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Diagnostics
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New Trends in Cardiovascular Imaging
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New Trends in Cardiovascular 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 May 2025 | Viewed by 3144

Special Issue Editor

Prof. Dr. Hans-Christoph Becker

E-Mail Website
Guest Editor
Department of Radiology, Center of Academic Medicine, 453 Quarry Rd, 3rd Floor, Room 324F, Stanford, CA 94305, USA
Interests: cardiac CT; cardiac MRI

Special Issue Information

Dear Colleagues,

In contemporary clinical practice, cardiac computed tomography (CT) and magnetic resonance imaging (MRI) have emerged as indispensable tools, now recommended in guidelines for evaluating patients with congenital heart disease, as well as those presenting with acute or chronic chest pain. The dynamic landscape of cardiac MRI is characterized by ongoing advancements, facilitating myocardial tissue characterization, quantitative perfusion imaging, and the innovative realm of 4D flow imaging. Concurrently, cardiac CT is progressing with enhanced spatial resolution and multi-energy imaging capabilities, which are particularly valuable in the assessment of coronary artery disease. These advancements enable evaluation with fractional flow reserve, the analysis of plaque composition, and the assessment of stent and bypass integrity.

Looking forward, the integration of artificial intelligence (AI) and machine learning stands poised to revolutionize the accessibility and utility of these imaging tools. Through AI-driven algorithms, interpretation and analysis may become more efficient and standardized, potentially expanding the reach of cardiac CT and MRI to a broader patient population.

This Special Issue aims to curate insights from leading experts in the field, focusing on the most promising aspects and clinical applications of the latest developments in cardiac CT and MRI. By highlighting these emerging trends and innovations, we seek to foster a deeper understanding of their potential impact on cardiac diagnostics and patient care.

Prof. Dr. Hans-Christoph Becker
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cardiac CT
  • cardiac MRI
  • hybrid and multimodality imaging
  • artificial intelligence and machine learning
  • coronary artery disease
  • myocardial tissue characterization
  • congenital heart disease

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Published Papers (5 papers)

