Advances in Cardiovascular and Pulmonary Imaging

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

Deadline for manuscript submissions: 31 March 2024 | Viewed by 5588

Special Issue Editors

1. Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Via Gramsci 14, 43126 Parma, Italy
2. Department of Diagnostic, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
Interests: cardiac imaging; pulmonary imaging; cardiac computed tomography; cardiac magnetic resonance; post-processing; artificial intelligence
Special Issues, Collections and Topics in MDPI journals
Vascular Surgery, University Hospital of Parma, Parma, Italy
Interests: vascular surgery; aneurysm; carotid; peripheral arterial disease; critical limb ischemia; vascular graft infection; 3D printing; vascular imaging; duplex ultrasound

Special Issue Information

Dear Colleagues,

This Special Issue showcases recent advances in concomitant cardiac and pulmonary imaging. In particular, selected original research articles are included that highlight the use of advanced imaging to carry out morphological and functional characterization via multimodality diagnostic techniques. These techniques are likely to become essential tools that can be used to support radiologist interpretations, as they can be eventually incorporated into the workflow. Potential applications that are of research interest include the implementation of automated anatomy, segmentation and measurement for diagnosis and 3D printing in order to predict optimal treatment selection and assess treatment response.

Dr. Chiara Martini
Dr. Paolo Perini
Guest Editors

Manuscript Submission Information

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Published Papers (7 papers)

