AIM: To assess clinical performance with prospective implementation of the ST-RADS scoring and compare it to traditional descriptions. MATERIALS AND METHODS: Following prospective implementation of ST-RADS in the electro...AIM: To assess clinical performance with prospective implementation of the ST-RADS scoring and compare it to traditional descriptions. MATERIALS AND METHODS: Following prospective implementation of ST-RADS in the electronic dictation system, fellowship-trained musculoskeletal radiologists classified soft tissue tumors and tumor-like lesions routinely. This IRB-approved audit study included 236 consecutive patients with MRIs from 01/2023 to 05/2024 at a tertiary care center. Data on patient demographics, imaging findings, lesion characteristics, biopsy results, treatments, and clinical outcomes were collected. Diagnostic accuracy of ST-RADS versus descriptive reporting was compared using McNemar test. RESULTS: The cohort (mean age: 54.3 years; 61.02 % female) had both lower extremity (47.03 %) and upper extremity (37.29 %) masses. The distribution included ST-RADS I (2.12 %), ST-RADS II (36.86 %), ST-RADS III (22.03 %), ST-RADS IV (5.93 %), ST-RADS V (4.24 %), and ST-RADS VI (28.81 %). ST-RADS demonstrated superior diagnostic accuracy compared to descriptive reporting overall (99.15 % vs. 92.80 %, p=0.000) and also within biopsy-confirmed cases (97.73 % vs. 82.95 %, p=0.00098). For benign tumors (ST-RADS I-III), ST-RADS achieved 100 % accuracy compared to 93.75 % for descriptive reporting (p=0.003). For malignant tumors (ST-RADS IV-VI), ST-RADS also showed higher accuracy compared to descriptive reporting (96.74 % vs. 89.13 %), although difference did not reach statistical significance (p=0.109). CONCLUSIONS: Prospective application of the ST-RADS scoring system demonstrated significantly superior accuracy compared to traditional descriptive methods. These results advocate for broader implementation of ST-RADS in clinical practice as a standardized method for classifying musculoskeletal soft tissue tumors, providing standardized management recommendations, and longitudinal data collection for tracking patient outcomes.
AIM: Although MRI studies report sensitivity and specificity rates of 80-90 % in acute adnexal torsion, the proportion of patients without torsion undergoing emergency surgery following pelvic MRI is significantly higher...AIM: Although MRI studies report sensitivity and specificity rates of 80-90 % in acute adnexal torsion, the proportion of patients without torsion undergoing emergency surgery following pelvic MRI is significantly higher. This study aims to compare MRI findings between surgically confirmed torsion-positive and torsion-negative cases. MATERIALS AND METHODS: Paediatric patients who underwent pelvic MRI and emergency surgery were retrospectively reviewed. Thirteen distinct MRI features were visually scored. Additionally, measurements of both ovaries, ADC values, the stromal thickness of the affected ovary, and the predisposing lesion were recorded. Two paediatric radiologists independently evaluated the images without knowledge of surgical outcomes. In cases of disagreement, a final consensus was reached with the involvement of an experienced abdominal radiologist. RESULTS: Among 64 surgically treated patients, 31 (48.4 %) had torsion. MRI of 58 patients (29 torsion-positive) was deemed of sufficient quality. All categorical variables significantly differed between groups, with the most indicative feature being the presence of a twisted pedicle (p<0.05). Differences were observed in T2-weighted, T1-weighted, and post-contrast ovarian parenchymal findings (p<0.05), whereas free fluid (p=0.352) and predisposing cysts (p=0.467) did not show significant differences. Ovarian size, volume, and ADC measurements were significantly different (p<0.05). ROC analysis identified stromal thickness as the most discriminative, with an AUC of 0.85. CONCLUSIONS: In cases where ultrasound is inconclusive, MRI provides high accuracy and interobserver agreement for acute adnexal torsion. While all ovarian and pedicle-related findings were significantly different between groups, the most diagnostically relevant features were the presence of a twisted pedicle, increased ovarian long-axis diameter, stromal thickening, and T2-weighted hypointense stroma.
