{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:02:06Z","timestamp":1792789326516,"version":"4.5.0"},"reference-count":30,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Science and Technology, Taiwan","award":["MOST 113-2314-B-002-038-MY3"],"award-info":[{"award-number":["MOST 113-2314-B-002-038-MY3"]}],"id":[{"id":"https:\/\/ror.org\/02kv4zf79","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Ministry of Science and Technology, Taiwan","award":["MOST 113-2321-B-002-044"],"award-info":[{"award-number":["MOST 113-2321-B-002-044"]}],"id":[{"id":"https:\/\/ror.org\/02kv4zf79","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Ministry of Science and Technology, Taiwan","award":["MOST 114-2811-B-002-207"],"award-info":[{"award-number":["MOST 114-2811-B-002-207"]}],"id":[{"id":"https:\/\/ror.org\/02kv4zf79","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Ministry of Science and Technology, Taiwan","award":["MOST 114-2321-B-002-021"],"award-info":[{"award-number":["MOST 114-2321-B-002-021"]}],"id":[{"id":"https:\/\/ror.org\/02kv4zf79","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Ministry of Science and Technology, Taiwan","award":["MOST 115-2628-B-002-027-MY3"],"award-info":[{"award-number":["MOST 115-2628-B-002-027-MY3"]}],"id":[{"id":"https:\/\/ror.org\/02kv4zf79","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Taiwan University Hospital","award":["MS441"],"award-info":[{"award-number":["MS441"]}],"id":[{"id":"https:\/\/ror.org\/03nteze27","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Taiwan University Hospital","award":["114O0006"],"award-info":[{"award-number":["114O0006"]}],"id":[{"id":"https:\/\/ror.org\/03nteze27","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Taiwan University Hospital","award":["114-CTC0029"],"award-info":[{"award-number":["114-CTC0029"]}],"id":[{"id":"https:\/\/ror.org\/03nteze27","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Taiwan University Hospital","award":["CTC115(MQ999)"],"award-info":[{"award-number":["CTC115(MQ999)"]}],"id":[{"id":"https:\/\/ror.org\/03nteze27","id-type":"ROR","asserted-by":"crossref"}]},{"award":["MS441"],"award-info":[{"award-number":["MS441"]}],"id":[{"id":"https:\/\/ror.org\/03nteze27","id-type":"ROR","asserted-by":"publisher"}]},{"award":["114O0006"],"award-info":[{"award-number":["114O0006"]}],"id":[{"id":"https:\/\/ror.org\/03nteze27","id-type":"ROR","asserted-by":"publisher"}]},{"award":["114-CTC0029"],"award-info":[{"award-number":["114-CTC0029"]}],"id":[{"id":"https:\/\/ror.org\/03nteze27","id-type":"ROR","asserted-by":"publisher"}]},{"award":["CTC115(MQ999)"],"award-info":[{"award-number":["CTC115(MQ999)"]}],"id":[{"id":"https:\/\/ror.org\/03nteze27","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009210","name":"Taiwan Food and Drug Administration","doi-asserted-by":"publisher","award":["MOHW115-FDA-D-212-134451"],"award-info":[{"award-number":["MOHW115-FDA-D-212-134451"]}],"id":[{"id":"10.13039\/100009210","id-type":"DOI","asserted-by":"publisher"}]},{"award":["MOHW115-FDA-D-212-134451"],"award-info":[{"award-number":["MOHW115-FDA-D-212-134451"]}],"id":[{"id":"https:\/\/ror.org\/0250say61","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Reliable predictors of perioperative risk beyond symptomatology in bronchogenic cyst (BC) resection are lacking. We aimed to compare perioperative outcomes across different imaging features to identify perioperative risk factors. Methods: We conducted a retrospective cohort study of 57 patients who underwent pathologically confirmed BC resection at a single tertiary center from 2004 to 2023. Preoperative unenhanced CT images were retrospectively reviewed for four prespecified imaging features. Only unenhanced images were used for imaging-feature classification and Hounsfield-unit measurement. Patients were stratified into two groups based on the presence (n = 19) or absence (n = 38) of abnormal features. The prespecified primary perioperative outcomes were peri-cystic adhesion, operative time, estimated intraoperative blood loss, and intensive care unit (ICU) length of stay. Secondary outcomes included chest-tube duration, postoperative hospital length of stay, major intraoperative complications, 30-day postoperative complications, and recurrence. Results: The abnormal image-feature group had a higher prevalence of male patients, symptomatic presentation, and larger cysts. Nineteen patients (33%) had at least one abnormal CT feature. Patients with abnormal CT features had significantly higher peri-cystic adhesion rates (68% vs. 34%; p = 0.015), longer mean operative times (128 \u00b1 60 vs. 87 \u00b1 35 min; p = 0.011), greater blood loss (100 \u00b1 150 vs. 4 \u00b1 24 mL; p = 0.012), and prolonged intensive care unit stays (0.84 \u00b1 1.21 vs. 0.05 \u00b1 0.23 days; p = 0.011) than those with normal imaging. No significant differences were observed in outcomes of chest-tube duration, postoperative hospital length of stay, or recurrence. The presence of abnormal features and cyst size remained significant in multivariate models. Conclusions: Abnormal imaging features on non-contrast CT and cyst size are associated with more challenging perioperative courses in BC resection. Incorporating these imaging features into preoperative assessment may enhance risk stratification and guide surgical approach decisions in the CT screening era.