Cardiothoracic Imaging: Recent Techniques and Applications in Diagnostics

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 16821

Special Issue Editor

Special Issue Information

Dear Colleagues,

Cardiothoracic imaging has always attracted enormous interest not only among radiologists but also among clinicians, due to the technological innovations applied to cardiothoracic imaging. In fact, recent technological progress has allowed a significant increase in the diagnostic accuracy of cardiothoracic imaging methods, unthinkable until a few years ago. New CT and MR scanners have reached such high levels of technology and performance as to revolutionize diagnostic imaging of the heart, lungs, and large and small vessels in elective and emergency setting. New CT scanners with clear dose savings and time-saving technology are becoming safer and allow more accurate diagnosis in emergencies by directing clinicians towards the most appropriate therapeutic management, while the latest generation of MR scanners and new postprocessing software make cardiac MRI an increasingly one-stop-shop method in many heart diseases.

Finally, it is necessary to mention how artificial intelligence, radiomics, and deep learning have also become a hot topic in chest imaging, e.g., in lung cancer, pneumonia, or diffuse pulmonary disease.

Therefore, the aim of this Special Issue is to show how new technology applied to radiology can improve imaging diagnostic accuracy in more frequent, often life-threatening, but also less common cardiothoracic diseases.

Dr. Giacomo Sica
Guest Editor

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Keywords

  • emergency
  • cardiac imaging
  • thoracic imaging
  • aorta
  • MRI
  • CT
  • radiomics
  • artificial intelligence
  • ILD

Published Papers (10 papers)

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Editorial

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3 pages, 157 KiB  
Editorial
Editorial for the Special Issue “Cardiothoracic Imaging: Recent Techniques and Applications in Diagnostics”
by Giacomo Sica, Gaetano Rea and Mariano Scaglione
Diagnostics 2024, 14(5), 461; https://doi.org/10.3390/diagnostics14050461 - 20 Feb 2024
Viewed by 601
Abstract
Technology is making giant strides and is increasingly improving the diagnostic imaging of both frequent and rare acute and chronic diseases [...] Full article