AIM: This study aims to survey the provision of Interventional Oncology (IO) services in the UK and compare the results to survey data collected in 2016. MATERIALS AND METHODS: A cross-sectional multicentre study of the...AIM: This study aims to survey the provision of Interventional Oncology (IO) services in the UK and compare the results to survey data collected in 2016. MATERIALS AND METHODS: A cross-sectional multicentre study of the provision of IO services was conducted across all interventional radiology (IR) departments in the UK. Data were collected using an electronic survey tool and executed via the UNITE Collaborative. IO procedures were defined using the Royal College of Radiologists classification categories. For each IR department information regarding demographic details, current IO procedures, equipment, and relevant infrastructure was collected. Thereafter, responses were compared to survey data collected in 2016. RESULTS: A total of 169 hospital boards were invited to participate, 132 (78%) of which responded stating they had an IR department, while 29 (17%) responded stating they had no IR department and 8 (5%) provided no response. Of the hospital boards with IR departments, 49% (n=65/132) provided both disease-modifying and supportive/symptomatic procedures and 51% (n=67/132) offered only supportive/symptomatic procedures. Compared to 2016, there was a modest increase in the provision of disease-modifying procedures with the largest growth seen in transarterial chemoembolisation (+9%), selective internal radiation therapy (+7%), and renal ablation (+8%). CONCLUSION: Over the last 8 years, the provision of IO services across the UK has only marginally grown in both supportive and disease-modifying domains. This study highlights the urgent need to identify and address barriers preventing access to IO procedures to ensure the UK population can benefit from modern, evidence-based IO care.
AIM: Although standardized 3D volume rendering techniques (VRT) and embolization guidance visualize and identify tumor-feeding arteries, current vessel tracking software lacks automatic angle recommendations. This forces...AIM: Although standardized 3D volume rendering techniques (VRT) and embolization guidance visualize and identify tumor-feeding arteries, current vessel tracking software lacks automatic angle recommendations. This forces an operator, e.g. an interventional radiologist, to leave an ongoing procedure to manually manipulate the system and find the best angle for each feeding vessel-requiring time-consuming re-scrubbing. We propose a computer vision algorithm that suggests a rotation/angle in the VRT where a tumor-feeding artery's view is maximized. We focus on hepatocellular carcinoma. METHODS: Our algorithm accepts a series of post-embolization guidance frames extracted from the 3D VRT; the VRT is rotated in 5° intervals from, e.g., ±15°, fixing one axis (e.g. CRAN/CAUD) and rotating the other (e.g. LAO/RAO). Our algorithm segments the embolization guidance line and recommends 4 views/angles by maximizing the features of line length (contour area) and convex hull area. We developed/iterated our algorithm using 19 patient cases and feedback from various experts. RESULTS: Over a 50-patient internal validation set, according to an interventional radiologist with 33 years of experience, a view/angle sufficient for the embolization task was always present among the top-4 views/angles suggested by our algorithm (100% retrieval relevance). CONCLUSION: Sufficient view/angle selection for hepatic artery embolization can be achieved using traditional computer vision. Our technique is much faster and more explainable than deep learning approaches, and could greatly improve radiologists' procedural efficiency. We recommend conducting a larger study with more patients and further technical iteration.
AIM: To evaluate the practice of Radiology Events and Learning Meetings (REALMs) in the National Health Service Radiology Departments (NHSRDs) and teleradiology companies (TRCs) servicing the UK market. MATERIALS AND MET...AIM: To evaluate the practice of Radiology Events and Learning Meetings (REALMs) in the National Health Service Radiology Departments (NHSRDs) and teleradiology companies (TRCs) servicing the UK market. MATERIALS AND METHODS: A national audit measuring the conduct of REALMs against standards derived from the Royal College of Radiologist (RCR) document "Standards for radiology events and learning meetings". Data collection was completed in October 2024. RESULTS: The response rate was 73 % (146/200) from NHSRDs and 100 % from TRCs (6/6). Most (97 %) NHSRDs and all six TRCs had a REALM. They occurred more frequently within the NHSRD with 72 % conducting 6 or more meetings a year compared to 33 % of TRCs. A REALM coordinator was present in 96 % of NHSRDs and 67 % of TRCs. Feedback to the primary reporter occurred in 85 % of NHSRDs and 83 % of TRCs. Only 33 % of NHSRDs and 50 % of TRCs disseminated learning points to radiologists. Lack of protected time was a barrier to REALM in 33 % of NHSRDs and remote working an issue for TRCs (50 %). REALM was still used for governance processes in 39 % of NHSRDs in contravention of the RCR guidance. CONCLUSION: There was excellent uptake of the REALM in both NHSRDs and TRCs. The frequency of meetings was higher, and the appointment of a formal REALM chair was more likely in NHSRDs compared to TRCs. Dissemination of the learning points from REALM, ensuring there is protected time for these meetings, and keeping REALM separate to governance processes were some of the key areas identified to ameliorate.
