Radiology. Cardiothoracic imaging最新文献

{"title":"Erratum for: Registration-guided GAN Synthesis of Virtual Contrast-enhanced Thoracic CT for Hilar and Mediastinal Lymph Node Detection.","authors":"Motohiko Yamazaki, Kanako Oyanagi, Yuma Fuzawa, Kyoryoku You, Tetsuya Nomura, Takuya Yagi, Naoya Koizumi, Akiko Tasaki, Masaki Tominaga, Ibuki Namihira, Satoru Kobayashi, Hiroyuki Ishikawa","doi":"10.1148/ryct.269001","DOIUrl":"https://doi.org/10.1148/ryct.269001","url":null,"abstract":"","PeriodicalId":21168,"journal":{"name":"Radiology. Cardiothoracic imaging","volume":"8 5","pages":"e269001"},"PeriodicalIF":4.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary Calcium after Breast Cancer Radiotherapy: Balancing Risk Stratification and Feasibility in Resource-limited Settings.","authors":"Laura Nataly Panqueva Giraldo, Valeria Del Castillo Herazo, Bibiana Pinzón Valderrama","doi":"10.1148/ryct.260304","DOIUrl":"https://doi.org/10.1148/ryct.260304","url":null,"abstract":"","PeriodicalId":21168,"journal":{"name":"Radiology. Cardiothoracic imaging","volume":"8 5","pages":"e260304"},"PeriodicalIF":4.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opportunistic Detection of Hepatic Steatosis Using Postcontrast Liver Attenuation at Coronary CT Angiography.","authors":"Duygu Karahacioglu, Gizem Cural Kula, Sezer Kula, Mert Veznikli, Medine Boge, Çetin Atasoy","doi":"10.1148/ryct.260148","DOIUrl":"https://doi.org/10.1148/ryct.260148","url":null,"abstract":"<p><p>Purpose To evaluate the diagnostic performance of postcontrast liver attenuation measured with coronary CT angiography (CCTA) for opportunistic detection of hepatic steatosis and to assess the impact of tube potential variation on optimal attenuation thresholds and overall performance. Materials and Methods This retrospective study included adult patients who underwent CCTA with concomitant unenhanced coronary Agatston scoring (January to December 2025). Moderate-to-severe hepatic steatosis was defined as unenhanced liver attenuation less than 40 HU. Postcontrast liver attenuation was measured using standardized regions of interest. Diagnostic performance was assessed using receiver operating characteristic analysis with Youden index-based threshold determination. Associations between hepatic steatosis, Agatston score categories, and Coronary Artery Disease Reporting and Data System (CAD-RADS) categorizations were evaluated using likelihood ratio χ² tests. Results Among 300 included patients (mean age ± SD, 55.6 years ± 12.0; 170 males), moderate-to-severe steatosis was present in 109 patients (36.3%). Postcontrast liver attenuation demonstrated high diagnostic performance across all settings (area under the receiver operating characteristic curve: 0.88, 0.95, and 0.89 at 100, 120, and 140 kVp, respectively). Optimal thresholds decreased with increasing tube potential (54, 47, and 40 HU at 100, 120, and 140 kVp, respectively). Patients with steatosis had a lower frequency of coronary artery calcium scores of zero (43.7% vs 57.6%) and a higher frequency of coronary artery calcium scores of 101-300 (11.7% vs 4.9%; <i>P</i> = .042), whereas CAD-RADS distribution was similar (<i>P</i> = .12). Conclusion Postcontrast liver attenuation measured with CCTA demonstrated promising diagnostic performance for opportunistic identification of moderate-to-severe hepatic steatosis across different tube potential settings. Hepatic steatosis was associated with coronary calcium burden but not with CAD-RADS categorization. <b>Keywords:</b> CT-Coronary Angiography, Abdomen/GI, Coronary Arteries, Liver <i>Supplemental material is available for this article.</i> © RSNA, 2026.</p>","PeriodicalId":21168,"journal":{"name":"Radiology. Cardiothoracic imaging","volume":"8 5","pages":"e260148"},"PeriodicalIF":4.