Research

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13 pages, 5998 KiB  
Article
ECG-Gated CCTA in the Assessment of Post-Procedural Complications
by Carlo Liguori, Giulia Lassandro, Giovanni Ferrandino, Stefano Giusto Picchi, Stefania Tamburrini, Gabriella Toro, Fabio Tamburro, Salvatore Masala and Mariano Scaglione
Diagnostics 2023, 13(15), 2500; https://doi.org/10.3390/diagnostics13152500 - 27 Jul 2023
Viewed by 836
Abstract
Introduction: The aim of our study was to assess the role of ECG-gated coronary CT angiography (CCTA) in the diagnosis, imaging follow-up, and treatment guidance in post-procedural/surgical interventions in the heart and thoracic aorta (PTCA, TAVI, PMK/ICD placement, CABGs). Materials and Methods: We [...] Read more.
Introduction: The aim of our study was to assess the role of ECG-gated coronary CT angiography (CCTA) in the diagnosis, imaging follow-up, and treatment guidance in post-procedural/surgical interventions in the heart and thoracic aorta (PTCA, TAVI, PMK/ICD placement, CABGs). Materials and Methods: We retrospectively evaluated 294 ECG-gated CCTA studies performed in our center from January 2020 to January 2023. CCTA studies were acquired to detect/exclude possible complications related to the endovascular or surgical procedure. Results: There were 27 cases (9.2%) of post-procedural complications. Patients enrolled in the study were 18 males and 9 females (male/female ratio: 2), with age ranging from 47 to 86 years (mean age, 68.3 years). Among percutaneous coronary intervention (PCI) complications, coronary intimal dissection with ascending aorta involvement was found to be the most frequent complication after PTCA (22.2%). Vascular wall pseudoaneurysm formation (11.1%) and coronary stent misalignment or displacement (14.8%) were complications less frequently encountered after PTCA. Right atrial or ventricular perforation with associated hemopericardium were the most common complications (18.5%) after pacemaker implantation. Complications encountered after aortic valve interventions were loosening and dislocation of the prosthesis associated with aortic root pseudoaneurysm (7.4%), para-valvular leak (11.1%), and hemopericardium (7.4%). In one patient who underwent transcatheter repair of patent foramen ovale (3.7%), CTTA detected the dislocation of the Amplatzer septal occluder. Conclusions: ECG-gated CCTA is a fundamental diagnostic tool for the detection of post-procedural endovascular/surgical complications to enable optimal patient management. Radiologists must be familiar with the use of cardiac synchronization in the course of CT and must be aware of all possible complications that can occur in the context of acute settings or routine follow-up studies. Full article
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17 pages, 1526 KiB  
Article
Infarct-like versus Non-Infarct-like Clinical Presentation of Acute Myocarditis: Comparison of Cardiac Magnetic Resonance (CMR) Findings
by Raffaella Capasso, Maria Chiara Imperato, Nicola Serra, Reimy Rodriguez, Maria Rivellini, Massimo De Filippo and Antonio Pinto
Diagnostics 2023, 13(15), 2498; https://doi.org/10.3390/diagnostics13152498 - 27 Jul 2023
Cited by 1 | Viewed by 859
Abstract
Background: The clinical presentation of acute myocarditis (AM) is widely variable, ranging from a subclinical disease to an infarct-like syndrome. Cardiac magnetic resonance (CMR) has become the reference non-invasive diagnostic tool for suspected AM, allowing the identification of the various hallmarks of myocardial [...] Read more.
