaging predictor of poor survival after curative resection of PDAC.

Kim H, et al. Korean J Radiol. 2025 Apr;26:e48. https://doi.org/10.3348/kjr.2024.1228

Objectives: This study aimed to analyze the usage patterns and hypersensitivity reaction (HSR) profiles of six nonionic iodinated contrast media (ICMs) used in computed tomography (CT) to enhance patient safety and inform evidence-based contrast agent selection. Methods: We retrospectively reviewed 248,209 CT scans obtained between January 2020 and December 2022. Six ICMs (iomeprol, iohexol, ioversol, iopromide, iodixanol, and iobitridol) were compared on the basis of their usage rates, HSR incidence, and severity. This study also evaluated the impact of premedication protocol reinforcement and assessed the quarterly HSR rates. Results: Among the 248,209 CT scans, 1603 (0.65%) were associated with HSRs. Most HSRs were mild (86.2%), with moderate (10.9%) and severe (2.9%) reactions being less common. Four ICMs were used as first-line agents and two ICMs were used as second-line agents. The second-line agents, iobitridol and iodixanol, exhibited 7–8 times higher HSR rates compared to the first-line agents. A modified premedication protocol implemented in mid-2022 significantly reduced the incidence of moderate HSRs (p = 0.0075). The quarterly analysis indicated a trend in higher HSR rates in the first quarter and a statistically significant increase in severe HSRs in the third quarter (p = 0.033). Conclusions: These findings highlight the importance of tailored premedication protocols and a 7–8 times higher rate of HSR with second-line agents in contrast-enhanced imaging. Future research should focus on elucidating the mechanisms underlying these variations to further refine contrast agent selection and management strategies.