Hrudaya Nath

• University of Alabama at Birmingham

The incidence of newly developed interstitial lung abnormalities (ILA) and fibrotic ILA have not been previously reported. Trained thoracic radiologists evaluated 13 944 cardiac CT scans for the presence of ILA in 6197 Multi-Ethnic Study of Atherosclerosis longitudinal cohort study participants >45 years of age from 2000 to 2012. 5% of the scans we...

Background: Anomalous coronary arteries (ACAs) may present increased risk for adverse cardiac events. We sought to evaluate the accuracy of conventional coronary angiography (CCA), as it is currently used in clinical practice, compared with expert interpretation and cardiac magnetic resonance imaging (CMR) in determining the site of origin and pro...

Vascular calcification is most commonly due to atherosclerosis. It has been well documented that absence of coronary calcification on a chest CT (CCT) is associated with low cardiovascular events and good prognosis. High CT calcium scores often result in a higher incidence of cardiovascular events and worse survival. In asymptomatic patients with a...

Background: Chronic obstructive pulmonary disease (COPD) remains a major cause of morbidity and mortality. Present-day diagnostic criteria are largely based solely on spirometric criteria. Accumulating evidence has identified a substantial number of individuals without spirometric evidence of COPD who suffer from respiratory symptoms and/or increa...

Rationale: Expiratory central airway collapse (ECAC) is associated with respiratory morbidity independent of underlying lung disease. However, not all smokers develop ECAC and the etiology of ECAC in adult smokers is unclear. Paraseptal emphysema in the paratracheal location, by untethering airway walls, may predispose smokers to developing ECAC....

Objective: As low-dose CT (LDCT) lung cancer screening moves into routine clinical practice, evaluation of nodules identified as new becomes critical. We examine the frequency and clinical outcomes of new lung nodules reported at the two postbaseline annual screening examinations (hereafter referred to as postbaseline time 1 [T1] and time 2 [T2]),...

Rationale: A substantial proportion of subjects without overt airflow obstruction have significant respiratory morbidity and structural abnormalities on computed tomography (CT). Whether regions of the lung that appear normal using traditional CT criteria have mild disease is not known. Objective: To identity subthreshold structural disease in n...

Purpose: The National Lung Screening Trial (NLST) demonstrated a reduction in lung cancer and all-cause mortality with low-dose CT (LDCT) screening. The aim of our study was to examine the time to diagnosis (TTD) of lung cancer in the LDCT arm of the NLST and assess its relationship with cancer characteristics and survival. Methods: The subjects...

Objectives: This study retrospectively analyses the screening CT examinations and outcomes of the National Lung Screening Trial (NLST) participants who had interval lung cancer diagnosed within 1 year after a negative CT screen and before the next annual screen. Methods: The screening CTs of all 44 participants diagnosed with interval lung cance...

Introduction Renal cancer incidence has increased markedly in the United States in recent decades, largely due to incidentally detected tumours from computed tomography imaging. Here, we analyze the potential for low-dose computed tomography lung cancer screening to detect renal cancer. Methods The National Lung Screening Trial randomized subjects...

Background Adults with interstitial lung disease (ILD) often have serologic evidence of autoimmunity of uncertain significance without overt autoimmune disease. We examined associations of rheumatoid arthritis (RA)-associated antibodies with subclinical ILD in community-dwelling adults. Methods We measured serum rheumatoid factor (RF) and anticycl...

Background COPD is associated with cardiovascular disease (CVD), and coronary artery calcification (CAC) provides incremental prognostic information. CAC is measured using Agatston scores on electrocardiographically gated CT scans. With increasing use of non-gated CT scans in clinical practice, we hypothesized that a simple visual Weston score woul...

Rationale: Acute exacerbations of chronic obstructive pulmonary disease (COPD) increase the risk of death and drive healthcare costs, but whether they accelerate loss of lung function remains controversial. Whether exacerbations in subjects with mild COPD or similar acute respiratory events in smokers without airflow obstruction affect lung functi...

Evidence suggests that lung injury, inflammation and extracellular matrix remodelling precede lung fibrosis in interstitial lung disease (ILD). We examined whether a quantitative measure of increased lung attenuation on computed tomography (CT) detects lung injury, inflammation and extracellular matrix remodelling in community-dwelling adults sampl...

Importance Central airway collapse greater than 50% of luminal area during exhalation (expiratory central airway collapse [ECAC]) is associated with cigarette smoking and chronic obstructive pulmonary disease (COPD). However, its prevalence and clinical significance are unknown.Objective To determine whether ECAC is associated with respiratory mo...

