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Incidental Apical Pleuroparenchymal Scarring on Computed Tomography: Diagnostic Yield, Progression, Morphologic Features and Clinical Significance

Toussie, Danielle; Finkelstein, Mark; Mendoza, Dexter; Concepcion, Jose; Stojanovska, Jadranka; Azour, Lea; Ko, Jane P; Moore, William H; Singh, Ayushi; Sasson, Arielle; Bhattacharji, Priya; Eber, Corey
PURPOSE/OBJECTIVE:Apical pleuroparenchymal scarring (APPS) is commonly seen on chest computed tomography (CT), though the imaging and clinical features, to the best of our knowledge, have never been studied. The purpose was to understand APPS's typical morphologic appearance and associated clinical features. PATIENTS AND METHODS/METHODS:A random generator selected 1000 adult patients from all 21516 chest CTs performed at urban outpatient centers from January 1, 2016 to December 31, 2016. Patients with obscuring apical diseases were excluded to eliminate confounding factors. After exclusions, 780 patients (median age: 64 y; interquartile range: 56 to 72 y; 55% males) were included for analysis. Two radiologists evaluated the lung apices of each CT for the extent of abnormality in the axial plane (mild: <5 mm, moderate: 5 to 10 mm, severe: >10 mm), craniocaudal plane (extension halfway to the aortic arch, more than halfway, vs below the arch), the predominant pattern (nodular vs reticular and symmetry), and progression. Cohen kappa coefficient was used to assess radiologists' agreement in scoring. Ordinal logistic regression was used to determine associations of clinical and imaging variables with APPS. RESULTS:APPS was present on 65% (507/780) of chest CTs (54% mild axial; 80% mild craniocaudal). The predominant pattern was nodular and symmetric. Greater age, female sex, lower body mass index, greater height, and white race were associated with more extensive APPS. APPS was not found to be associated with lung cancer in this cohort. CONCLUSION/CONCLUSIONS:Classifying APPS by the extent of disease in the axial or craniocaudal planes, in addition to the predominant pattern, enabled statistically significant associations to be determined, which may aid in understanding the pathophysiology of apical scarring and potential associated risks.
PMID: 38798201
ISSN: 1536-0237
CID: 5663232

Editorial for "Liver T1 Mapping Derived From Cardiac Magnetic Resonance Imaging: A Potential Prognostic Marker in Idiopathic Dilated Cardiomyopathy" [Comment]

Stojanovska, Jadranka; Feng, Li; Gilani, Nima
PMID: 38180166
ISSN: 1522-2586
CID: 5732162

The Society for Cardiovascular Magnetic Resonance Registry at 150,000

Tong, Matthew S; Slivnick, Jeremy A; Sharif, Behzad; Kim, Han W; Young, Alistair A; Sierra-Galan, Lilia M; Mukai, Kanae; Farzaneh-Far, Afshin; Al-Kindi, Sadeer; Chan, Angel T; Dibu, George; Elliott, Michael D; Ferreira, Vanessa M; Grizzard, John; Kelle, Sebastian; Lee, Simon; Malahfji, Maan; Petersen, Steffen E; Polsani, Venkateshwar; Toro-Salazar, Olga H; Shaikh, Kamran A; Shenoy, Chetan; Srichai, Monvadi B; Stojanovska, Jadranka; Tao, Qian; Wei, Janet; Weinsaft, Jonathan W; Wince, W Benjamin; Chudgar, Priya D; Judd, Matthew; Judd, Robert M; Shah, Dipan J; Simonetti, Orlando P
BACKGROUND:Cardiovascular magnetic resonance (CMR) is increasingly utilized to evaluate expanding cardiovascular conditions. The Society for Cardiovascular Magnetic Resonance (SCMR) Registry is a central repository for real-world clinical data to support cardiovascular research, including those relating to outcomes, quality improvement, and machine learning. The SCMR Registry is built on a regulatory-compliant, cloud-based infrastructure that houses searchable content and Digital Imaging and Communications in Medicine images. The goal of this study is to summarize the status of the SCMR Registry at 150,000 exams. METHODS:The processes for data security, data submission, and research access are outlined. We interrogated the Registry and presented a summary of its contents. RESULTS:Data were compiled from 154,458 CMR scans across 20 United States sites, containing 299,622,066 total images (∼100 terabytes of storage). Across reported values, the human subjects had an average age of 58 years (range 1 month to >90 years old), were 44% (63,070/145,275) female, 72% (69,766/98,008) Caucasian, and had a mortality rate of 8% (9,962/132,979). The most common indication was cardiomyopathy (35,369/131,581, 27%), and most frequently used current procedural terminology code was 75561 (57,195/162,901, 35%). Macrocyclic gadolinium-based contrast agents represented 89% (83,089/93,884) of contrast utilization after 2015. Short-axis cines were performed in 99% (76,859/77,871) of tagged scans, short-axis late gadolinium enhancement (LGE) in 66% (51,591/77,871), and stress perfusion sequences in 30% (23,241/77,871). Mortality data demonstrated increased mortality in patients with left ventricular ejection fraction <35%, the presence of wall motion abnormalities, stress perfusion defects, and infarct LGE, compared to those without these markers. There were 456,678 patient-years of all-cause mortality follow-up, with a median follow-up time of 3.6 years. CONCLUSION/CONCLUSIONS:The vision of the SCMR Registry is to promote evidence-based utilization of CMR through a collaborative effort by providing a web mechanism for centers to securely upload de-identified data and images for research, education, and quality control. The Registry quantifies changing practice over time and supports large-scale real-world multicenter observational studies of prognostic utility.
PMCID:11314894
PMID: 38971501
ISSN: 1532-429x
CID: 5698512