AIM: To quantify regional LV deformation parameters in subjects with chronic myocardial infarction (MI) by the combination of CMR feature tracking (CMR-FT) and LGE images to assess segmental myocardial function in remote...AIM: To quantify regional LV deformation parameters in subjects with chronic myocardial infarction (MI) by the combination of CMR feature tracking (CMR-FT) and LGE images to assess segmental myocardial function in remote myocardium and to evaluate their relationships with infarct size and post-infarction LV global function. MATERIALS AND METHODS: CMR-images (SSFP cine and LGE) were acquired from 34 chronic MI patients and 32 healthy volunteers included in this retrospective study. LV ejection fraction (LVEF), infarct size (IS), CMR-FT regional circumferential, radial and longitudinal strain (CS, RS, LS), time-to-peak strain (TTP-CS, TTP-RS, TTP-LS) and rotation were measured. RESULTS: CS, RS and LS were greater for remote, adjacent and border zones than for infarct areas (p<0.01); TTP-CS, TTP-RS and TTP-LS values were shorter for remote and border zones than for infarct areas (p<0.05). Maximum apical rotation was found at the border zone (p<0.05). Remote CS, RS and LS in MI were significantly lower than in healthy subjects (p<0.01). Remote CS and LS correlated with IS (CS: r=0.75, LS: r=0.82, p<0.0001) and LVEF (CS: r=-0.87, LS: r=-0.83, p<0.001). In ROC analysis for the detection of contractile dysfunction in RM, IS and LVEF performed best with AUCs of 0.98 and 0.94, showing cut-off values of 17 % and 54 %, respectively. CONCLUSIONS: Quantitative assessment of LV strain and rotation provides deformation characteristics of infarct, border and remote areas in patients with chronic MI, relating contractile dysfunction in remote areas to the extent of the infarcted region, which could offer useful clinical insights into the LV remodeling process.
BACKGROUND: Mechanical thrombectomy (MT) is an effective treatment in a large vessel acute ischaemic stroke. Despite its established efficacy, many United Kingdom (UK) centres still face challenges in providing extended...BACKGROUND: Mechanical thrombectomy (MT) is an effective treatment in a large vessel acute ischaemic stroke. Despite its established efficacy, many United Kingdom (UK) centres still face challenges in providing extended and 24/7 MT access, partly due to workforce constraints. Training interventional radiologists (IRs) in MT may represent a promising alternative to address the shortfall of trained operators. MATERIALS AND METHODS: This retrospective single-centre study analysed consecutive patients with large vessel occlusion undergoing MT between December 2017 and November 2023. This included a model of MT delivery involving IR and interventional neuroradiologists (INRs) jointly. Outcomes included successful revascularisation (modified Thrombolysis in Cerebral Infarction score ≥2b), first-pass effect, procedural time, 90-day modified Rankin Scale (mRS) scores, symptomatic intracranial haemorrhage (sICH), and mortality. A regression model was employed to calculate propensity scores using age, the Alberta Stroke Program Early CT Score , and clot location as variables for efficacy and safety outcomes. RESULTS: Of 252 procedures, IRs performed 50, while INRs performed 62 cases independently. Post-propensity matching, 90-day functional independence (mRS: 0-2) was similar (IRs 61.1 % vs INRs 60.0 %; P=.924). Outcomes such as successful reperfusion (IRs: 86.5 % vs INRs: 81.6 %; P=.562), puncture to reperfusion time (33 vs 28 minutes; P=.192), and sICH (5.4 % vs 0.0 %; P=.146) did not significantly differ. Operator type did not predict a favourable mRS score (0-2) in a logistic regression model. CONCLUSION: Vascular IRs with structured MT training and local governance evaluation achieved comparable outcomes to INRs within a UK real-world practice. These findings support the role of IRs in addressing workforce gaps and expanding access towards 24/7 MT availability.