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancements in Contrast-enhanced Thoracic MR Angiography.","authors":"Jason Craft, Timothy Carter, Josh Y Cheng, Karl P Kunze, Michaela Schmidt, Omar K Khalique, Rene Botnar, Claudia Prieto","doi":"10.1148/ryct.260136","DOIUrl":"https://doi.org/10.1148/ryct.260136","url":null,"abstract":"<p><p>There is a clinical need for high-spatial-resolution, electrocardiography (ECG)-gated, respiratory-navigated contrast-enhanced (CE) thoracic MR angiography (MRA; hereafter, NAV CE MRA) robust to physiologic motion artifacts. Compared with first-pass gated techniques, ECG-triggered NAV MRA more effectively suppresses motion and exhibits greater acquisition efficiency and/or artifact mitigation than non-CE MRA. Gradient-echo or balanced steady-state free precession NAV CE MRA has conventionally used diaphragmatic navigators to minimize respiratory motion and parallel imaging for acquisition acceleration. The development of image-based navigators (iNAVs) and variable golden-step Cartesian trajectory with spiral profile order sampling represents a progressive technologic innovation for three-dimensional thoracic CE MRA (hereafter, iNAV CE MRA). iNAV CE MRA can also be combined with time-resolved angiography and abdominopelvic first-pass CE MRA for dynamic information and/or extended anatomic coverage. In this review, we describe techniques for NAV CE MRA motion correction, contrast agent considerations, noncontrast alternatives, use in clinical applications, limitations, and future potential. <b>Keywords:</b> MR Angiography, Congenital, Aorta, Pulmonary Veins, Motion Correction, Aortic Disease, Congenital Heart Disease, Pulmonary Vein Angiography, Variable Density Sampling <i>Supplemental material is available for this article.</i> © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license.</p>","PeriodicalId":21168,"journal":{"name":"Radiology. Cardiothoracic imaging","volume":"8 5","pages":"e260136"},"PeriodicalIF":4.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Atrial Strain Prediction of New-Onset Atrial Fibrillation in Apical Hypertrophic Cardiomyopathy with Cardiac MRI.","authors":"Yipei Song, Mengyao Hu, Tian Zheng, Xiwen Wang, Qimin Fang, Ziyan Feng, Lianggeng Gong","doi":"10.1148/ryct.250266","DOIUrl":"10.1148/ryct.250266","url":null,"abstract":"<p><p>Purpose To evaluate the predictive value of cardiac MRI-derived left atrial strain (LAS) for new-onset atrial fibrillation (AF) in apical hypertrophic cardiomyopathy (AHCM). Materials and Methods This retrospective study included patients with AHCM with no prior history of AF who underwent 3.0-T cardiac MRI between May 2016 and December 2023. LAS parameters-reservoir strain (εs), conduit strain (εe), and booster pump strain (εa)-and minimum left atrial volume index (LAVI_min) were measured. The clinical end point was new-onset AF as confirmed with electrocardiography, Holter monitoring, or implantable cardiac devices. Cox proportional hazards models and time-dependent receiver operating characteristic (ROC) analyses were performed to evaluate associations and discriminatory performance for new-onset AF. Results A total of 156 patients (mean age, 51.0 years ± 11.5 [SD]; 113 male) were included. During a median follow-up of 33 months, AF occurred in 21 patients. In multivariable Cox models adjusted for age, body mass index, and LAVI_min, LAS parameters were independently associated with incident AF (εs: hazard ratio [HR], 0.79 [95% CI: 0.69, 0.90], <i>P</i> < .001; εa: HR, 0.65 [95% CI: 0.50, 0.83], <i>P</i> < .001; and εe: HR, 0.79 [95% CI: 0.65, 0.95], <i>P</i> = .01). In the nested Cox models, adding LAS to a baseline clinical-volumetric model improved model fit and discrimination, with the χ² value improving from 36.22 to 54.90 and the concordance index value improving from 0.846 to 0.930 (<i>P</i> < .001 for both). The LAVI_min provided complementary prognostic information, with its contribution varying across strain-specific models. Time-dependent ROC analyses demonstrated that LAS identified the development of AF well across prespecified time horizons. Conclusion Cardiac MRI-derived LAS was independently associated with new-onset AF in AHCM and provided incremental prognostic value beyond routine clinical and left atrial volumetric measures. <b>Keywords:</b> Apical Hypertrophic Cardiomyopathy, Atrial Fibrillation, Cardiac MRI, Left Atrial Strain, Heart, Cardiomyopathies, MR Imaging <i>Supplemental material is available for this article.</i> © RSNA, 2026.</p>","PeriodicalId":21168,"journal":{"name":"Radiology. Cardiothoracic imaging","volume":"8 4","pages":"e250266"},"PeriodicalIF":4.