Invited Commentary: Mitral Annular Disease: An Underrecognized and Forgotten Entity

Stojanovska, Jadranka; Fujikura, Kana
PMID: 38870046
ISSN: 1527-1323
CID: 5669322

SCMR expert consensus statement for cardiovascular magnetic resonance of patients with a cardiac implantable electronic device

Kim, Daniel; Collins, Jeremy D; White, James A; Hanneman, Kate; Lee, Daniel C; Patel, Amit R; Hu, Peng; Litt, Harold; Weinsaft, Jonathan W; Davids, Rachel; Mukai, Kanae; Ng, Ming-Yen; Luetkens, Julian A; Roguin, Ariel; Rochitte, Carlos E; Woodard, Pamela K; Manisty, Charlotte; Zareba, Karolina M; Mont, Lluis; Bogun, Frank; Ennis, Daniel B; Nazarian, Saman; Webster, Gregory; Stojanovska, Jadranka
Cardiovascular magnetic resonance (CMR) is a proven imaging modality for informing diagnosis and prognosis, guiding therapeutic decisions, and risk stratifying surgical intervention. Patients with a cardiac implantable electronic device (CIED) would be expected to derive particular benefit from CMR given high prevalence of cardiomyopathy and arrhythmia. While several guidelines have been published over the last 16 years, it is important to recognize that both the CIED and CMR technologies, as well as our knowledge in MR safety, have evolved rapidly during that period. Given increasing utilization of CIED over the past decades, there is an unmet need to establish a consensus statement that integrates latest evidence concerning MR safety and CIED and CMR technologies. While experienced centers currently perform CMR in CIED patients, broad availability of CMR in this population is lacking, partially due to limited availability of resources for programming devices and appropriate monitoring, but also related to knowledge gaps regarding the risk-benefit ratio of CMR in this growing population. To address the knowledge gaps, this SCMR Expert Consensus Statement integrates consensus guidelines, primary data, and opinions from experts across disparate fields towards the shared goal of informing evidenced-based decision-making regarding the risk-benefit ratio of CMR for patients with CIEDs.
PMID: 38219955
ISSN: 1532-429x
CID: 5668442

Imaging of Cardiac Fibrosis: An Update, From the AJR Special Series on Imaging of Fibrosis

Karur, Gauri R; Aneja, Ashish; Stojanovska, Jadranka; Hanneman, Kate; Latchamsetty, Rakesh; Kersting, David; Rajiah, Prabhakar Shantha
Myocardial fibrosis (MF) is defined as excessive production and deposition of extra-cellular matrix proteins that result in pathologic myocardial remodeling. Three types of MF have been identified: replacement fibrosis from tissue necrosis, reactive fibrosis from myocardial stress, and infiltrative interstitial fibrosis from progressive deposition of nondegradable material such as amyloid. Although echocardiography, nuclear medicine, and CT play important roles in the assessment of MF, MRI is pivotal in the evaluation of MF, with the late gadolinium enhancement (LGE) technique used as a primary end point. The LGE technique focuses on the pattern and distribution of gadolinium accumulation in the myocardium and assists in the diagnosis and establishment of the cause of both ischemic and nonischemic cardiomyopathy. LGE MRI also aids prognostication and risk stratification. In addition, LGE MRI is used to guide the management of patients considered for ablation for arrhythmias. Parametric mapping techniques, including T1 mapping and extracellular volume measurement, allow detection and quantification of diffuse fibrosis, which may not be detected by LGE MRI. These techniques also allow monitoring of disease progression and therapy response. This review provides an update on the imaging of MF, including prognostication and risk stratification tools, electrophysiologic considerations, and disease monitoring.
PMID: 37753860
ISSN: 1546-3141
CID: 5725272

