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Clinical Applications of Cardiovascular Computed Tomography (CT)
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Clinical Applications of Cardiovascular Computed Tomography (CT)

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Imaging".

Deadline for manuscript submissions: 31 May 2025 | Viewed by 7971

Special Issue Editor

Dr. David C. Rotzinger

E-Mail Website
Guest Editor
Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
Interests: CT; CT angiography; spectral CT; coronary artery disease; pulmonary embolism; cardiac imaging

Special Issue Information

Dear Colleagues,

In its three decades of existence, cardiovascular CT has profoundly disrupted patient assessment and has established itself as one of the most recommended tests to guide patient management. This success was attributed to CT’s unique ability to depict morphology with incredible detail, but also physiology and function during the same examination. Despite tremendous technological developments that have helped improve imaging speed, diagnostic accuracy, and patient safety, CT is constantly reinventing itself with new applications arising regularly. Open questions remain regarding the prevention and treatment of cardiovascular disease, primarily based on the need to identify high-risk patients before they experience clinical symptoms and to guide invasive therapy. At the same time, the worldwide use of CT is still on the rise, raising safety concerns. In younger patients, the main issue is the exposure to ionizing radiation, while for the elderly with impaired renal function, the principal concern may be contrast-associated acute kidney injury.

This special issue aims to provide new insights into the clinical benefits of cardiovascular CT, including novel technology (spectral imaging, reconstruction algorithms, quantitative or functional imaging, artificial intelligence), advances in disease diagnosis and prevention, and emerging techniques (fractional flow reserve, perfusion imaging, pericoronary fat attenuation).

Dr. David C. Rotzinger
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. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly 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 2700 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

  • computed tomography angiography
  • cardiovascular imaging
  • contrast media
  • spectral computed tomography
  • quantitative imaging
  • coronary artery disease
  • aortic disease
  • pulmonary embolism
  • structural heart disease

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Published Papers (6 papers)