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-quantified Myosteatosis at CAC CT for Prediction of Atrial Fibrillation and Heart Failure: The Multi-Ethnic Study of Atherosclerosis.","authors":"Amir Azimi, Kyle Atlas, Anthony P Reeves, Chenyu Zhang, Jakob Wasserthal, Seyed Reza Mirjalili, Thomas Atlas, Claudia I Henschke, David F Yankelevitz, Javier J Zulueta, Jeffrey I Mechanick, Andrea Branch, Ning Ma, Rowena Yip, Wenjun Fan, Sion K Roy, Khurram Nasir, Sabee Molloi, Zahi A Fayad, Michael V McConnell, Ioannis A Kakadiaris, George S Abela, Rozemarijn Vliegenthart, David J Maron, Jagat Narula, Kim A Williams, Prediman K Shah, Matthew J Budoff, Daniel Levy, Emelia J Benjamin, Nathan D Wong, Morteza Naghavi","doi":"10.1148/ryct.250214","DOIUrl":"10.1148/ryct.250214","url":null,"abstract":"<p><p>Purpose To evaluate whether the artificial intelligence (AI)-quantified mean thoracic skeletal muscle (TSM) attenuation from coronary artery calcium (CAC) scans predicts incident cardiovascular disease (CVD), with a focus on atrial fibrillation (AF) and heart failure (HF). Materials and Methods Data from the Multi-Ethnic Study of Atherosclerosis, including participants without baseline CVD who underwent CAC scanning, were retrospectively analyzed. Myosteatosis was defined by sex-specific, AI-quantified mean TSM attenuation cutoffs. The Cox proportional hazards model was used to compare total CVD, AF, and HF risks between the bottom and top quartiles of TSM attenuation after adjusting for CVD risk factors, inflammatory markers, insulin resistance, Agatston score, TSM volume, and social determinants of health. Results Among 5739 participants (mean age, 62.1 years ± 10.3 [SD]; 3002 [52.3%] female), 1826 CVD events occurred over 19 years, including 1139 AF and 359 HF events. Myosteatosis was independently associated with increased risks of total CVD (hazard ratio [HR], 1.48 [95% CI: 1.25, 1.75]; <i>P</i> = .001), AF (HR, 1.68 [95% CI: 1.37, 2.07]; <i>P</i> < .001), and HF (HR, 1.61 [95% CI: 1.18, 2.19]; <i>P</i> < .002). Participants with both myosteatosis and high Agatston scores had markedly higher cumulative incidences compared with those with high Agatston scores alone (total CVD: 84.6% vs 68.6%; AF: 52.9% vs 42.4%; HF: 22.6% vs 16.1%). Adding myosteatosis to the Agatston score significantly improved prediction (time-dependent area under the receiver operating characteristic curve, total CVD: 0.74 vs 0.80, <i>P</i> < .001; AF: 0.68 vs 0.76, <i>P</i> < .001; HF: 0.73 vs 0.78, <i>P</i> = .007). Conclusion AI-quantified mean TSM attenuation on CAC scans independently predicted AF and HF and enhanced the Agatston score's predictive value. <b>Keywords:</b> Myosteatosis, Coronary Artery Calcium Scan, Atrial Fibrillation, Heart Failure, Artificial Intelligence, Applications-CT, Cardiac, Thorax, Muscular, Heart ClinicalTrials.gov NCT00005487 <i>Supplemental material is available for this article.</i> © RSNA, 2026.</p>","PeriodicalId":21168,"journal":{"name":"Radiology. Cardiothoracic imaging","volume":"8 4","pages":"e250214"},"PeriodicalIF":4.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phase-Resolved Functional Lung MRI-derived Pulmonary Arterial Pulse Wave Velocity Correlates with 12-Month Mortality in Participants with Pulmonary Hypertension: A Post Hoc Analysis of a Multicenter Study.","authors":"Marius M Klein, Andreas Voskrebenzev, Filip Klimeš, Milan Speth, Robin A Müller, Karen M Olsson, Julian Glandorf, Claus P Heußel, Ekkehard Grünig, Henning Gall, Ardeschir Ghofrani, Fritz Roller, Sebastian Harth, Helen Marshall, Paul J C Hughes, Andrew J Swift, David G Kiely, Jürgen Behr, Julien Dinkel, Dietrich Beitzke, Irene M Lang, Kai-Helge Schmidt, Karl-Friedrich Kreitner, Thomas Frauenfelder, Silvia Ulrich, Okka W Hamer, Jim Wild, Jens Vogel-Claussen","doi":"10.1148/ryct.250508","DOIUrl":"10.1148/ryct.250508","url":null,"abstract":"<p><p>Purpose To evaluate pulmonary arterial pulse wave velocity (PWV) derived from phase-resolved functional lung (PREFUL) MRI in participants with suspected pulmonary hypertension (PH), assess its association with established markers, and investigate its prognostic value for 12-month mortality. Materials and Methods This post hoc analysis of a