Background: The clinical presentation of acute myocarditis (AM) is widely variable, ranging from a subclinical disease to an infarct-like syndrome. Cardiac magnetic resonance (CMR) has become the reference non-invasive diagnostic tool for suspected AM, allowing the identification of the various hallmarks of myocardial inflammation (edema, fibrosis, and hyperemia). The aim of the study was to investigate any differences in morphological, functional, and tissue characterization CMR parameters between infarct-like AM in patients with unobstructed coronary arteries and non-infarct-like AM, diagnosed according to the original Lake-Louise Criteria (LLC); Methods: We retrospectively selected 39 patients diagnosed with AM according to LLC, divided into 2 groups according to the clinical presentation: infarct-like in group 1 patients and non-infarct-like in group 2 patients. CMR morphologic, functional, and tissue characterization parameters were analyzed and compared. Results: In group 1, CMR tissue characterization parameters were mainly altereda in septal location with mesocardial myocardial involvement; in group 2, CMR tissue characterization parameters were mainly altered in a lateral location with subepicardial myocardial involvement mainly at the mid-cavity. No significant differences in morphological or functional parameters were observed between the two study groups. Conclusions: Our results showed differences in the localization and distribution of myocardial tissue damage assessed by CMR among forms of AM accompanied by an infarct-like clinical presentation compared with non-infarct-like presentations of AM. The mechanisms underlying the different preferential sites of damage observed in our study are not known, and we do not exclude the possibility of their prognostic implications. Full article
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12 pages, 1471 KiB  
Article
Enhancing Radiation Dose Efficiency in Prospective ECG-Triggered Coronary CT Angiography Using Calcium-Scoring CT
by Muhammad Taha Hagar, Martin Soschynski, Matthias Benndorf, Thomas Stein, Jana Taron, Christopher L. Schlett, Fabian Bamberg and Tobias Krauss
Diagnostics 2023, 13(12), 2062; https://doi.org/10.3390/diagnostics13122062 - 14 Jun 2023
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Abstract
Background: This study investigates whether the scan length adjustment of prospectively ECG-triggered coronary CT angiography (CCTA) using calcium-scoring CT (CAS-CT) images can reduce overall radiation doses. Methods: A retrospective analysis was conducted on 182 patients who underwent CAS-CT and prospectively ECG-triggered CCTA using [...] Read more.
Background: This study investigates whether the scan length adjustment of prospectively ECG-triggered coronary CT angiography (CCTA) using calcium-scoring CT (CAS-CT) images can reduce overall radiation doses. Methods: A retrospective analysis was conducted on 182 patients who underwent CAS-CT and prospectively ECG-triggered CCTA using a second-generation Dual-Source CT scanner. CCTA planning was based on CAS-CT images, for which simulated scout view planning was performed for comparison. Effective doses were compared between two scenarios: Scenario 1—CAS-CT-derived CCTA + CAS-CT and Scenario 2—scout-view-derived CCTA without CAS-CT. Dose differences were further analyzed with respect to scan mode and body mass index. Results: Planning CCTA using CAS-CT led to a shorter scan length than planning via scout view (114.3 ± 9.7 mm vs. 133.7 ± 13.2 mm, p < 0.001). The whole-examination effective dose was slightly lower for Scenario 1 (3.2 [1.8–5.3] mSv vs. 3.4 [1.5–5.9] mSv; p < 0.001, n = 182). Notably, Scenario 1 resulted in a significantly lower radiation dose for sequential scans and obese patients. Only high-pitch spiral CCTA showed dose reduction in Scenario 2. Conclusions: Using CAS-CT for planning prospectively ECG-triggered CCTA reduced the overall radiation dose administered compared to scout view planning without CAS-CT, except for high-pitch spiral CCTA, where a slightly opposite effect was observed. Full article
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Review