AIM: Cerebral small vessel disease (CSVD) is a disorder of cerebral microvessels defined by clinical presentation and imaging that affects cerebral small arteries, arterioles, capillaries, and venules. Previous studies o...AIM: Cerebral small vessel disease (CSVD) is a disorder of cerebral microvessels defined by clinical presentation and imaging that affects cerebral small arteries, arterioles, capillaries, and venules. Previous studies on CSVD were mainly focused on cerebral small arteries; however, there are only a few reports on the association between deep medullary veins (DMVs) and CSVD, especially the association between the number of DMVs and one of the imaging makers of CSVD-brain atrophy. The aim of this study is to investigate the relationship between DMVs and brain atrophy using 3.0T magnetic resonance images (MRI). MATERIAL AND METHODS: We analyzed the complete clinical and imaging data of 101 hospitalized patients diagnosed with CSVD. DMVs was identified in the periventricular area using susceptibility-weighted imaging (SWI). Brain atrophy was assessed using voxel-based morphometry (VBM) calculations of gray matter (GM), white matter (WM), and cerebrospinal fluid volume fractions. RESULTS: Our results showed that the number of DMVs was significantly correlated with GM fraction (β = 0.315, P = 0.019, adjusted for age, hypertension, diabetes mellitus, and WM fraction). We also found that with increase in CSVD burden, there was no statistically significant association between the number of DMVs and GM fraction (β = 0.071, P = 0.688, adjusted for age, hypertension, diabetes mellitus, and WM fraction). CONCLUSION: Our results provide evidence that fewer DMVs are associated with a smaller GM fraction in patients with a low burden of CSVD (β = 0.604, P = 0.008, adjusted for age, hypertension, diabetes mellitus, and WM fraction), while the number of DMVs is associated with brain atrophy and the progression of CSVD.
AIM: Accurate differentiation true true progression (TP) and treatment response (TR) in high-grade gliomas (HGGs) remains challenging due to confounding alterations in tumour parenchymal areas. Evaluation of non-enhancin...AIM: Accurate differentiation true true progression (TP) and treatment response (TR) in high-grade gliomas (HGGs) remains challenging due to confounding alterations in tumour parenchymal areas. Evaluation of non-enhancing peritumoural regions (NEPTRs) plays a prominent role. This study aimed to assess diagnostic accuracy in distinguishing TP from TR by quantifying perfusion and diffusion differences in NEPTRs imaged with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion tensor imaging (DTI). MATERIALS AND METHODS: Patients who had newly enhanced lesions or had developed enhanced lesions were retrospectively enrolled. All patients had undergone conventional imaging sequences, DTI, and DCE. Histopathological diagnosis or longitudinal clinical and imaging follow-up over 6 months was used to distinguish TP from TR. Volume transfer contrast (Ktrans), extravascular extracellular volume fraction (Ve), initial area under the time concentration curve (iAUC), fractional anisotropy (FA), and apparent diffusion coefficient (ADC) were measured in enhanced lesions and NEPTRs. Student's t-tests and receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic performance. RESULTS: TP lesions displayed higher Ktrans, Ve, and iAUC and lower FA and ADC values in the enhanced lesions. Moreover, significantly higher Ktrans and lower FA values were found in NEPTRs associated with TP. The Ktrans from DCE of enhanced lesions and the FA from DTI of NEPTRs showed high diagnostic efficacies of 0.875 and 0.861, respectively. Notably, the area under the ROC curve of Ktrans in NEPTRs reached 0.831. The combined diagnostic performance of the three parameters reached 0.983, with 96.7% sensitivity and 92.9% specificity. CONCLUSION: By quantifying perfusion and diffusion in enhanced lesions and NEPTRs, DCE in combination with DTI imaging can distinguish TP from TR.