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Research

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12 pages, 3195 KiB  
Article
Subtraction CT Angiography for the Evaluation of Lower Extremity Artery Disease with Severe Arterial Calcification
by Ryoichi Tanaka and Kunihiro Yoshioka
J. Cardiovasc. Dev. Dis. 2025, 12(4), 131; https://doi.org/10.3390/jcdd12040131 - 2 Apr 2025
Viewed by 195
Abstract
(1) Background: Peripheral arterial CT angiography (CTA) is an alternative to conventional angiography for diagnosing lower extremity artery disease (LEAD). However, severe arterial calcifications often hinder accurate assessment of arterial stenosis. This study evaluated the diagnostic performance of subtraction CTA with volume position [...] Read more.
(1) Background: Peripheral arterial CT angiography (CTA) is an alternative to conventional angiography for diagnosing lower extremity artery disease (LEAD). However, severe arterial calcifications often hinder accurate assessment of arterial stenosis. This study evaluated the diagnostic performance of subtraction CTA with volume position matching compared to conventional CTA, using invasive digital subtraction angiography (DSA) as the gold standard. (2) Methods: Thirty-two patients with LEAD (mean age: 69.6 ± 10.8 years; M/F = 28:4) underwent subtraction CTA and DSA. The arterial tree was divided into 20 segments per patient, excluding segments with a history of bypass surgery. Subtraction was performed separately for each limb using volume position matching. Maximum intensity projections were reconstructed from both conventional and subtraction CTA data. Percent stenosis per arterial segment was measured using calipers and compared with DSA. Segments were classified as stenotic (>50% luminal narrowing) or not, with heavily calcified or stented segments assigned as incorrect. (3) Results: Of 640 segments, 636 were analyzed. Subtraction CTA and conventional CTA left 13 (2.0%) and 160 (25.2%) segments uninterpretable, respectively. Diagnostic accuracies (accuracy, precision, recall, macro F1 score) for subtraction CTA were 0.885, 0.884, 0.936, and 0.909, compared to 0.657, 0.744, 0.675, and 0.708 for conventional CTA. (4) Conclusions: Subtraction CTA with volume position matching is feasible and achieves high diagnostic accuracy in patients with severe calcific sclerosis. Full article
(This article belongs to the Special Issue Clinical Applications of Cardiovascular Computed Tomography (CT))
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11 pages, 2301 KiB  
Article
Evaluating Epicardial Fat Density Using ROI-Based Analysis: A Feasibility Study
by Giovanni Lorusso, Nicola Maggialetti, Luca De Marco, Sterpeta Guerra, Ilaria Villanova, Sara Greco, Chiara Morelli, Nicola Maria Lucarelli, Michele Mariano and Amato Antonio Stabile Ianora
J. Cardiovasc. Dev. Dis. 2025, 12(3), 81; https://doi.org/10.3390/jcdd12030081 - 20 Feb 2025
Viewed by 365
Abstract
Epicardial fat density (EFD) is implicated in cardiovascular diseases. This study aimed to assess the regional variability of epicardial fat density (EFD) using coronary computed tomography (CCT) and evaluate the feasibility of ROI-based measurements as an alternative to full segmentation. A retrospective analysis [...] Read more.
Epicardial fat density (EFD) is implicated in cardiovascular diseases. This study aimed to assess the regional variability of epicardial fat density (EFD) using coronary computed tomography (CCT) and evaluate the feasibility of ROI-based measurements as an alternative to full segmentation. A retrospective analysis was conducted on 171 patients undergoing coronary CCT. EFD was measured on non-contrast scans acquired globally and in three predefined regions of interest (ROIs) for coronary calcium scoring: the aortic bulb, right posterolateral wall, and cardiac apex. Global EFD was quantified using semi-automated segmentation software (3D Slicer 5.6.2), while regional EFD values were manually determined. Statistical analyses were performed to compare global and regional EFD measurements. Global EFD averaged −83.92 ± 5.19 HU, while regional EFD showed significant variability. The aortic bulb had lower EFD values (−97.54 ± 12.80 HU) compared to the apex (−93.42 ± 18.94 HU) and right posterolateral wall (−94.99 ± 12.16 HU). Paired t-tests confirmed statistically significant differences between global and regional EFD values (p < 0.000). This study highlights significant regional variability in EFD across specific cardiac regions, suggesting that ROI-based assessments may not reliably reflect global EFD characteristics. Full article
(This article belongs to the Special Issue Clinical Applications of Cardiovascular Computed Tomography (CT))
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12 pages, 1763 KiB  
Article
Thrombus Imaging Characteristics to Predict Early Recanalization in Anterior Circulation Large Vessel Occlusion Stroke
by Nerea Arrarte Terreros, Jeffrey Stolp, Agnetha A. E. Bruggeman, Isabella S. J. Swijnenburg, Ricardo R. Lopes, Laura C. C. van Meenen, Adrien E. D. Groot, Manon Kappelhof, Jonathan M. Coutinho, Yvo B. W. E. M. Roos, Bart J. Emmer, Ludo F. M. Beenen, Diederik W. J. Dippel, Wim H. van Zwam, Ed van Bavel, Henk A. Marquering and Charles B. L. M. Majoie
J. Cardiovasc. Dev. Dis. 2024, 11(4), 107; https://doi.org/10.3390/jcdd11040107 - 29 Mar 2024
Viewed by 1831
Abstract
The early management of transferred patients with a large vessel occlusion (LVO) stroke could be improved by identifying patients who are likely to recanalize early. We aim to predict early recanalization based on patient clinical and thrombus imaging characteristics. We included 81 transferred [...] Read more.
The early management of transferred patients with a large vessel occlusion (LVO) stroke could be improved by identifying patients who are likely to recanalize early. We aim to predict early recanalization based on patient clinical and thrombus imaging characteristics. We included 81 transferred anterior-circulation LVO patients with an early recanalization, defined as the resolution of the LVO or the migration to a distal location not reachable with endovascular treatment upon repeated radiological imaging. We compared their clinical and imaging characteristics with all (322) transferred patients with a persistent LVO in the MR CLEAN Registry. We measured distance from carotid terminus to thrombus (DT), thrombus length, density, and perviousness on baseline CT images. We built logistic regression models to predict early recanalization. We validated the predictive ability by computing the median area-under-the-curve (AUC) of the receiver operating characteristics curve for 100 5-fold cross-validations. The administration of intravenous thrombolysis (IVT), longer transfer times, more distal occlusions, and shorter, pervious, less dense thrombi were characteristic of early recanalization. After backward elimination, IVT administration, DT and thrombus density remained in the multivariable model, with an AUC of 0.77 (IQR 0.72–0.83). Baseline thrombus imaging characteristics are valuable in predicting early recanalization and can potentially be used to optimize repeated imaging workflow. Full article
(This article belongs to the Special Issue Clinical Applications of Cardiovascular Computed Tomography (CT))
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13 pages, 2204 KiB  
Article
A Pilot Study on the Role of Computed Tomography in the Management of Patients with Coronary Artery Anomalies in Romania
by Adriana Sorina Capisizu, Dragos Cuzino and Silviu Marcel Stanciu
J. Cardiovasc. Dev. Dis. 2023, 10(4), 170; https://doi.org/10.3390/jcdd10040170 - 15 Apr 2023
Cited by 1 | Viewed by 2319
Abstract
Coronary artery anomalies may occur during embryogenesis and can lead to changes in the vascularization of the heart, possible ischemia, and an increased risk of sudden death. A retrospective study was conducted with the aim of assessing the prevalence of coronary anomalies in [...] Read more.
Coronary artery anomalies may occur during embryogenesis and can lead to changes in the vascularization of the heart, possible ischemia, and an increased risk of sudden death. A retrospective study was conducted with the aim of assessing the prevalence of coronary anomalies in a Romanian sample of patients, investigated with computed tomography angiography for coronary artery disease. The objectives of the study were to identify the anomalies of the coronary arteries and to conduct an anatomical classification according to Angelini. The study also consisted of evaluations regarding coronary artery calcification in the sample of patients by the Agatston calcium score and assessments regarding the presence of cardiac symptoms and their association with coronary abnormalities. The results showed a prevalence of coronary anomalies of 8.7%, of which 3.8% were origin and course anomalies and 4.9% were coronary anomalies with intramuscular bridging of the left anterior descending artery. Recommendations for practice include the widespread use of coronary computed tomography angiography for the diagnosis of coronary artery anomalies and coronary artery disease in larger patient groups and encouraging this investigation across the country. Full article
(This article belongs to the Special Issue Clinical Applications of Cardiovascular Computed Tomography (CT))
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Review