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11 pages, 501 KiB  
Review
Advanced CMR Techniques in Anderson-Fabry Disease: State of the Art
by Andrea Ponsiglione, Marco De Giorgi, Raffaele Ascione, Carmela Nappi, Luca Sanduzzi, Antonio Pisani, Serena Dell’Aversana, Alberto Cuocolo and Massimo Imbriaco
Diagnostics 2023, 13(15), 2598; https://doi.org/10.3390/diagnostics13152598 - 4 Aug 2023
Cited by 3 | Viewed by 1225
Abstract
Anderson-Fabry disease (AFD) is a rare multisystem X-linked lysosomal storage disorder caused by α-galactosidase A enzyme deficiency. Long-term cardiac involvement in AFD results in left ventricular hypertrophy and myocardial fibrosis, inducing several complications, mainly arrhythmias, valvular dysfunction, and coronary artery disease. Cardiac magnetic [...] Read more.
Anderson-Fabry disease (AFD) is a rare multisystem X-linked lysosomal storage disorder caused by α-galactosidase A enzyme deficiency. Long-term cardiac involvement in AFD results in left ventricular hypertrophy and myocardial fibrosis, inducing several complications, mainly arrhythmias, valvular dysfunction, and coronary artery disease. Cardiac magnetic resonance (CMR) represents the predominant noninvasive imaging modality for the assessment of cardiac involvement in the AFD, being able to comprehensively assess cardiac regional anatomy, ventricular function as well as to provide tissue characterization. This review aims to explore the role of the most advanced CMR techniques, such as myocardial strain, T1 and T2 mapping, perfusion and hybrid imaging, as diagnostic and prognostic biomarkers. Full article
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29 pages, 10232 KiB  
Review
Thoracic Diseases: Technique and Applications of Dual-Energy CT
by Armando Perrella, Giulio Bagnacci, Nunzia Di Meglio, Vito Di Martino and Maria Antonietta Mazzei
Diagnostics 2023, 13(14), 2440; https://doi.org/10.3390/diagnostics13142440 - 21 Jul 2023
Cited by 3 | Viewed by 1790
Abstract
Dual-energy computed tomography (DECT) is one of the most promising technological innovations made in the field of imaging in recent years. Thanks to its ability to provide quantitative and reproducible data, and to improve radiologists’ confidence, especially in the less experienced, its applications [...] Read more.
Dual-energy computed tomography (DECT) is one of the most promising technological innovations made in the field of imaging in recent years. Thanks to its ability to provide quantitative and reproducible data, and to improve radiologists’ confidence, especially in the less experienced, its applications are increasing in number and variety. In thoracic diseases, DECT is able to provide well-known benefits, although many recent articles have sought to investigate new perspectives. This narrative review aims to provide the reader with an overview of the applications and advantages of DECT in thoracic diseases, focusing on the most recent innovations. The research process was conducted on the databases of Pubmed and Cochrane. The article is organized according to the anatomical district: the review will focus on pleural, lung parenchymal, breast, mediastinal, lymph nodes, vascular and skeletal applications of DECT. In conclusion, considering the new potential applications and the evidence reported in the latest papers, DECT is progressively entering the daily practice of radiologists, and by reading this simple narrative review, every radiologist will know the state of the art of DECT in thoracic diseases. Full article
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14 pages, 1651 KiB  
Review
Beyond Visual Interpretation: Quantitative Analysis and Artificial Intelligence in Interstitial Lung Disease Diagnosis “Expanding Horizons in Radiology”
by Gaetano Rea, Nicola Sverzellati, Marialuisa Bocchino, Roberta Lieto, Gianluca Milanese, Michele D’Alto, Giorgio Bocchini, Mauro Maniscalco, Tullio Valente and Giacomo Sica
Diagnostics 2023, 13(14), 2333; https://doi.org/10.3390/diagnostics13142333 - 10 Jul 2023
Cited by 9 | Viewed by 2003
Abstract
Diffuse lung disorders (DLDs) and interstitial lung diseases (ILDs) are pathological conditions affecting the lung parenchyma and interstitial network. There are approximately 200 different entities within this category. Radiologists play an increasingly important role in diagnosing and monitoring ILDs, as they can provide [...] Read more.
Diffuse lung disorders (DLDs) and interstitial lung diseases (ILDs) are pathological conditions affecting the lung parenchyma and interstitial network. There are approximately 200 different entities within this category. Radiologists play an increasingly important role in diagnosing and monitoring ILDs, as they can provide non-invasive, rapid, and repeatable assessments using high-resolution computed tomography (HRCT). HRCT offers a detailed view of the lung parenchyma, resembling a low-magnification anatomical preparation from a histological perspective. The intrinsic contrast provided by air in HRCT enables the identification of even the subtlest morphological changes in the lung tissue. By interpreting the findings observed on HRCT, radiologists can make a differential diagnosis and provide a pattern diagnosis in collaboration with the clinical and functional data. The use of quantitative software and artificial intelligence (AI) further enhances the analysis of ILDs, providing an objective and comprehensive evaluation. The integration of “meta-data” such as demographics, laboratory, genomic, metabolomic, and proteomic data through AI could lead to a more comprehensive clinical and instrumental profiling beyond the human eye’s capabilities. Full article
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18 pages, 6664 KiB  
Review
Multidetector CT Imaging Biomarkers as Predictors of Prognosis in Shock: Updates and Future Directions