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Research

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12 pages, 1129 KiB  
Article
CCTA-Guided Selective Invasive Coronary Catheterization: A Strategy to Reduce Contrast Volume and Improve Efficiency
by Jorge Dahdal, Ruurt Jukema, Aernout G. Somsen, Eline Kooijman, Ellaha Wahedi, Jorrit S. Lemkes, Pieter G. Raijmakers, Ton Heestermans, Niels van Royen, Paul Knaapen and Ibrahim Danad
Diagnostics 2025, 15(7), 890; https://doi.org/10.3390/diagnostics15070890 - 1 Apr 2025
Viewed by 442
Abstract
Background: Symptomatic patients with unilateral obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA), involving either the right or left coronary artery, typically undergo per-protocol bilateral coronary visualization during invasive coronary angiography (ICA). However, a selective visualization approach may be [...] Read more.
Background: Symptomatic patients with unilateral obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA), involving either the right or left coronary artery, typically undergo per-protocol bilateral coronary visualization during invasive coronary angiography (ICA). However, a selective visualization approach may be sufficient. Objectives: The objectives of this study were to assess the accuracy of CCTA in excluding hemodynamically significant coronary stenosis in patients with unilateral CAD and to evaluate whether a CCTA-guided selective ICA strategy can reduce procedure time and contrast agent use. Methods: In this cross-sectional cohort study, 454 patients with clinically suspected stable CAD who underwent CCTA prior to ICA were included. The study population consisted of 190 patients with unilateral obstructive CAD, defined as ≥50% diameter stenosis on CCTA, and an absence of obstructive CAD on the contralateral side. ICA with invasive functional assessment was used as the reference standard. Results: CCTA demonstrated a high accuracy, 97.4% (95% CI: 94–99%), in excluding hemodynamically significant disease in the contralateral arteries without obstructive CAD. Compared to the conventional ICA approach, a CCTA-guided selective visualization strategy resulted in significant reductions in procedure time and contrast agent usage: procedure time and contrast agent usage were reduced by 27% (95% CI: 12.1–47.5%) and 46.8% (95% CI: 27.5–67.0%), respectively. Conclusions: In patients with unilateral obstructive CAD identified by CCTA, a CCTA-guided selective ICA visualization strategy is highly accurate in ruling out hemodynamically significant CAD on the contralateral side. Additionally, this unilateral ICA approach has the potential to reduce both contrast agent usage and procedure time compared to the conventional bilateral visualization strategy. Full article
(This article belongs to the Special Issue New Trends in Cardiovascular Imaging)
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14 pages, 2614 KiB  
Article
Left Ventricular Twist and Circumferential Strain from MRI Tagging Predict Early Cardiovascular Disease in Duchenne Muscular Dystrophy
by Zhan-Qiu Liu, Patrick Magrath, Nyasha G. Maforo, Michael Loecher, Holden H. Wu, Ashley Prosper, Pierangelo Renella, Nancy Halnon and Daniel B. Ennis
Diagnostics 2025, 15(3), 326; https://doi.org/10.3390/diagnostics15030326 - 30 Jan 2025
Viewed by 835
Abstract
Background/Objectives: Duchenne Muscular Dystrophy (DMD) is a prevalent fatal genetic disorder, and heart failure is the leading cause of mortality. Peak left ventricular (LV) circumferential strain (Ecc), twist, and circumferential-longitudinal shear angle (θCL) are promising biomarkers for the improved [...] Read more.
Background/Objectives: Duchenne Muscular Dystrophy (DMD) is a prevalent fatal genetic disorder, and heart failure is the leading cause of mortality. Peak left ventricular (LV) circumferential strain (Ecc), twist, and circumferential-longitudinal shear angle (θCL) are promising biomarkers for the improved and early diagnosis of incipient heart failure. Our goals were as follows: 1) to characterize a spectrum of functional and rotational LV biomarkers in boys with DMD compared with healthy age-matched controls; and 2) to identify LV biomarkers of early cardiomyopathy in the absence of abnormal LVEF or LGE. Methods: Boys with DMD (N = 43) and age-matched healthy volunteers (N = 16) were prospectively enrolled and underwent a 3T CMR exam after obtaining informed consent. Breath-held MRI tagging was used to estimate left ventricular Ecc at the mid-ventricular level as well as the twist, torsion, and θCL between basal and apical LV short-axis slices. A two-tailed t-test with unequal variance was used to test group-wise differences. Multiple comparisons were performed with Holm–Sidak post hoc correction. Multiple-regression analysis was used to test for correlations among biomarkers. A binomial logistic regression model assessed each biomarker’s ability to distinguish the following: (1) healthy volunteers vs. DMD patients, (2) healthy volunteers vs. LGE(−) DMD patients, and (3) LGE(−) DMD patients vs. LGE(+) DMD patients. Results: There was a significant impairment in the peak mid-wall Ecc [−17.0 ± 4.2% vs. −19.5 ± 1.9%, p < 7.8 × 10−3], peak LV twist (10.4 ± 4.3° vs. 15.6 ± 3.1°, p < 8.1 × 10−4), and peak LV torsion (2.03 ± 0.82°/mm vs. 2.8 ± 0.5°/mm, p < 2.6 × 10−3) of LGE(−) DMD patients when compared to healthy volunteers. There was a further significant reduction in the Ecc, twist, torsion, and θCL for LGE(+) DMD patients when compared to LGE(−) DMD patients. In the LGE(+) DMD patients, age significantly correlated with LVEF (r2 = 0.42, p = 9 × 10−3), peak mid-wall Ecc (r2 = 0.27, p = 0.046), peak LV Twist (r2 = 0.24, p = 0.06), peak LV torsion (r2 = 0.28, p = 0.04), and peak LV θCL (r2 = 0.23, p = 0.07). In the LGE(−) DMD patients, only the peak mid-wall Ecc was significantly correlated with age (r2 = 0.25, p = 0.006). The peak LV twist outperformed the peak mid-wall LV Ecc and EF in distinguishing DMD patients from healthy volunteer groups (AUC = 0.88, 0.80, and 0.72), as well as in distinguishing LGE(−) DMD patients from healthy volunteers (AUC = 0.83, 0.74, and 0.62). The peak LV twist and peak mid-wall LV Ecc performed similarly in distinguishing the LGE(−) and LGE(+) DMD cohorts (AUC = 0.74, 0.77, and 0.79). Conclusions: The peak mid-wall LV Ecc, peak LV twist, peak LV torsion, and peak LV θCL were significantly impaired in advance of the decreased LVEF and the development of focal myocardial fibrosis in boys with DMD and therefore were apparent prior to significant irreversible injury. Full article
(This article belongs to the Special Issue New Trends in Cardiovascular Imaging)
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11 pages, 1329 KiB  
Article
MRI-Based Circumferential Strain in Boys with Early Duchenne Muscular Dystrophy Cardiomyopathy
by Zhan-Qiu Liu, Nyasha G. Maforo, Patrick Magrath, Ashley Prosper, Pierangelo Renella, Nancy Halnon, Holden H. Wu and Daniel B. Ennis
Diagnostics 2024, 14(23), 2673; https://doi.org/10.3390/diagnostics14232673 - 27 Nov 2024
Viewed by 822
Abstract
Background: In boys with Duchenne muscular dystrophy (DMD), cardiomyopathy has become the primary cause of death. Although both positive late gadolinium enhancement (LGE) and reduced left ventricular ejection fraction (LVEF) are late findings in a DMD cohort, LV end-systolic circumferential strain at middle [...] Read more.
Background: In boys with Duchenne muscular dystrophy (DMD), cardiomyopathy has become the primary cause of death. Although both positive late gadolinium enhancement (LGE) and reduced left ventricular ejection fraction (LVEF) are late findings in a DMD cohort, LV end-systolic circumferential strain at middle wall (Ecc) serves as a biomarker for detecting early impairment in cardiac function associated with DMD. However, Ecc derived from cine Displacement Encoding with Stimulated Echoes (DENSE) has not been quantified in boys with DMD. We aim to: (1) use cine DENSE to quantify regional Ecc in LGE negative (-) boys with DMD and healthy controls; and (2) compare Ecc with LVEF in terms of differentiating DMD boys with LGE (-) from healthy boys. Methods: 10 LGE (-) boys with DMD and 12 healthy boys were enrolled prospectively in an IRB-approved study for CMR at 3T. Navigator-gated cine DENSE was used to obtain short-axis mid-ventricular data and estimate global and regional Ecc. Group-wise differences were tested via a Wilcoxon rank-sum test. Within-group differences were tested via a Skillings-Mack test followed by pairwise Wilcoxon signed-rank tests. A binomial logistic regression model was adopted to differentiate between DMD boys with LGE (-) and healthy boys. Results: When compared to healthy boys, LGE (-) boys with DMD demonstrated significantly impaired septal Ecc [−0.13 (0.01) vs. −0.16 (0.03), p = 0.019]. In comparison to the Ecc in other segments, both groups of boys exhibited significantly reduced septal Ecc and significantly elevated lateral Ecc. Septal Ecc outperformed LVEF in distinguishing DMD boys with LGE (-) from healthy boys. Conclusions: Reduced septal Ecc may serve as an early indicator of cardiac involvement in LGE (-) DMD boys prior to reduced LVEF and a positive LGE finding. Full article
(This article belongs to the Special Issue New Trends in Cardiovascular Imaging)
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Review