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14 pages, 1817 KiB  
Review
Coronary Computed Angiography and Coronary Artery Calcium Score for Preoperative Cardiovascular Risk Stratification in Patients Undergoing Noncardiac Surgery
by Ioannis Kyriakoulis, Sriram S. Kumar, Georgios D. Lianos, Dimitrios Schizas and Damianos G. Kokkinidis
J. Cardiovasc. Dev. Dis. 2025, 12(4), 159; https://doi.org/10.3390/jcdd12040159 - 17 Apr 2025
Viewed by 182
Abstract
Perioperative and long-term postoperative major adverse cardiovascular events (MACE) are a leading cause of morbidity and mortality in patients undergoing noncardiac surgery. In selected high-risk patients, when information about cardiovascular status may influence surgical decisions, preoperative risk stratification is reasonable, with stress imaging [...] Read more.
Perioperative and long-term postoperative major adverse cardiovascular events (MACE) are a leading cause of morbidity and mortality in patients undergoing noncardiac surgery. In selected high-risk patients, when information about cardiovascular status may influence surgical decisions, preoperative risk stratification is reasonable, with stress imaging being the preferred method. Coronary computed angiography (CCTA) and coronary artery calcium score (CACS) offer direct anatomical assessment of atherosclerotic coronary arteries and help gauge the extent and severity of coronary artery disease. Strong evidence supports that CCTA and CACS, either alone or in combination, are reliable methods for assessing the risk of both perioperative and long-term postoperative MACE, often demonstrating equal or superior prognostic performance compared to traditional imaging tools. Moreover, integrating CCTA or CACS into standard preoperative imaging protocols further enhances perioperative risk prediction and improves the ability to accurately stratify patients. Future research is needed to better define the role of CCTA and CACS in preoperative cardiovascular risk evaluation of patients undergoing noncardiac surgery. Full article
(This article belongs to the Special Issue Clinical Applications of Cardiovascular Computed Tomography (CT))
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Other

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9 pages, 876 KiB  
Study Protocol
Investigating the Influence of High-Speed Gantry Rotation in Cardiac CT on Motion Artifacts in Aortic Stenosis Patients Not Premedicated with β-Blockers: The FAST-CCT Randomized Trial Protocol
by Guillaume Fahrni, Giuseppe Gullo, Aisha Touray, Stéphane Fournier, Anne-Marie Jouannic, Henri Lu, Damien Racine, Olivier Muller, Chiara Pozzessere, Salah D. Qanadli and David C. Rotzinger
J. Cardiovasc. Dev. Dis. 2023, 10(10), 424; https://doi.org/10.3390/jcdd10100424 - 12 Oct 2023
Cited by 2 | Viewed by 2279
Abstract
Background: Coronary CT angiography (CCTA) is increasingly used as a non-invasive tool to assess coronary artery disease (CAD). However, CCTA is subject to motion artifacts, potentially limiting its clinical utility. Despite faster (0.35 and 0.28 s/rot) gantry rotation times, low (60–65 bpm) heartbeat [...] Read more.
Background: Coronary CT angiography (CCTA) is increasingly used as a non-invasive tool to assess coronary artery disease (CAD). However, CCTA is subject to motion artifacts, potentially limiting its clinical utility. Despite faster (0.35 and 0.28 s/rot) gantry rotation times, low (60–65 bpm) heartbeat is recommended, and the use of β-blockers is often needed. Technological advancements have resulted in the development of faster rotation speeds (0.23 s/rot). However, their added value in patients not premedicated with β-blockers remains unclear. This prospective single-center, two-arm, randomized, controlled trial aims to assess the influence of fast rotation on coronary motion artifacts, diagnostic accuracy of CCTA for CAD, and patient safety. Methods: We will randomize a total of 142 patients aged ≥ 50 scheduled for an aortic stenosis work-up to receive CCTA with either a fast (0.23) or standard (0.28 s/rot) gantry speed. Primary outcome: rate of CCTAs with coronary motion artifacts hindering interpretation. Secondary outcomes: assessable coronary segments rate, diagnostic accuracy against invasive coronary angiography (ICA), motion artifact magnitude per segment, contrast-to-noise ratio (CNR), and patient ionizing radiation dose. The local ethics committee has approved the protocol. Potential significance: FAST-CCT may improve motion artifact reduction and diagnosis quality, thus eliminating the need for rate control and β-blocker administration. Clinicaltrials.gov identifier: NCT05709652. Full article
(This article belongs to the Special Issue Clinical Applications of Cardiovascular Computed Tomography (CT))
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