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Research

15 pages, 1496 KiB  
Article
Ultrasound in the Diagnosis of Non-Expandable Lung: A Prospective Observational Study of M-Mode, B-Mode, and 2D-Shear Wave Elastography
Diagnostics 2024, 14(2), 204; https://doi.org/10.3390/diagnostics14020204 - 18 Jan 2024
Viewed by 598
Abstract
Background: Non-expandable lung (NEL) has severe implications for patient symptoms and impaired lung function, as well as crucial implications for the management of malignant pleural effusion (MPE). Indwelling pleural catheters have shown good symptom relief for patients with NEL; hence, identifying patients early [...] Read more.
Background: Non-expandable lung (NEL) has severe implications for patient symptoms and impaired lung function, as well as crucial implications for the management of malignant pleural effusion (MPE). Indwelling pleural catheters have shown good symptom relief for patients with NEL; hence, identifying patients early in their disease is vital. With the inability of the lung to achieve pleural apposition following thoracentesis and the formation of a hydropneumothorax, traditionally, chest X-ray and clinical symptoms have been used to make the diagnosis following thoracentesis. It is our aim to investigate whether ultrasound measurement of lung movement during respiration can predict NEL before thoracentesis, thereby aiding clinicians in their planning for the optimal treatment of affected patients. Methods: A total of 49 patients were consecutively included in a single-centre trial performed at a pleural clinic. Patients underwent protocolled ultrasound assessment pre-thoracentesis with measurements of lung and diaphragm movement and shear wave elastography measurements of the pleura and pleural effusion at the planned site of thoracentesis. Results: M-mode measurements of lung movement provided the best diagnostic ROC-curve results, with an AUC of 0.81. Internal validity showed good results utilising the calibration belt test and Brier test. Conclusion: M-mode measurement of lung movement shows promise in diagnosing NEL before thoracentesis in patients with known or suspected MPE. A validation cohort is needed to confirm the results. Full article
(This article belongs to the Special Issue Advances in Cardiovascular and Pulmonary Imaging)
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11 pages, 902 KiB  
Article
Experimental Examination of Conventional, Semi-Automatic, and Automatic Volumetry Tools for Segmentation of Pulmonary Nodules in a Phantom Study
Diagnostics 2024, 14(1), 28; https://doi.org/10.3390/diagnostics14010028 - 22 Dec 2023
Viewed by 497
Abstract
The aim of this study is to examine the precision of semi-automatic, conventional and automatic volumetry tools for pulmonary nodules in chest CT with phantom N1 LUNGMAN. The phantom is a life-size anatomical chest model with pulmonary nodules representing solid and subsolid metastases. [...] Read more.
The aim of this study is to examine the precision of semi-automatic, conventional and automatic volumetry tools for pulmonary nodules in chest CT with phantom N1 LUNGMAN. The phantom is a life-size anatomical chest model with pulmonary nodules representing solid and subsolid metastases. Gross tumor volumes (GTVis) were contoured using various approaches: manually (0); as a means of semi-automated, conventional contouring with (I) adaptive-brush function; (II) flood-fill function; and (III) image-thresholding function. Furthermore, a deep-learning algorithm for automatic contouring was applied (IV). An intermodality comparison of the above-mentioned strategies for contouring GTVis was performed. For the mean GTVref (standard deviation (SD)), the interquartile range (IQR)) was 0.68 mL (0.33; 0.34–1.1). GTV segmentation was distributed as follows: (I) 0.61 mL (0.27; 0.36–0.92); (II) 0.41 mL (0.28; 0.23–0.63); (III) 0.65 mL (0.35; 0.32–0.90); and (IV) 0.61 mL (0.29; 0.33–0.95). GTVref was found to be significantly correlated with GTVis (I) p < 0.001, r = 0.989 (III) p = 0.001, r = 0.916, and (IV) p < 0.001, r = 0.986, but not with (II) p = 0.091, r = 0.595. The Sørensen–Dice indices for the semi-automatic tools were 0.74 (I), 0.57 (II) and 0.71 (III). For the semi-automatic, conventional segmentation tools evaluated, the adaptive-brush function (I) performed closest to the reference standard (0). The automatic deep learning tool (IV) showed high performance for auto-segmentation and was close to the reference standard. For high precision radiation therapy, visual control, and, where necessary, manual correction, are mandatory for all evaluated tools. Full article
(This article belongs to the Special Issue Advances in Cardiovascular and Pulmonary Imaging)
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13 pages, 2890 KiB  
Article
Detectability and Volumetric Accuracy of Pulmonary Nodules in Low-Dose Photon-Counting Detector Computed Tomography: An Anthropomorphic Phantom Study
Diagnostics 2023, 13(22), 3448; https://doi.org/10.3390/diagnostics13223448 - 15 Nov 2023
Viewed by 769
Abstract
The aim of this phantom study was to assess the detectability and volumetric accuracy of pulmonary nodules on photon-counting detector CT (PCD-CT) at different low-dose levels compared to conventional energy-integrating detector CT (EID-CT). In-house fabricated artificial nodules of different shapes (spherical, lobulated, spiculated), [...] Read more.