The ACR recognizes that low-dose CT for lung cancer screening has the potential to significantly reduce mortality from lung cancer in the appropriate high-risk population. The ACR supports the recommendations of the US Preventive Services Task Force and the National Comprehensive Cancer Network for screening patients. To be effective, lung cancer s...

Screening for lung cancer using low-dose computed tomography (CT) reduces lung cancer mortality. However, in addition to a high rate of benign nodules, lung cancer screening detects a large number of indolent cancers that generally belong to the adenocarcinoma spectrum. Individualized management of screen-detected adenocarcinomas would be facilitat...

Chronic obstructive pulmonary disease causes significant morbidity and concomitant pulmonary vascular disease and cardiac dysfunction are associated with poor prognosis. Computed tomography-detected relative pulmonary artery (PA) enlargement defined as a PA to ascending aorta diameter ratio >1 (PA:A>1) is a marker for pulmonary hypertension and pre...

Small animal models of lung fibrosis are essential for unraveling the molecular mechanisms underlying human fibrotic lung diseases; additionally, they are useful for pre-clinical testing of candidate anti-fibrotic agents. The current end-point measures of experimental lung fibrosis involve labor-intensive histological and biochemical analyses. Thes...

Lung cancer screening with low-dose computed tomography (LDCT) has been recommended, based primarily on the results of the National Lung Screening Trial (NLST). The American College of Radiology recently released Lung-RADS, a classification system for LDCT lung cancer screening. To retrospectively apply the Lung-RADS criteria to the NLST. Secondary...

The ACR recognizes that low-dose CT for lung cancer screening has the potential to significantly reduce mortality from lung cancer in the appropriate high-risk population. The ACR supports the recommendations of the US Preventive Services Task Force and the National Comprehensive Cancer Network for screening patients. To be effective, lung cancer s...

Purpose: Detection and quantification of coronary artery calcium (CAC) has a prognostic value for future cardiovascular events, beyond that accrued from other cardiovascular risk factors. CAC is conventionally measured as an Agatston score from an EKG-gated non-contrast CT of the heart using special software. The predominant indication for coronary...

Objective: Current and former smokers are at an increased risk for lung cancer and cardiovascular disease (CVD). We investigated two methods of visual scoring of coronary artery calcium on lung cancer screening computed tomography (CT) to predict cardiovascular and all-cause mortality. Participants and methods: Cases were 1000 participants, age...

Background: Computed tomography (CT) screening for lung cancer has been associated with a high frequency of false positive results because of the high prevalence of indeterminate but usually benign small pulmonary nodules. The acceptability of reducing false-positive rates and diagnostic evaluations by increasing the nodule size threshold for a po...

Background: Bronchodilator response has been noted in a significant proportion of patients with chronic obstructive pulmonary disease (COPD). However, there are also reports of a paradoxical response to β₂ agonists resulting in bronchoconstriction. Asymptomatic bronchoconstriction is likely to be far more common than is symptomatic bronchoconstric...

Background: The risk factors for acute episodes of respiratory disease in current and former smokers who do not have COPD are unknown. Methods: Eight thousand two hundred forty-six non-Hispanic white and black current and former smokers in the Genetic Epidemiology of COPD (COPDGene) cohort had longitudinal follow-up (LFU) every 6 months to deter...

Chemoprevention is an important potential tool in reducing lung cancer incidence. Noncalcified nodules (NCN) observed on low-dose computed tomography (LDCT) have been proposed as intermediate endpoints in chemoprevention trials, but whether NCNs represent cancer precursors is unclear. We analyzed data from subjects in the LDCT arm of the National L...

Cardiovascular morbidity and mortality is high in patients with chronic obstructive pulmonary disease (COPD) and arterial stiffness is a potentially modifiable risk factor with added predictive value beyond that obtained from traditional risk factors. Arterial stiffness has been the target of pharmacologic and exercise interventions in patients wit...

Introduction: Anomalies of coronary artery origin where the artery arises from the opposite aortic cusp are associated with adverse cardiac events; those of the left main and the left anterior descending coronary arteries (LMCA and LAD) are thought to be at particular risk. However, there are few outcomes data on anomalies identified in adulthood;...

The National Lung Screening Trial (NLST) reported a 20% reduction in lung cancer specific mortality using low-dose chest CT (LDCT) compared with chest radiograph (CXR) screening. The high number of false positive screens with LDCT (around 25%) raises concerns. NLST radiologists reported LDCT screens as either positive or not positive, based primari...

