Objective To evaluate the feasibility of single-shot whole thoracic time-resolved MR angiography (TR-MRA) to identify the feeding arteries of pulmonary arteriovenous malformations (PAVMs) and reperfusion of the lesion after embolization in patients with multiple PAVMs. Materials and Methods Nine patients (8 females and 1 male; age range, 23–65 years) with a total of 62 PAVMs who underwent percutaneous embolization for multiple PAVMs and were subsequently followed up using TR-MRA and CT obtained within 6 months from each other were retrospectively reviewed. All imaging analyses were performed by two independent readers blinded to clinical information. The visibility of the feeding arteries on maximum intensity projection (MIP) reconstruction and multiplanar reconstruction (MPR) TR-MRA images was evaluated by comparing them to CT as a reference. The accuracy of TR-MRA for diagnosing reperfusion of the PAVM after embolization was assessed in a subgroup with angiographic confirmation. The reliability between the readers in interpreting the TR-MRA results was analyzed using kappa (κ) statistics. Results Feeding arteries were visible on the original MIP images of TR-MRA in 82.3% (51/62) and 85.5% (53/62) of readers 1 and 2, respectively. Using the MPR, the rates increased to 93.5% (58/62) and 95.2% (59/62), respectively (κ = 0.760 and 0.792, respectively). Factors for invisibility were the course of feeding arteries in the anteroposterior plane, proximity to large enhancing vessels, adjacency to the chest wall, pulsation of the heart, and small feeding arteries. Thirty-seven PAVMs in five patients had angiographic confirmation of reperfusion status after embolization (32 occlusions and 5 reperfusions). TR-MRA showed 100% (5/5) sensitivity and 100% (32/32, including three cases in which the feeding arteries were not visible on TR-MRA) specificity for both readers. Conclusion Single-shot whole thoracic TR-MRA with MPR showed good visibility of the feeding arteries of PAVMs and high accuracy in diagnosing reperfusion after embolization. Single-shot whole thoracic TR-MRA may be a feasible method for the follow-up of patients with multiple PAVMs.

Background Patients with bronchiectasis commonly experience disease exacerbations, which cause significant morbidity and mortality. However, data regarding the clinical features of bronchiectasis patients hospitalized with hemoptysis are scarce. Methods We retrospectively collected the data of patients with bronchiectasis-associated hospitalization at a tertiary referral center in Korea, and classified them into the hemoptysis and infective exacerbation (IE) groups. The presence of hemoptysis was defined as a volume of expectorated blood larger than 10 mL per 24 hours. The clinical, radiological, and laboratory parameters were compared between the two groups. Results Patients were classified into the hemoptysis [267 (54.5%)] and IE [223 (45.5%)] groups. Among the 44 patients of the hemoptysis group, 37 (84.1%) presented with hemoptysis than with IE at the recurrent episode. The hemoptysis group had a significantly lower 30-day mortality than that of the IE group. Previous pulmonary tuberculosis (TB), mycetoma, and bronchial artery hypertrophy were independently associated with the hemoptysis group. In contrast, male sex, poor performance status, colonization of Pseudomonas aeruginosa , ≥3 involved lobes, cystic bronchiectasis, and emphysema were inversely associated with the hemoptysis group. The absence of hemoptysis was one of the independent predictors of 30-day mortality in patients with bronchiectasis-associated hospitalization. Conclusions In Korea, bronchiectasis patients hospitalized with hemoptysis exhibit a distinct phenotype, and are more likely to have previous pulmonary TB, mycetoma, and bronchial artery hypertrophy. Hemoptysis is associated with a lower risk of short-term mortality compared to IE in bronchiectasis-associated hospitalization.

Hemoptysis is a common cause of emergency department (ED) visits. There is little data about the role of systemic hypertension as a cause of hemoptysis. The aim of this study was to evaluate the association between systemic blood pressure and the unknown etiology of hemoptysis. This retrospective study included consecutive patients who visited the ED owing to hemoptysis and underwent a chest computed tomography between January 2011 and June 2021. Details of the initial blood pressure at the ED visit were compared between two groups with identified and unidentified causes of hemoptysis. In total, 1105 adult patients were included. The etiology of hemoptysis was identified in 1042 patients (94.3%) and remained unidentified in 63 patients (5.7%). The percentage of patients with severe hypertension was significantly higher in patients with unidentified causes of hemoptysis than in those with identified causes (35% vs. 11%, p < 0.001). In multivariate analysis, age, ever-smoker, and initial systolic blood pressure were significantly associated with hemoptysis of unidentified causes. Although further studies are needed, our findings suggest a possible association between high blood pressure and cryptogenic hemoptysis.

급성 관동맥 증후군(acute coronary syndrome)은 대부분 죽상경화 관상동맥 질환(atherosclerotic coronary artery disease)에 의해 발생하지만, 비죽상경화 관상동맥 질환에서도 발생할 수 있다. 고식적 관상동맥 혈관조영술은 동맥 내강의 협착이나 확장 등의 형상에 대한 정보만을 제공하고, 동맥경화반이나 동맥벽에 대한 평가가 어려워 관상동맥 이상의 원인 질환의 진단에 낮은 특이도를 보인다. 반면, 관상동맥 전산화단층촬영 혈관조영술은 혈관경화반의 특징, 혈관벽의 조영증강뿐 아니라 연접한 대동맥이나 폐동맥의 변화 등도 함께 관찰할 수 있어, 비죽상경화 관상상동맥질환의 진단 및 다양한 원인 감별에 도움이 된다. 따라서 이 종설에서는 다양한 비죽상경화 관상동맥 질환들을 소개하고, 이의 병태생리 및 대표적인 관상동맥 전산화단층촬영 혈관조영술의 영상 소견에 대해 설명하고자 한다.

BACKGROUND Many COVID-19 patients rapidly progress into respiratory failure with a broad range of severity. Identification of the high-risk cases is critical for early intervention. OBJECTIVE The aim of this study is to develop deep learning models that can rapidly diagnose high-risk COVID-19 patients based on computed tomography (CT) images and clinical data. METHODS We analyzed 297 COVID-19 patients from five hospitals in Daegu, South Korea. A mixed model (ACNN) including an artificial neural network for clinical data and a convolution-neural network for 3D CT imaging data is developed to classify high-risk cases with a severe progression (event) from low-risk COVID-19 patients (event-free). RESULTS By using the mixed ACNN model, we could obtain high classification performance using novel coronavirus pneumonia (NCP) lesion images (93.9% accuracy, 80.8% sensitivity, 96.9% specificity, and 0.916 AUC) and using lung segmentation images (94.3% accuracy, 74.7% sensitivity, 95.9% specificity, and 0.928 AUC) for event vs. event-free groups. CONCLUSIONS Our study has successfully differentiated high-risk cases among COVID-19 patients using the imaging and clinical features of COVID-19 patients. The developed model is potentially utilized as a prediction tool for intervening active therapy.