The aim of this phantom study was to assess the detectability and volumetric accuracy of pulmonary nodules on photon-counting detector CT (PCD-CT) at different low-dose levels compared to conventional energy-integrating detector CT (EID-CT). In-house fabricated artificial nodules of different shapes (spherical, lobulated, spiculated), sizes (2.5–10 mm and 5–1222 mm3), and densities (−330 HU and 100 HU) were randomly inserted into an anthropomorphic thorax phantom. The phantom was scanned with a low-dose chest protocol with PCD-CT and EID-CT, in which the dose with PCD-CT was lowered from 100% to 10% with respect to the EID-CT reference dose. Two blinded observers independently assessed the CT examinations of the nodules. A third observer measured the nodule volumes using commercial software. The influence of the scanner type, dose, observer, physical nodule volume, shape, and density on the detectability and volumetric accuracy was assessed by a multivariable regression analysis. In 120 CT examinations, 642 nodules were present. Observer 1 and 2 detected 367 (57%) and 289 nodules (45%), respectively. With PCD-CT and EID-CT, the nodule detectability was similar. The physical nodule volumes were underestimated by 20% (range 8–52%) with PCD-CT and 24% (range 9–52%) with EID-CT. With PCD-CT, no significant decrease in the detectability and volumetric accuracy was found at dose reductions down to 10% of the reference dose (p > 0.05). The detectability and volumetric accuracy were significantly influenced by the observer, nodule volume, and a spiculated nodule shape (p < 0.05), but not by dose, CT scanner type, and nodule density (p > 0.05). Low-dose PCD-CT demonstrates potential to detect and assess the volumes of pulmonary nodules, even with a radiation dose reduction of up to 90%. Full article
(This article belongs to the Special Issue Advances in Cardiovascular and Pulmonary Imaging)
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14 pages, 3773 KiB  
Communication
Eye Lens Radiation Dose to Nurses during Cardiac Interventional Radiology: An Initial Study
Diagnostics 2023, 13(18), 3003; https://doi.org/10.3390/diagnostics13183003 - 20 Sep 2023
Viewed by 662
Abstract
Although interventional radiology (IVR) is preferred over surgical procedures because it is less invasive, it results in increased radiation exposure due to long fluoroscopy times and the need for frequent imaging. Nurses engaged in cardiac IVR receive the highest lens radiation doses among [...] Read more.
Although interventional radiology (IVR) is preferred over surgical procedures because it is less invasive, it results in increased radiation exposure due to long fluoroscopy times and the need for frequent imaging. Nurses engaged in cardiac IVR receive the highest lens radiation doses among medical workers, after physicians. Hence, it is important to measure the lens exposure of IVR nurses accurately. Very few studies have evaluated IVR nurse lens doses using direct dosimeters. This study was conducted using direct eye dosimeters to determine the occupational eye dose of nurses engaged in cardiac IVR, and to identify simple and accurate methods to evaluate the lens dose received by nurses. Over 6 months, in a catheterization laboratory, we measured the occupational dose to the eyes (3 mm dose equivalent) and neck (0.07 mm dose equivalent) of nurses on the right and left sides. We investigated the relationship between lens and neck doses, and found a significant correlation. Hence, it may be possible to estimate the lens dose from the neck badge dose. We also evaluated the appropriate position (left or right) of eye dosimeters for IVR nurses. Although there was little difference between the mean doses to the right and left eyes, that to the right eye was slightly higher. In addition, we investigated whether it is possible to estimate doses received by IVR nurses from patient dose parameters. There were significant correlations between the measured doses to the neck and lens, and the patient dose parameters (fluoroscopy time and air kerma), implying that these parameters could be used to estimate the lens dose. However, it may be difficult to determine the lens dose of IVR nurses accurately from neck badges or patient dose parameters because of variation in the behaviors of nurses and the procedure type. Therefore, neck doses and patient dose parameters do not correlate well with the radiation eye doses of individual IVR nurses measured by personal eye dosimeters. For IVR nurses with higher eye doses, more accurate measurement of the radiation doses is required. We recommend that a lens dosimeter be worn near the eyes to measure the lens dose to IVR nurses accurately, especially those exposed to relatively high doses. Full article
(This article belongs to the Special Issue Advances in Cardiovascular and Pulmonary Imaging)
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18 pages, 1872 KiB  
Article
Myocardial Tissue Characterization in Patients with Hypertensive Crisis, Positive Troponin, and Unobstructed Coronary Arteries: A Cardiovascular Magnetic Resonance-Based Study
Diagnostics 2023, 13(18), 2943; https://doi.org/10.3390/diagnostics13182943 - 14 Sep 2023
Cited by 1 | Viewed by 607
Abstract
Hypertensive crisis can present with cardiac troponin elevation and unobstructed coronary arteries. We used cardiac magnetic resonance (CMR) imaging to characterize the myocardial tissue in patients with hypertensive crisis, elevated cardiac troponin, and unobstructed coronary arteries. Patients with hypertensive crisis and elevated cardiac [...] Read more.
Hypertensive crisis can present with cardiac troponin elevation and unobstructed coronary arteries. We used cardiac magnetic resonance (CMR) imaging to characterize the myocardial tissue in patients with hypertensive crisis, elevated cardiac troponin, and unobstructed coronary arteries. Patients with hypertensive crisis and elevated cardiac troponin with coronary artery stenosis <50% were enrolled. Patients with troponin-negative hypertensive crisis served as controls. All participants underwent CMR imaging at 1.5 Tesla. Imaging biomarkers and tissue characteristics were compared between the groups. There were 19 patients (63% male) with elevated troponin and 24 (33% male) troponin-negative controls. The troponin-positive group was older (57 ± 11 years vs. 47 ± 14 years, p = 0.015). The groups had similar T2-weighted signal intensity ratios and native T1 times. T2 relaxation times were longer in the troponin-positive group, and the difference remained significant after excluding infarct-pattern