Purpose: To characterize the variability in radiologists' interpretations of computed tomography (CT) studies in the National Lung Screening Trial (NLST) (including assessment of false-positive rates [FPRs] and sensitivity), to examine factors that contribute to variability, and to evaluate trade-offs between FPRs and sensitivity among different g...

SESSION TYPE: Miscellaneous Cases IIPRESENTED ON: Tuesday, October 23, 2012 at 11:15 AM - 12:30 PMINTRODUCTION: Challenging cases are gratifying when they are solved by pooling of inputs by experts in multiple disciplines. We present one such case of a young woman who was breathless for two years.CASE PRESENTATION: A 40 year old Caucasian female pr...

Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with accelerated loss of lung function and death. Identification of patients at risk for these events, particularly those requiring hospitalization, is of major importance. Severe pulmonary hypertension is an important complication of advanced COPD and predicts acute exace...

To measure reader variability related to the evaluation of screening chest radiographs (CXRs) for findings of primary lung cancer. From the National Lung Screening Trial (NLST), 100 cases were randomly selected from baseline CXR examinations for retrospective interpretation by 9 NLST radiologists; images with noncalcified lung nodules (NCNs) or oth...

The purposes of this study were: to describe chest CT findings in normal non-smoking controls and cigarette smokers with and without COPD; to compare the prevalence of CT abnormalities with severity of COPD; and to evaluate concordance between visual and quantitative chest CT (QCT) scoring. Volumetric inspiratory and expiratory CT scans of 294 subj...

Two recent metaanalyses of genome-wide association studies conducted by the CHARGE and SpiroMeta consortia identified novel loci yielding evidence of association at or near genome-wide significance (GWS) with FEV(1) and FEV(1)/FVC. We hypothesized that a subset of these markers would also be associated with chronic obstructive pulmonary disease (CO...

The characterization of young adults who develop late-onset diseases may augment the detection of novel genes and promote new pathogenic insights. We analyzed data from 2,500 individuals of African and European ancestry in the COPDGene Study. Subjects with severe, early-onset chronic obstructive pulmonary disease (COPD) (n=70, age < 55 yr, FEV1 < 5...

To measure reader agreement in determining whether lung nodules detected at baseline screening computed tomography (CT) had changed at subsequent screening examinations and to evaluate the variability in recommendations for further follow-up. All subjects were enrolled in the National Lung Screening Trial (NLST), and each participant consented to t...

PURPOSE The aim of this study was to test the feasibility of performing adenosine augmented MDCT (AMDCT) using single source 64 detector scanner in a random population referred for SPECT and to compare the MDCT perfusion results with SPECT-MPI and coronary artery stenosis (CAS) METHOD AND MATERIALS This project was approved by our IRB. Consecutive...

COPD patients are at increased risk for cardiovascular morbidity and mortality independent of smoking habits. Recent studies suggest CT emphysema is an independent predictor of cardiovascular risk as evidenced by its association with arterial stiffness and impaired endothelial function. We examined the relationship between demographics, lung functi...

PURPOSE To retrospectively evaluate the accuracy of mathematical indices as shape descriptor of endo-myocardial border in both the right ventricle (RV) and left ventricle (LV) measured from ECG-gated multi-detector computed tomography angiography (MDCTA), in the prediction of pulmonary arterial pressure (PAP) in patients with pulmonary arterial hyp...

PURPOSE To retrospectively assess right ventricle (RV) contractility in longitudinal, radial and circumferential planes from ECG-gated multi-detector computed tomography angiography (MDCTA) and correlate with severity of increased RV systolic pressure (RVSP) determined from right-sided heart catheterization (RHC). METHOD AND MATERIALS Study group...

Coronary artery calcification (CAC) and thoracic aortic calcification, (TAC) are frequently detected on ungated multidetector computed tomography (MDCT) performed for lung evaluations. We sought to evaluate concordance of CAC and TAC scores on ungated (thoracic) and electrocardiogaphically (ECG)-gated (cardiac) MDCT scans. Fifty patients, enrolled...

PURPOSE To evaluate the relationship between the right heart catheterization, pulmonary artery distensibility, and diastolic right ventricular outflow tract (RVOT) wall thickness measured from ECG-gated 64-detector MDCT in patients with pulmonary hypertension (PHT) from different causes METHOD AND MATERIALS From our cardiac CT database we retrospe...