<\/jats:p>","DOI":"10.3390\/diagnostics16183000","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T10:09:17Z","timestamp":1789553357000},"page":"3000","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Unenhanced CT Features and Perioperative Outcomes in Bronchogenic Cyst Resection"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6065-8421","authenticated-orcid":false,"given":"Kai-Man","family":"U","sequence":"first","affiliation":[{"name":"Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei 100225, Taiwan"},{"name":"Division of Thoracic Surgery, Department of Surgery, Fu Jen Catholic University Hospital, New Taipei City 24352, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9512-5409","authenticated-orcid":false,"given":"Pei-Hsing","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei 100225, Taiwan"},{"name":"Institute of Biomedical Engineering, National Taiwan University, Taipei 10617, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0594-3732","authenticated-orcid":false,"given":"Min-Shu","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Department of Pathology, National Taiwan University Hospital, Taipei 100225, Taiwan"},{"name":"Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei 10051, Taiwan"},{"name":"Department of Pathology, National Taiwan University Cancer Center, Taipei 106037, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4262-8712","authenticated-orcid":false,"given":"Yu-Sen","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, National Taiwan University Hospital, Taipei 100225, Taiwan"},{"name":"Department of Radiology, National Taiwan University College of Medicine, Taipei100225, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3697-0386","authenticated-orcid":false,"given":"Tzu-Pin","family":"Lu","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei 100225, Taiwan"},{"name":"Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100225, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"given":"Hsao-Hsun","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei 100225, Taiwan"},{"name":"Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei 106037, 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Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1056\/NEJMoa1911793","article-title":"Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial","volume":"382","author":"Scholten","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1001\/jamainternmed.2023.1116","article-title":"Significant incidental findings in the national lung screening trial","volume":"183","author":"Gareen","year":"2023","journal-title":"JAMA Intern. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1513\/AnnalsATS.201612-1023OC","article-title":"Frequency of incidental findings and subsequent evaluation in low-dose computed tomographic scans for lung cancer screening","volume":"14","author":"Morgan","year":"2017","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1510\/icvts.2010.233114","article-title":"Should asymptomatic bronchogenic cysts in adults be treated conservatively or with surgery?","volume":"11","author":"Kirmani","year":"2010","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1378\/chest.106.1.79","article-title":"Presentation and management of bronchogenic cysts in the adult","volume":"106","author":"Patel","year":"1994","journal-title":"Chest"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4873","DOI":"10.1245\/s10434-022-11483-7","article-title":"Primary tumor resection for Stage IV non-small-cell lung cancer without progression after first-line epidermal growth factor receptor-tyrosine kinase inhibitor treatment: A retrospective case\u2013control study","volume":"29","author":"Kuo","year":"2022","journal-title":"Ann. Surg. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Chen, P.-H., Chuang, J.-H., Lu, T.-P., Hung, W.-T., Liao, H.-C., Tsai, T.-M., Lin, M.-W., Chen, K.-C., Hsu, H.-H., and Chen, J.-S. (2022). Non-intubated versus intubated video-assisted thoracic surgery in patients aged 75 years and older: A propensity matching study. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.880007"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.jfma.2019.07.004","article-title":"Clinical outcome of subcentimeter non-small cell lung cancer after VATS resection: Single institute experience with 424 patients","volume":"119","author":"Tsou","year":"2020","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1016\/j.athoracsur.2018.07.030","article-title":"Preoperative dye localization for thoracoscopic lung surgery: Hybrid versus computed tomography room","volume":"106","author":"Chen","year":"2018","journal-title":"Ann. Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"225","DOI":"10.5761\/atcs.oa.20-00244","article-title":"Prognostic factors and long-term results in patients who underwent videothoracoscopic bronchogenic cyst excision","volume":"27","author":"Aker","year":"2021","journal-title":"Ann. Thorac. Cardiovasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1016\/j.athoracsur.2020.05.031","article-title":"Resection of bronchogenic cysts in symptomatic versus asymptomatic patients: An outcome analysis","volume":"112","author":"Fievet","year":"2021","journal-title":"Ann. Thorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1148\/radiology.217.2.r00nv19441","article-title":"Bronchogenic cyst: Imaging features with clinical and histopathologic correlation","volume":"217","author":"McAdams","year":"2000","journal-title":"Radiology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/0003-4975(91)90848-K","article-title":"Primary cysts and tumors of the mediastinum","volume":"51","author":"Cohen","year":"1991","journal-title":"Ann. Thorac. Surg."},{"key":"ref_15","first-page":"m2917","article-title":"Prospective validation of classification of intraoperative adverse events (ClassIntra): International, multicentre cohort study","volume":"370","author":"Gomes","year":"2020","journal-title":"BMJ"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-Dindo classification of surgical complications: Five-year experience","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1007\/BF02482273","article-title":"Clinical features and management of bronchogenic cysts: Report of 17 cases","volume":"29","author":"Kanemitsu","year":"1999","journal-title":"Surg. Today"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s00408-007-9056-4","article-title":"Pulmonary and mediastinal bronchogenic cysts: A clinicopathologic study of 33 cases","volume":"186","author":"Djilani","year":"2008","journal-title":"Lung"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.ejcts.2009.03.041","article-title":"Thoracoscopic resection of mediastinal bronchogenic cysts in adults","volume":"36","author":"Diso","year":"2009","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/j.athoracsur.2004.03.092","article-title":"Video-assisted thoracoscopic surgery of mediastinal bronchogenic cysts in adults: A single-center experience","volume":"78","author":"Weber","year":"2004","journal-title":"Ann. Thorac. Surg."},{"key":"ref_21","unstructured":"Sharma, S., Limaiem, F., Collier, S.A., and Mlika, M. (2024). Bronchogenic cyst. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/S0929-6646(09)60210-2","article-title":"Intrapulmonary bronchogenic cysts: Computed tomography, clinical and histopathologic correlations","volume":"106","author":"Chang","year":"2007","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Ma, T.-T., Chen, G., Wang, D., Xu, H., and Zhang, J.-G. (2023). Clinical and imaging characteristics of patients with bronchogenic cysts: A single-center retrospective analysis. BMC Med. Imaging, 23.","DOI":"10.1186\/s12880-023-01042-1"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1148\/radiol.2473062124","article-title":"Multidetector CT evaluation of congenital lung anomalies","volume":"247","author":"Lee","year":"2008","journal-title":"Radiology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1093\/icvts\/ivu228","article-title":"Video-assisted thoracic surgery for bronchogenic cysts: Is this the surgical approach of choice?","volume":"19","author":"Jung","year":"2014","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1016\/j.athoracsur.2012.06.042","article-title":"Bronchogenic cyst: Best time for surgery?","volume":"94","author":"Fievet","year":"2012","journal-title":"Ann. Thorac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"26","DOI":"10.21037\/med-22-46","article-title":"Bronchogenic cysts: A narrative review","volume":"7","author":"Gross","year":"2023","journal-title":"Mediastinum"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1016\/j.athoracsur.2009.01.049","article-title":"Video-assisted mediastinoscopic drainage of a bronchogenic cyst presenting with cardiac dysfunction","volume":"88","author":"Aslam","year":"2009","journal-title":"Ann. Thorac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1016\/0003-4975(92)90412-W","article-title":"Asymptomatic bronchogenic cysts: What is the best management?","volume":"53","author":"Bolton","year":"1992","journal-title":"Ann. Thorac. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"17","DOI":"10.17116\/endoskop20202606117","article-title":"Videothoracoscopic interventions for tumors and cysts of the mediastinum","volume":"26","author":"Topolnitsky","year":"2020","journal-title":"Endosk. Khirurgiya"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/3000\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:24:26Z","timestamp":1789705466000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/3000"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":30,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diagnostics16183000"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16183000","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]}}}