late gadolinium enhancement (LGE) from the analysis. Extracellular volume (ECV) was higher in the troponin-positive group (25 ± 4 ms vs. 22 ± 3 ms, p = 0.008) and correlated strongly with T2 relaxation time (rs = 0.701, p = 0.022). Late gadolinium enhancement was 32% more prevalent in the troponin-positive group (82% vs. 50%, p = 0.050), with 29% having infarct-pattern LGE. T2 relaxation time was independently associated with troponin positivity (OR 2.1, p = 0.043), and both T2 relaxation time and ECV predicted troponin positivity (C-statistics: 0.71, p = 0.009; and 0.77, p = 0.006). Left ventricular end-diastolic and left atrial volumes were the strongest predictors of troponin positivity (C-statistics: 0.80, p = 0.001; and 0.82, p < 0.001). The increased T2 relaxation time and ECV and their significant correlation in the troponin-positive group suggest myocardial injury with oedema, while the non-ischaemic LGE could be due to myocardial fibrosis or acute necrosis. These CMR imaging biomarkers provide important clinical indices for risk stratification and prognostication in patients with hypertensive crisis. Full article
(This article belongs to the Special Issue Advances in Cardiovascular and Pulmonary Imaging)
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11 pages, 1474 KiB  
Article
Possible Use of Linear Echobronchoscope for Diagnosis of Peripheral Pulmonary Nodules
Diagnostics 2023, 13(14), 2393; https://doi.org/10.3390/diagnostics13142393 - 17 Jul 2023
Viewed by 904
Abstract
Echobronchoscope-guided transbronchial needle aspiration (EBUS-TBNA) is mainly used as the transbronchial approach to hilar/mediastinal lymph nodes or lesions, for diagnostic or staging purposes. Moreover, the role of linear EBUS-TBNA as a diagnostic tool for central intrapulmonary lesions adjacent to the trachea or the [...] Read more.
Echobronchoscope-guided transbronchial needle aspiration (EBUS-TBNA) is mainly used as the transbronchial approach to hilar/mediastinal lymph nodes or lesions, for diagnostic or staging purposes. Moreover, the role of linear EBUS-TBNA as a diagnostic tool for central intrapulmonary lesions adjacent to the trachea or the major bronchi is also well established. However, since the tip of the ultrasound probe at the distal end of the echobronchoscope is very thin, it can be wedged through smaller peripheral bronchi, reaching the distal parenchyma and allowing for peripheral pulmonary lesion sampling. The main aim of this retrospective study was to evaluate the diagnostic yield and the safety of EBUS-TBNA in the diagnosis of pulmonary peripheral nodules. The database of the Interventional Pulmonology Unit of Azienda Ospedaliero-Universitaria delle Marche (Ancona, Italy) was evaluated to identify peripheral pulmonary nodules approached by EBUS-TBNA. Thirty patients with a single peripheral pulmonary nodule located peripherally to the subsegmental bronchi of the lower lobes and adjacent to a small bronchus greater than 3 mm in diameter were included in this study. The nodule was visible using endoscopic ultrasound in 28 patients and the diagnosis was obtained via EBUS-TBNA in 26 cases (12 adenocarcinoma, 5 typical carcinoid tumors, 4 hamartoma and 5 metastatic lesions). The diagnostic yield was 86.6% for all 30 patients and 92.8% if only the 28 patients in which the lesion was visualized via echobronchoscopy were considered. No relevant adverse events were observed. We conclude that EBUS-TBNA may be an effective and safe option to sample pulmonary peripheral nodules in selected patients with lower lobe peripheral pulmonary lesions adjacent to small bronchi greater than 3 mm in diameter and reachable with the EBUS-TBNA probe. Full article
(This article belongs to the Special Issue Advances in Cardiovascular and Pulmonary Imaging)
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26 pages, 4652 KiB  
Article
Microwave Near-Field Dynamical Tomography of Thorax at Pulmonary and Cardiovascular Activity
Diagnostics 2023, 13(6), 1051; https://doi.org/10.3390/diagnostics13061051 - 09 Mar 2023
Viewed by 899
Abstract
The developed near-field microwave diagnostics of dynamical lung tomography provide information about variations of air and blood content depth structure in the processes of breathing and heart beating that are unattainable for other available methods. The method of dynamical pulse 1D tomography (profiling) [...] Read more.
The developed near-field microwave diagnostics of dynamical lung tomography provide information about variations of air and blood content depth structure in the processes of breathing and heart beating that are unattainable for other available methods. The method of dynamical pulse 1D tomography (profiling) is based on solving the corresponding nonlinear ill-posed inverse problem in the extremely complicated case of the strongly absorbing frequency-dispersive layered medium with the dual regularization method—a new Lagrange approach in the theory of ill-posed problems. This method has been realized experimentally by data of bistatic measurements with two electrically small bow-tie antennas that provide a subwavelength resolution. The proposed methods of 3D lung tomography based on the multisensory pulse, multifrequency, or multi-base measurements are based on solving the corresponding integral equations in the Born approximation. The experimental 3D tomography of lung air content was obtained by the results of the multiple 1D pulse profiling by pulse measurements in several grid points over the planar square region of the thorax. Additionally, the possible applicability of multifrequency measurements of scattered harmonic signals in the monitoring of lungs was demonstrated by four-frequency measurements in the process of breathing. The results demonstrated the feasibility of the proposed control in the diagnosis of some lung diseases. Full article
(This article belongs to the Special Issue Advances in Cardiovascular and Pulmonary Imaging)
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