We sought to demonstrate the distinguishing features between interarterial and intraseptal courses of an anomalous left coronary artery from the right sinus of Valsalva (RSV) on X-ray angiography, using an ex vivo model. An anomalous left main coronary artery (LMCA) arising from the RSV can take prepulmonary, retro-aortic, interarterial (IA) or int...

The purpose of this study was to describe the effect of implementing an imaging quality assurance program on CT image quality in the Lung Screening Study component of the National Lung Screening Trial. The National Lung Screening Trial is a multicenter study in which 53,457 subjects at increased risk of lung cancer were randomized to undergo three...

PURPOSE In lung cancer screening, interpretation of f/u CT involves detecting new abnormalities and evaluating the status of previously noted nodules, including changes in size, attenuation and contour which may be subject to reader interpretation. This study examined, in a small subset of images, reader variability in assessment of changes in lung...

To evaluate agreement among radiologists on the interpretation of pulmonary findings at low-dose computed tomographic (CT) screening examinations for lung cancer. Institutional review board approval and informed consent were obtained. HIPAA guidelines were followed. Sixteen radiologists from the 10 National Lung Screening Trial screening centers of...

PURPOSE We describe variability in interpretation of baseline chest radiographs (CXRs) by radiologists in the Lung Screening Study (LSS) component of NLST. METHOD AND MATERIALS From about 17,000 participants in the CXR arm of LSS, 100 radiographs were randomly selected utilizing a stratified sampling scheme based on the original radiologist's inte...

We sought to determine the incidence and imaging features by coronary angiography and cardiac magnetic resonance imaging (MRI) of anomalies in which the right, circumflex, and left anterior descending coronary arteries arise separately from the right sinus of Valsalva. The anomalous origin of all major coronary arteries from separate ostia in the r...

The Lung Screening Study (LSS) was a pilot study designed to assess the feasibility of conducting a large scale randomized controlled trial (RCT) of low radiation dose spiral computed tomography (LDCT) versus chest X-ray (CXR) for lung cancer screening. Baseline results of LSS have been previously reported. Here, we report on the findings at the ye...

Low-radiation dose spiral computed tomography (LDCT) currently is being evaluated as a screening modality for lung carcinoma in a randomized trial. Although several diagnostic algorithms for the workup of positive LDCT screens have been proposed, to the authors' knowledge there is no widely accepted standard to date and there are few nationwide dat...

Introduction: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by fibrofatty replacement of the RV myocardium. Two imaging techniques used to assess patients suspected of having ARVC are magnetic resonance imaging (MRI) and right ventricular angiography (RVA). Traditionally, RVA has played a central role in the diagnosis of...

Coronary tracheal collaterals are often seen on annual surveillance coronary angiograms in patients with heart-lung transplants and represent a normal postoperative finding.

A 53 -year-old black man presented with recurrent episodes of hemoptysis, with 1.5 cups of bright red blood expectorated over a 2-day period. He denied having fever, chest pain, vomiting, night sweats, shortness of breath, or dizziness. He had had a dry cough for several months before admission to the hospital. He also had lost 40 lb from dieting i...

Fiberoptic bronchoscopy (FOB) is frequently used to diagnose and stage bronchogenic carcinoma (BC). However, the value of FOB in diagnosis/staging BC presenting as a pulmonary nodule or mass (PNM) is controversial. Since chest CT is usually obtained in these patients, it may be used in patient selection for preoperative FOB. Evaluation of the role...

Metastasis along the needle track (NTM) after a transthoracic needle biopsy (TNB) is considered a very rare complication. A survey of the membership of the Society of Thoracic Radiology and a review of the English-language literature were conducted to assess the incidence of this complication and its predisposing factors and natural history. A ques...

The purpose of this lesson is to discuss the natural history of usual pneumonias, factors that influence their resolution, and the differential diagnosis of their radiographic appearance. Suggestions for the judicious use of other imaging studies, such as computed tomography (CT) and lung biopsy, in the management of this vexing problem also are pr...

We report the usefulness of transesophageal echocardiography in evaluating a patient with sclerosing mediastinitis. The technique enabled us to identify a mass obstructing the superior vena cava and right upper and lower pulmonary veins, and infiltrating and invaginating into the left atrial cavity. Transesophageal echocardiography was superior to...

The posterior descending artery (PDA) arises from the right coronary artery (RCA) in approximately 85% of people; only in from 10 to 15% does it arise from the circumflex artery. We report an unusual case of origin of the PDA from a branch of the left anterior descending artery (LAD). The PDA passed through the interventricular septum before it rea...