prospective multicenter Chronic Thromboembolic Pulmonary Hypertension Diagnosis Europe MRI (CHANGE MRI) study included participants with suspected chronic thromboembolic PH and complete PREFUL MRI between July 2016 and November 2023. PREFUL MRI-based two-dimensional images acquired at 1.5 T using spoiled gradient-echo sequences were used to calculate quantified perfusion, perfusion defect percentages, and PWV. Group comparisons were performed between PH and no PH and among PH groups using age- and sex-adjusted models (analysis of covariance framework). Spearman correlations with right heart catheterization and cardiac MRI parameters and associations with 12-month mortality were assessed using multivariable regression and Cox proportional hazard models. A <i>P</i> value less than .05 was considered statistically significant. Results A total of 632 participants (median age, 66 years; IQR, 22 years; 368 [58%] female) were included. Of these, 415 had confirmed PH, and 13 died within 12 months. PWV was higher in pulmonary arterial hypertension than in chronic thromboembolic PH (2.76 m/sec ± 1.32 vs 1.84 m/sec ± 1.29; <i>P</i> < .001). In participants with PH, PWV was associated with mortality (hazard ratio, 2.28 per SD increase [1.47 m/sec]; <i>P</i> < .001). PWV showed independent associations with right ventricular ejection fraction (β = -0.024 m/sec per percentage point; <i>P</i> < .001) and perfusion defect percentage (β = 0.014 m/sec per percentage point; <i>P</i> = .02). Conclusion Pulmonary arterial PWV derived from PREFUL MRI was higher in PH and independently associated with right ventricular function and 12-month mortality. <b>Keywords:</b> Functional Lung MRI, Pulmonary Arteries, Lung ClinicalTrials.gov identifier: NCT02791282 <i>Supplemental material is available for this article.</i> © RSNA, 2026.</p>","PeriodicalId":21168,"journal":{"name":"Radiology. Cardiothoracic imaging","volume":"8 4","pages":"e250508"},"PeriodicalIF":4.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of Common Thoracic Abnormalities with 0.55-T Lung MRI Compared with Chest CT: A Reader Performance Study.","authors":"Felicia Tang, Timothy Chen, Sayedomid Ebrahimzadeh, Brandon K K Fields, Yoo Jin Lee, Jonathan Liu, Adam Yen, Kiara Bowers, Richard B Schonour, Pan Su, Pedro Itriago Leon, Omar Darwish, Peder Larson, Yang Yang, Jae Ho Sohn","doi":"10.1148/ryct.250367","DOIUrl":"https://doi.org/10.1148/ryct.250367","url":null,"abstract":"<p><p>Purpose To assess image quality and detection performance of 0.55-T MRI for common lung pathologies in a multireader study. Materials and Methods Twenty-eight participants were prospectively enrolled at a tertiary academic medical center between January 1, 2023, and August 31, 2023, and underwent same-day chest CT and 0.55-T MRI with respiratory-triggered T2-weighted axial BLADE and T1-weighted ultrashort echo time sequences. Six radiologists evaluated the quality of the MRI using a Likert-type scale and assessed common lung abnormalities. Sensitivity was calculated as the proportion of CT-confirmed lesions detected on MRI and was compared between readers by training status using the Kruskal-Wallis test. Fleiss κ values were calculated for interreader agreement. Nodule measurements were compared between modalities using the Pearson correlation coefficient. Results Twenty-eight participants (mean age ± SD, 59 years ± 19; 17 female) were included. The overall quality of 80% (134 of 168) of the images was scored as good or higher. 0.55-T MRI achieved sensitivities of at least 85% for consolidations and large solid nodules (≥6 mm) and less than 40% for emphysema, ground-glass nodules, and small nodules (<6 mm). Readers achieved moderate agreement in lesion detection (κ, 0.51; 95% CI: 0.37, 0.61), with no evidence of a difference in sensitivity when stratified by training level (<i>P</i> = .56). Nodule size at CT and MRI was strongly correlated (<i>r</i> = 0.79-0.95; <i>P</i> < .001). Conclusion Consolidation and large solid nodules were well detected on 0.55-T MRI, whereas the detection performance for small nodules, ground-glass nodules, and emphysema was limited. <b>Keywords:</b> MR-Imaging, MR-Diffusion Weighted Imaging, Thorax, Lung, Mediastinum, Pleura, Pulmonary Arteries, Imaging Sequences, Observer Performance, Technology Assessment <i>Supplemental material is available for this article.