by Tullio Valente, Giorgio Bocchini, Candida Massimo, Gaetano Rea, Roberta Lieto, Salvatore Guarino, Emanuele Muto, Ahmad Abu-Omar, Mariano Scaglione and Giacomo Sica
Diagnostics 2023, 13(13), 2304; https://doi.org/10.3390/diagnostics13132304 - 7 Jul 2023
Viewed by 1450
Abstract
A severe mismatch between the supply and demand of oxygen is the common sequela of all types of shock, which present a mortality of up to 80%. Various organs play a protective role in shock and contribute to whole-body homeostasis. The ever-increasing number [...] Read more.
A severe mismatch between the supply and demand of oxygen is the common sequela of all types of shock, which present a mortality of up to 80%. Various organs play a protective role in shock and contribute to whole-body homeostasis. The ever-increasing number of multidetector CT examinations in severely ill and sometimes unstable patients leads to more frequently encountered findings leading to imminent death, together called “hypovolemic shock complex”. Features on CT include dense opacification of the right heart and major systemic veins, venous layering of contrast material and blood, densely opacified parenchyma in the right hepatic lobe, decreased enhancement of the abdominal organ, a dense pulmonary artery, contrast pooling in dependent lungs, and contrast stasis in pulmonary veins. These findings are biomarkers and prognostic indicators of paramount importance which stratify risk and improve patient outcomes. In this review, we illustrate the various CT patterns in shock and review the spectrum and prognostic significance of thoraco-abdominal vascular and visceral alarming signs of impending death with the intention of increasing awareness among radiologists and radiographers to prepare for immediate resuscitation when required. Full article
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17 pages, 2604 KiB  
Review
Artificial Intelligence Applications in Cardiovascular Magnetic Resonance Imaging: Are We on the Path to Avoiding the Administration of Contrast Media?
by Riccardo Cau, Francesco Pisu, Jasjit S. Suri, Lorenzo Mannelli, Mariano Scaglione, Salvatore Masala and Luca Saba
Diagnostics 2023, 13(12), 2061; https://doi.org/10.3390/diagnostics13122061 - 14 Jun 2023
Cited by 6 | Viewed by 1353
Abstract
In recent years, cardiovascular imaging examinations have experienced exponential growth due to technological innovation, and this trend is consistent with the most recent chest pain guidelines. Contrast media have a crucial role in cardiovascular magnetic resonance (CMR) imaging, allowing for more precise characterization [...] Read more.
In recent years, cardiovascular imaging examinations have experienced exponential growth due to technological innovation, and this trend is consistent with the most recent chest pain guidelines. Contrast media have a crucial role in cardiovascular magnetic resonance (CMR) imaging, allowing for more precise characterization of different cardiovascular diseases. However, contrast media have contraindications and side effects that limit their clinical application in determinant patients. The application of artificial intelligence (AI)-based techniques to CMR imaging has led to the development of non-contrast models. These AI models utilize non-contrast imaging data, either independently or in combination with clinical and demographic data, as input to generate diagnostic or prognostic algorithms. In this review, we provide an overview of the main concepts pertaining to AI, review the existing literature on non-contrast AI models in CMR, and finally, discuss the strengths and limitations of these AI models and their possible future development. Full article
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14 pages, 1640 KiB  
Review
Primary Lymphoproliferative Lung Diseases: Imaging and Multidisciplinary Approach
by Luca Gozzi, Diletta Cozzi, Edoardo Cavigli, Chiara Moroni, Caterina Giannessi, Giulia Zantonelli, Olga Smorchkova, Ron Ruzga, Ginevra Danti, Elena Bertelli, Valentina Luzzi, Valeria Pasini and Vittorio Miele
Diagnostics 2023, 13(7), 1360; https://doi.org/10.3390/diagnostics13071360 - 6 Apr 2023
Cited by 1 | Viewed by 4475
Abstract
Lymphoproliferative lung diseases are a heterogeneous group of disorders characterized by primary or secondary involvement of the lung. Primary pulmonary lymphomas are the most common type, representing 0.5–1% of all primary malignancies of the lung. The radiological presentation is often heterogeneous and non-specific: [...] Read more.
Lymphoproliferative lung diseases are a heterogeneous group of disorders characterized by primary or secondary involvement of the lung. Primary pulmonary lymphomas are the most common type, representing 0.5–1% of all primary malignancies of the lung. The radiological presentation is often heterogeneous and non-specific: consolidations, masses, and nodules are the most common findings, followed by ground-glass opacities and interstitial involvement, more common in secondary lung lymphomas. These findings usually show a prevalent perilymphatic spread along bronchovascular bundles, without a prevalence in the upper or lower lung lobes. An ancillary sign, such as a “halo sign”, “reverse halo sign”, air bronchogram, or CT angiogram sign, may be present and can help rule out a differential diagnosis. Since a wide spectrum of pulmonary parenchymal diseases may mimic lymphoma, a correct clinical evaluation and a multidisciplinary approach are mandatory. In this sense, despite High-Resolution Computer Tomography (HRCT) representing the gold standard, a tissue sample is needed for a certain and definitive diagnosis. Cryobiopsy is a relatively new technique that permits the obtaining of a larger amount of tissue without significant artifacts, and is less invasive and more precise than surgical biopsy. Full article
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