AIM: To report imaging findings of Sinus of Valsalva (SOV) aneurysms (SOVAs), their complications, and additional vascular/cardiac findings on CT angiography. MATERIALS AND METHODS: A retrospective review of 12,568 CT co...AIM: To report imaging findings of Sinus of Valsalva (SOV) aneurysms (SOVAs), their complications, and additional vascular/cardiac findings on CT angiography. MATERIALS AND METHODS: A retrospective review of 12,568 CT coronary angiograms and aortograms (electrocardiographic (ECG) gated and non-gated) between December 2021 and December 2024, and acquired on a 192 dual-source/energy CT scanner, was performed. Patients diagnosed with SOVAs were recorded and analyzed in detail. RESULTS: Among the 12,568 cases, 34 cases had SOVAs. There were 29 males and 5 females, with a mean age of 37.38 (Range, 13-67 years). The incidence of SOVAs was 0.27 %. Twenty-eight patients (82 %) had congenital aneurysms, while six patients (18 %) had acquired aneurysms. Fourteen patients (41.3 %) were clinically silent, while the remaining 20 patients were symptomatic, of whom 13 had ruptured SOVAs. Breathlessness was the most common clinical presentation, observed in 10 patients (29.4 %), followed by palpitations in 7 (20.5 %), and chest pain in 3 patients (8.8 %). On CT angiography, congenital SOVAs were diagnosed in 28 patients, and the right SOVAs were the most common (n=14). Unruptured aneurysms were more common (21 patients; 61.7 %). Of the ruptured aneurysms (n=13), type V aneurysms constituted the majority (n=5; 38 %). CONCLUSION: SOVAs can have catastrophic presentations if not diagnosed and treated promptly. CT angiograms with current multi- or dual-source CT scanners enable the precise diagnosis of SOVAs, predict impending rupture and complications due to compression or rupture, and explicitly demonstrate their relationship with surrounding structures. This article comprehensively enumerates the imaging features of SOVAs on CT angiography.
AIM: To evaluate the impact of a single-energy metal artifact reduction algorithm on image quality in lower extremity CT angiography (CTA) of patients with metallic implants. MATERIALS AND METHODS: This retrospective, si...AIM: To evaluate the impact of a single-energy metal artifact reduction algorithm on image quality in lower extremity CT angiography (CTA) of patients with metallic implants. MATERIALS AND METHODS: This retrospective, single-center study included patients with metallic implants in the lower extremity who underwent lower extremity CTA between January 2021 and December 2024. All scans were performed on a 320-detector row CT scanner. Standard images were reconstructed with hybrid iterative reconstruction, and an additional reconstruction was performed with a projection-based single-energy metal artifact reduction (SEMAR) algorithm. Objective image quality was assessed by measuring image noise in target tissues (arteries, muscle, subcutaneous fat, cortical bone, medullary bone) on both standard and SEMAR images. Subjective image quality was evaluated for arteries, muscle, and bone using a 5-point scale. Scores ≥4 were considered diagnostic. Paired t-tests or Wilcoxon signed-rank tests were used for comparisons, as appropriate RESULTS: The study group included 30 patients. SEMAR reconstruction significantly reduced image noise and artifact index in all evaluated tissues compared to standard images with objective assessment (p<0.001 for each target tissue). Subjective evaluation of diagnostic-quality showed marked improvements with the SEMAR algorithm for each target tissue compared to the standard images using a 5-point scale (p<0.001 for each). For arterial structures, only 5 of 30 cases (16.6 %) were considered diagnostic on the standard images (score 4 or 5), whereas with SEMAR 28 of 30 cases (93.3 %) were diagnostic. CONCLUSIONS: SEMAR significantly reduced artifacts and image noise, restoring diagnostic image quality for vessels and surrounding tissues.
AIM: While the field of interventional radiology (IR) has seen significant advancements in recent years, there remains a stark gender gap within the subspeciality. The study aims to evaluate how the gender composition of...AIM: While the field of interventional radiology (IR) has seen significant advancements in recent years, there remains a stark gender gap within the subspeciality. The study aims to evaluate how the gender composition of the faculty at the UK's national IR scientific meeting has evolved over a decade. MATERIAL AND METHODS: A faculty list, including all speakers and moderators, of the British Society of Interventional Radiology Annual Scientific Meeting (BSIR ASM) from 2013 to 2022 was retrieved from program handbooks. The demographics of the faculty members and the organising committee (Scientific Programme Committee [SPC]) were obtained from institutional or personal professional websites. The primary aim of the study was to assess the percentage change of male versus female faculty at the BSIR ASM over this time. RESULTS: The number of female faculty grew from 1 to 22 from 2013 to 2022, an increase from 5.9% to 30.8%. Notably, there was a drop in female faculty during the COVID-19 pandemic (27% in 2019 before the pandemic vs 22.8% in 2021). Trendlines fitted with and without data from the COVID-19 years are shown. Overall, there was a mean increase of 3% of female faculty at the ASM each year. The highest percentage of women in SPC was 50%. CONCLUSION: Despite the continuing gender gap in IR trainee and consultant numbers, there has been a positive trend in female representation at the faculty level at this meeting over the decade. It is important to continue to address the factors which contribute to the gap and consider different ways of strengthening female recruitment and retention within IR.