</i> © RSNA, 2026.</p>","PeriodicalId":21168,"journal":{"name":"Radiology. Cardiothoracic imaging","volume":"8 4","pages":"e250367"},"PeriodicalIF":4.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary Plaque Phenotype in Ischemic Stroke Survivors: A Quantitative Coronary CT Angiography Comparison with Acute Myocardial Infarction and Stable Chest Pain.","authors":"Rahul G Muthalaly, Julian Giovannucci, Andrew Lin, Sean Tan, Nitesh Nerlekar, Adam J Nelson, Damini Dey, Thanh Phan, Henry Ma, Stephen J Nicholls","doi":"10.1148/ryct.260039","DOIUrl":"https://doi.org/10.1148/ryct.260039","url":null,"abstract":"","PeriodicalId":21168,"journal":{"name":"Radiology. Cardiothoracic imaging","volume":"8 4","pages":"e260039"},"PeriodicalIF":4.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Low-Attenuation Noncalcified Plaque Shape and Degree of Intraplaque Embeddedness Using Atherosclerotic Imaging-enabled Quantitative CT with Acute Coronary Syndrome.","authors":"Shant Malkasian, Nick S Nurmohamed, Hyuk-Jae Chang, Andrew D Choi, Hugo Marques, Sabee Molloi, Alexander van Rosendael, Benjamin J W Chow, Daniele Andreini, Edoardo Conte, Erica Maffei, Fabian Plank, Gianluca Pontone, Gudrun Feuchtner, Habib Samady, Hyung-Bok Park, Ibrahim Danad, Iksung Cho, Jeroen J Bax, Hyun-Ji Lee, Ji Min Sung, Lohendran Baskaran, Martin Hadamitzky, Matthew J Budoff, Peter H Stone, Ran Heo, Ricardo C Cury, Sang-Eun Lee, Subhi J Al'Aref, Wijnand J Stuijfzand, Yong-Jin Kim, Filippo Cademartiri, Renu Virmani, Jagat Narula, Kavitha Chinnaiyan, Todd C Villines, Jonathon Leipsic, Leslee J Shaw, Fay Y Lin, Tami Crabtree, Udo Hoffman, James P Earls","doi":"10.1148/ryct.250117","DOIUrl":"10.1148/ryct.250117","url":null,"abstract":"<p><p>Purpose To assess the association of low-attenuation noncalcified plaque (LAP) morphologic features, including shape and degree of intraplaque embeddedness, using atherosclerotic imaging-enabled quantitative CT with acute coronary syndrome (ACS). Materials and Methods In this secondary analysis of the Incident Coronary Syndromes Identified by CT (ICONIC) study, a retrospective-nested, case-control, multicenter study of patients with future ACS after coronary CT angiography propensity matched with controls, atherosclerotic imaging-enabled quantitative CT analysis was performed between February and September 2022. LAP morphology was determined qualitatively according to geometric shape (crescent, lobular, spherical, or bean) and degree of intraplaque embeddedness (<90°, 90°-179°, 180°-269°, 270°-360°) within the vessel wall. Shapes were based on visual assessment of LAP contours, including features of curvature, symmetry, and lobulated and protruding components. Adverse LAP morphology (ALM) was defined by morphologic features associated with ACS using log-rank testing. Multivariable Cox regression was performed with ALM as the independent variable, adjusting for plaque burden and diameter stenosis. Results A total of 446 patients (mean age ± SD, 62.44 years ± 11.05; 277 male; 223 cases, 223 controls) with a mean follow-up of 2.45 years ± 2.49 were included in this study. Twenty-two patients were excluded due to missing images or poor image quality. Lobular, bean, and spherical LAP shape or LAP with a degree of intraplaque embeddedness greater than or equal to 180° was associated with increased ACS risk (log-rank <i>P</i> < .05 for each). These morphologic features thus defined ALM. Among 74 of 446 (16.6%) patients with ALM, 57 patients experienced ACS. Patients with ALM had a 3.24-fold increased risk for ACS (adjusted hazard ratio, 3.24 [95% CI: 1.44, 7.30]; <i>P</i> = .005). Conclusion ALM was independently associated with ACS. <b>Keywords:</b> Coronary Angiography, Coronary Arteries ClinicalTrials.gov identifier: NCT02959099 <i>Supplemental material is available for this article.</i> © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license.</p>","PeriodicalId":21168,"journal":{"name":"Radiology. Cardiothoracic imaging","volume":"8 4","pages":"e250117"},"PeriodicalIF":4.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}