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15 pages, 1528 KiB  
Review
18F-Fluorodeoxyglucose Imaging for Assessing Cardiovascular Inflammation
by Nagara Tamaki, Tadao Aikawa and Osamu Manabe
Diagnostics 2025, 15(5), 573; https://doi.org/10.3390/diagnostics15050573 - 27 Feb 2025
Viewed by 571
Abstract
Cardiovascular inflammation has recently emerged as a critical issue across various cardiovascular diseases. Various non-invasive imaging modalities are applied for assessing cardiovascular inflammation. Positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) is a valuable non-invasive imaging tool for identifying active cardiovascular inflammation. It [...] Read more.
Cardiovascular inflammation has recently emerged as a critical issue across various cardiovascular diseases. Various non-invasive imaging modalities are applied for assessing cardiovascular inflammation. Positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) is a valuable non-invasive imaging tool for identifying active cardiovascular inflammation. It is utilized in evaluating conditions, such as cardiac sarcoidosis, endocarditis, vasculitis, and unstable atherosclerosis. Furthermore, management of cardiovascular complications after aggressive cancer therapy has increasingly been required in cancer patients. FDG PET is considered a suitable approach not only for the assessment of tumor responses to cancer therapy, but also for early and accurate detection of cardiovascular complications. This review highlights the clinical value of FDG PET under appropriate patient preparation. The future perspectives of new molecular imaging tools for assessing active cardiovascular inflammation have been described. Full article
(This article belongs to the Special Issue New Trends in Cardiovascular Imaging)
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Other

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4 pages, 1015 KiB  
Interesting Images
Visualizing Aortic Inflammation by Diffusion-Weighted Whole-Body Imaging with Background Body Signal Suppression (DWIBS)
by Asuka Suzuki, Koji Hayashi, Mamiko Sato, Yuka Nakaya, Toyoaki Miura, Naoko Takaku, Toshiko Iwasaki and Yasutaka Kobayashi
Diagnostics 2025, 15(9), 1151; https://doi.org/10.3390/diagnostics15091151 - 30 Apr 2025
Abstract
A 75-year-old man, with a history of descending thoracic aortic rupture and dissection treated with aortic stenting at 73 years old, was admitted for rehabilitation following recurrent cerebral ischemic attacks. Upon admission, blood tests revealed elevated inflammatory markers, including a C-reactive protein (CRP) [...] Read more.
A 75-year-old man, with a history of descending thoracic aortic rupture and dissection treated with aortic stenting at 73 years old, was admitted for rehabilitation following recurrent cerebral ischemic attacks. Upon admission, blood tests revealed elevated inflammatory markers, including a C-reactive protein (CRP) level of 10.75 mg/dL and a D-dimer level of 4.2 µg/mL, alongside microcytic anemia. Despite thorough evaluations using computed tomography (CT) and ultrasound, the origin of these abnormalities remained unidentified. Two months later, MRI using diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) revealed hyperintensities in the thoracic aorta. He remained asymptomatic and progressed well during rehabilitation, prompting continued observation. However, three months after admission, he developed hemoptysis. Contrast-enhanced CT showed pneumonia, as well as enhanced lesions in the aortic wall, confirming aortic inflammation. Due to concerns about aortic stent ulceration, an emergency stent graft insertion extending to the superior mesenteric artery was performed. He recovered uneventfully and was discharged. DWIBS is an MRI-based tool that avoids exposure to radiation or contrast agents and is cost-effective. MRI using DWIBS demonstrated high signal accumulations in the aortic wall, indicative of inflammation. These findings suggest that DWIBS holds significant potential as a powerful imaging tool for detecting and assessing inflammation, particularly in the aorta. Full article
(This article belongs to the Special Issue New Trends in Cardiovascular Imaging)
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