Introduction: Unilateral pulmonary edema (UPE) is a potential complication after mitral valve surgery (MVS), and its cause is not yet fully understood. Definitions are inconsistent, and previous studies have reported wide variance in the incidence of UPE. This research aims at the evaluation of the Radiographic Assessment of Lung Edema (RALE) score concerning assessment of UPE after MVS in order to provide an accurate and consistent definition of this pathology. Methods and Results: Postoperative chest X-ray images of 676 patients after MVS (minimally invasive MVS, n = 434; conventional MVS, n = 242) were retrospectively analyzed concerning presence of UPE. UPE was diagnosed only after exclusion of other pathologies up until the eighth postoperative day. RALE values were calculated for each patient. ROC analysis was performed to assess diagnostic performance. UPE was diagnosed in 18 patients (2.8%). UPE occurred significantly more often in the MI-MVS group (p = 0.045; MI-MVS n = 15; C-MVS n = 3). Postoperative RALE values for the right hemithorax (Q1 + Q2) > 12 and the right-to-left RALE difference ((Q1 + Q2) − (Q3 + Q4)) > 13 provide a sensitivity of up to 100% and 94.4% and a specificity of up to 88.4% and 94.2% for UPE detection. Conclusion: The RALE score is a practical tool for assessment of chest X-ray images after MVS with regard to UPE and provides a clear definition of UPE. In addition, it enables objective comparability when assessing of the postoperative course. The given score thresholds provide a sensitivity and specificity of up to 94%. Further, UPE after MVS seems to be a rather rare pathology with an incidence of 2.6%.

Background/Objectives: Thrombus composition influences the success of endovascular therapy in stroke, but conventional CT is limited in determining it. Spectral-detector-CT (SDCT) can apply material-decomposition and virtual monoenergetic (MonoE) imaging, which may provide a way to gain information on thrombus composition. This experimental study aimed to evaluate the differentiability of heterogeneous thrombi with variable red blood cell (RBC) content using SDCT. Methods: Ten thrombus entities with different compositions on RBC and plasma, thus fibrin content, were manufactured (volumetric RBC%/Plasma% = 90/10; 80/20; 70/30; 60/40; 50/50; 40/60; 30/70; 20/80; 10/90; 5/95) and scanned in an SDCT. Conventional Hounsfield-unit (HU) values, spectral electron density (ED), effective atomic number (Z-effective) and HU in MonoE maps ranging from 40– to 200 keV were evaluated for thrombus differentiation. Results: Conventional HU increased with RBC content, allowing us to differentiate the entities (p < 0.001). ED values also increased with RBC content and allowed for differentiation too (p < 0.001). Z-effective values showed no differences among the different entities (p > 0.05). Regarding the mass-attenuation curves from 40 to 200 keV the different thrombi showed a similar curve progression with highest HU values at 40 and lowest at 200 keV. The thrombi could be distinguished overall at each monoenergetic level by HU (p < 0.001 for each level). The absolute decrease in HU between 40 and 200 keV was thereby not significantly different between the different entities, but the relative decrease was, as it was more pronounced in thrombi with lower RBC content (p < 0.001). Conclusions: Spectral CT enables differentiation between thrombi with different RBC and fibrin contents by means of ED or analysis of the mass-attenuation curve. This offers alternative possibilities that go beyond characterisation based on CT-density alone. The additional inclusion of spectral parameters in thrombus diagnostics could therefore improve diagnosis and treatment.

Purpose: Thymic involution, a hallmark of immune ageing, is associated with chronic low-grade inflammation (“inflammaging”) and has been implicated in age-associated inflammatory diseases, including atherosclerosis. This study aimed to evaluate the association between persistent thymus and coronary artery calcification based on the Agatston score. Materials and Methods: In an exploratory effort, we retrospectively analyzed 206 patients aged 40–64 years who underwent ECG-triggered thoracic CT between 2019 and 2024. Coronary artery calcifications were quantified on virtual non-contrast reconstructions using the Agatston score. Thymic tissue was graded on a five-point scale based on the extent of fatty replacement, with higher grades indicating greater thymic preservation. Results: The cohort included 126 men and 80 women. Complete fatty replacement of the thymus (Grade 0) was seen more often in men compared to women (51/126 vs. 18/80; p = 0.011). Linear regression analysis revealed a significant inverse association between thymus grade and coronary Agatston score (Beta (B) = −28.8 (95% CI −45.3 to −12.3); p = 0.001). After adjusting for age and sex, higher thymic grades remained significantly associated with lower coronary Agatston scores (B = −22.2 (95% CI: −41.7 to −2.6); p = 0.03). Further analysis with adjustments for cardiovascular risk factors was not performed. Conclusions: Residual thymic tissue was significantly inversely associated with coronary artery calcification, and this association persisted after adjustment for age and sex. These findings support the hypothetical concept that morphologically detectable thymic remnants may reflect interindividual differences in immune ageing and inflammaging that are associated with age-related inflammatory disease phenotypes. The results of this hypothesis-generating study give incentive to further investigate the nature and strength of these associations in prospective studies.