AIM: The aim of this study was to assess the agreement and diagnostic accuracy of structured preoperative computed tomography (CT) findings compared to intraoperative findings in advanced ovarian cancer patients undergoi...AIM: The aim of this study was to assess the agreement and diagnostic accuracy of structured preoperative computed tomography (CT) findings compared to intraoperative findings in advanced ovarian cancer patients undergoing primary or interval cytoreductive surgery. MATERIALS AND METHODS: Patients with CT scans suggesting advanced ovarian cancer were enrolled in the study. Agreement between CT reports, reviewed using European Society of Urogenital Radiology (ESUR) criteria, and surgical findings were evaluated with the kappa coefficient. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each radiologic feature. RESULTS: From February 2018 to September 2020, 258 patients with International Federation of Gynaecology and Obstetrics (FIGO) stage IIIB-IV epithelial ovarian cancer were enrolled. Agreement between ESUR-reviewed CT reports and surgical findings was slight to fair (kappa = 0.115-0.352). The most common CT findings were peritoneal carcinomatosis, omental metastases, and bowel involvement. Sensitivity and specificity of peritoneal carcinomatosis were 0.91 (95% confidence interval [CI]: 0.86-0.94) and 0.19 (95% CI: 0.10-0.31), with an area under the receiver operating characteristic curve (AUC) of 0.55 (95% CI: 0.46-0.64). Omental metastases had a sensitivity of 0.91 (95% CI: 0.87-0.95) and specificity of 0.27 (95% CI: 0.16-0.40) with an AUC of 0.59 (95% CI: 0.52-0.65). Bowel involvement showed a sensitivity of 0.61 (95% CI: 0.54-0.67), specificity of 0.71 (95% CI: 0.58-0.83), and AUC of 0.66 (95% CI: 0.58-0.74). CONCLUSION: This study demonstrates limited concordance between ESUR-reviewed CT reports and intraoperative findings in advanced ovarian cancer. Even when interpreted by expert radiologists, CT imaging alone may inadequately reflect disease burden. These findings emphasise the ongoing challenges of imaging-based surgical planning and support the need for further development and validation of more accurate preoperative assessment tools.
PURPOSE: To estimate mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) using cardiac magnetic resonance (CMR) in connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH...PURPOSE: To estimate mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) using cardiac magnetic resonance (CMR) in connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH). MATERIALS AND METHODS: This retrospective study included 144 CTD patients (50 CTD-nonPAH, 70 CTD-PAH derivation, 24 CTD-PAH validation) from September 2017 to March 2024. Patients underwent both CMR and right heart catheterization (RHC) within 7 days. CMR parameters, including ventricular volumes, and pulmonary arterial hemodynamics, were measured and compared with RHC-derived mPAP and PVR. Multivariate regression models for mPAP and PVR were developed and validated. Spearman's correlation and Bland-Altman analysis were used to assess model accuracy. RESULTS: Ventricular mass index (VMI), interventricular septum (IVS) angle, and IVS curvature correlated strongly with RHC-based mPAP (r=0.73, 0.71, and -0.69; all P<0.01). A right ventricular ejection fraction (RVEF) threshold of 22 % was identified: when RVEF > 22 %, mPAP and RVEF were negatively correlated (P<0.001); no correlation was found when RVEF ≤ 22 % (P=0.657). For RVEF > 22 %, the following CMR model was established to predict mPAP: 32.454 + (42.616 × VMI) - (19.276 × IVS curvature). Another CMR model for predicting PVR was developed: 8.664 + (28.495 × VMI) - (0.053 × RVESVI) - (7.206 × RV SV/ESV). Validation demonstrated good correlations with RHC (mPAP: r=0.679; PVR: r=0.625, both P≤0.001). Bland-Altman analysis confirmed agreement between CMR and RHC. CONCLUSIONS: CMR provides a noninvasive method for estimating mPAP and PVR in CTD-PAH patients, with potential utility in pulmonary hemodynamic assessment.