Chest Intensive Care Unit Imaging: Pearls and Pitfalls

Villasana-Gomez, Geraldine; Toussie, Danielle; Kaufman, Brian; Stojanovska, Jadranka; Moore, William H; Azour, Lea; Traube, Leah; Ko, Jane P
Imaging plays a major role in the care of the intensive care unit (ICU) patients. An understanding of the monitoring devices is essential for the interpretation of imaging studies. An awareness of their expected locations aids in identifying complications in a timely manner. This review describes the imaging of ICU monitoring and support catheters, tubes, and pulmonary and cardiac devices, some more commonly encountered and others that have been introduced into clinical patient care more recently. Special focus will be placed on chest radiography and potential pitfalls encountered.
PMID: 38816084
ISSN: 1557-8216
CID: 5663832

The effect of tube voltage on scan-rescan reproducibility of compositional plaque volume: technical variability is not true biological change

Calicchio, Francesca; Hu, Eric; Newlander, Shawn; Van Rosendael, Alexander; Epstein, Elizabeth; Robinson, Austin; Spierling Bagsic, Samantha R; Stojanovska, Jadranka; Gonzalez, Jorge; Wesbey, George
PMCID:11195690
PMID: 39045182
ISSN: 2755-9637
CID: 5723622

Competency based curriculum for cardiovascular magnetic resonance: A position statement of the Society for Cardiovascular Magnetic Resonance

Nguyen, Elsie T; Ordovas, Karen; Herbst, Phil; Kozor, Rebecca; Ng, Ming-Yen; Natale, Luigi; Nijveldt, Robin; Salgado, Rodrigo; Sanchez, Felipe; Shah, Dipan; Stojanovska, Jadranka; Valente, Anne Marie; Westwood, Mark; Plein, Sven
This position statement guides cardiovascular magnetic resonance (CMR) imaging program directors and learners on the key competencies required for Level II and III CMR practitioners, whether trainees come from a radiology or cardiology background. This document is built upon existing curricula and was created and vetted by an international panel of cardiologists and radiologists on behalf of the Society for Cardiovascular Magnetic Resonance (SCMR).
PMID: 38215698
ISSN: 1532-429x
CID: 5628742

Mitral Annular Disjunction: Review of an Increasingly Recognized Mitral Valve Entity

Gulati, Aishwarya; Gulati, Vaibhav; Hu, Ray; Rajiah, Prabhakar Shantha; Stojanovska, Jadranka; Febbo, Jennifer; Litt, Harold I.; Pavri, Behzad; Sundaram, Baskaran
Mitral annular disjunction (MAD) refers to atrial displacement of the hinge point of the mitral valve annulus from the ventricular myocardium. MAD leads to paradoxical expansion of the annulus in systole and may often be associated with mitral valve prolapse (MVP), leaflet degenera-tion, myocardial and papillary muscle fibrosis, and, potentially, malignant cardiac arrhythmias. Patients with MAD and MVP may present sim-ilarly, and MAD is potentially the missing link in explaining why some patients with MVP experience adverse outcomes. Patients with a 5 mm or longer MAD distance have an elevated risk of malignant cardiac arrhythmia compared with those with a shorter MAD distance. Evaluation for MAD is an important component of cardiac imaging, especially in patients with MVP and unexplained cardiac arrhythmias. Cardiac MRI is an important diagnostic tool that aids in recognizing and quantifying MAD, MVP, and fibrosis in the papillary muscle and myocardium, which may predict and help improve outcomes following electrophysiology procedures and mitral valve surgery. This article reviews the history, pathophysiology, controversy, prevalence, clinical implications, and imaging considerations of MAD, focusing on cardiac MRI.
SCOPUS:85183054443
ISSN: 2638-6135
CID: 5630482