Objectives: Radiology reports are primarily written for professional communication and may be difficult for patients to understand. We investigated whether AI-based simplification of a single standardized neuroradiology report improves participant-rated communication quality compared with a conventional professional-language report. Materials and methods: In this prospective, randomized, blinded study, 100 adults received either an AI-simplified or a conventional report based on the same standardized neuroradiology case. Two board-certified radiologists reviewed the simplified version before evaluation. Participants rated clarity and structure, tone and trust, usability, and overall impression on structured 5-point scales. No objective comprehension test was performed. Group differences were assessed using Welch’s t -tests, with effect sizes reported as Cohen’s d ; Mann–Whitney U -tests served as sensitivity analyses. Open-ended responses were analyzed qualitatively. Results: Participants rated the AI-simplified report more favorably across all domains (all p < 0.001). Effect sizes were large to very large, ranging from d = 1.31 for Tone and Trust to d = 2.10 for Overall Impression. Nonparametric sensitivity analyses confirmed all group differences. Qualitative responses likewise emphasized clearer explanations, simpler language, and improved structure. Conclusion: In this single standardized neuroradiology case, AI-based simplification improved participant-rated communication quality. Studies using multiple cases and outputs should determine whether such perceived improvements translate into objective comprehension, recall, decision-making, and clinically meaningful communication benefits. Key Points: Question Can radiologist-reviewed AI simplification address the communication gap by improving perceived communication quality of a standardized neuroradiology report compared with a conventional professional-language report? Findings In this randomized study with concealed AI involvement, the AI-simplified report received higher ratings across all four participant-rated communication domains. Critical relevance statement In a standardized neuroradiology report, AI-based simplification improved perceived communication quality, supporting further evaluation of patient-facing report explanations as adjuncts to conventional reports with explicit quality-assurance criteria.

Objective: Pulmonary infarction (PI) is a recognised complication of acute pulmonary embolism (PE). While computed tomography pulmonary angiography (CTPA) provides high-resolution morphological imaging, it does not permit direct functional assessment of regional lung perfusion. Spectral CT pulmonary angiography (SCTPA) enables quantitative perfusion analysis using iodine maps. However, the relationship between peripheral perfusion impairment, subsegmental emboli (SSE), and PI remains incompletely understood. This study investigated their association using SCTPA. Materials and methods: This retrospective single-centre study included 62 patients: 31 with SCTPA-confirmed acute PE and at least one PI, and 31 controls without PE or PI. Peripheral iodine concentration (pIC) was quantified in standardised subpleural regions of interest in each lung segment. Embolic burden was assessed using the Mastora score. SSE were identified on SCTPA and analysed on a segmental basis. Results: A total of 440 embolic occlusions were identified. In this selected cohort, PI occurred exclusively in segments affected by SSE and was not observed in segments without SSE. In mixed-effects modelling, SSE were independently associated with reduced pIC (β = -0.706, p < 0.001), while segmental emboli were also independently associated with lower pIC (β = -0.137, p < 0.001); lobar and central emboli showed no significant independent associations. The Mastora score showed a moderate correlation with the number of manifest PI (ρ = 0.566, p = 0.011). Conclusion: In this cohort, SSE were closely associated with PI and reduced peripheral iodine concentration. Quantitative pIC reflects regional hypoperfusion and provides functional information on lung perfusion in acute PE. Key Points: Question: Can spectral CT-derived peripheral iodine concentration characterise regional perfusion impairment associated with subsegmental emboli and pulmonary infarction in acute pulmonary embolism? Findings: In this selected cohort, pulmonary infarction occurred only in segments with subsegmental emboli, which showed reduced peripheral iodine concentration (pIC) on spectral CT iodine maps. Relevance statement: Spectral CT-derived peripheral iodine concentration may provide functional information on regional hypoperfusion in acute pulmonary embolism and improve understanding of infarction-related perfusion impairment.

Background Augmented reality (AR) may improve and standardize the preoperative informed consent process (ICP) by providing interactive three-dimensional visualizations of anatomical structures and surgical procedures. This randomised, controlled study evaluated the effect of AR-assisted education on knowledge acquisition, surgery-related anxiety, and patient satisfaction in patients undergoing counselling for elective vascular surgery. Methods Sixty-two patients presenting for elective vascular surgery counselling were randomised to receive either standard written education or AR-supported instruction using three-dimensional anatomical visualization. Knowledge was assessed using objective multiple-choice testing and subjective Likert-scale ratings across four domains: procedural understanding, risks and complications, therapeutic alternatives, and postoperative expectations. Surgery-related anxiety was measured using the two procedure-related anxiety items of the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Patient satisfaction was evaluated post-intervention. Results Objective knowledge was significantly higher in the AR group (median 66.7%, IQR 58.3–83.3) compared with the non-AR group (median 50.0%, IQR 33.3–66.7; p = 0.001). Subjective knowledge ratings (p = 0.137), post-intervention anxiety (p = 0.257), and patient satisfaction (p = 0.358) did not differ significantly between the two groups. Conclusion AR-assisted patient education may improve objective knowledge acquisition during preoperative vascular surgery counselling. AR-assisted visualization appears to be a useful adjunct for improving objective comprehension during the informed consent process.