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Advances in Cardiovascular Computed Tomography (CT)
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Advances in Cardiovascular Computed Tomography (CT)

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 30 October 2026 | Viewed by 2749

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, 1011 Lausanne, Switzerland
Interests: CT; cardiovascular imaging; coronary arteries; radiology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In its three decades of existence, cardiovascular CT has profoundly revolutionized 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 not only 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 highlight the latest developments and cutting-edge research in cardiovascular computed tomography (CT). We invite submissions that show recent advancements across the spectrum of cardiovascular CT, encompassing both clinical applications and foundational scientific works.

Topics of interest include, but are not limited to, the following:

Clinical Innovations: Novel diagnostic and prognostic applications, advanced image acquisition and reconstruction techniques, artificial intelligence and machine learning in clinical workflows, quantitative CT analysis, and clinical outcomes studies.

Experimental and Pre-clinical Research: Investigations into new contrast agents or acquisition protocols, radiation dose reduction strategies, novel hardware developments, functional imaging techniques, and studies utilizing ex vivo systems to explore the underlying mechanisms of cardiovascular disease or validate new CT methodologies.

You may choose our Joint Special Issue in JCDD.

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 250 words) can be sent to the Editorial Office for assessment.

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 Clinical Medicine 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

  • 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 (4 papers)

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Research

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11 pages, 1219 KB  
Article
Application of the Novel Two-Compartmental Model to Quantify Coronary Artery Calcium: A Pilot Study
by Yu-Tai Shih, Zhe-Yu Lin and Jay Wu
J. Clin. Med. 2026, 15(5), 1997; https://doi.org/10.3390/jcm15051997 - 5 Mar 2026
Viewed by 370
Abstract
Background: Cardiovascular disease (CVD) remains a major global health concern and the leading cause of mortality and disability. Early detection and prevention strategies rely heavily on evaluating coronary artery calcification, traditionally assessed using the coronary artery calcium score (CACS). However, CACS is [...] Read more.
Background: Cardiovascular disease (CVD) remains a major global health concern and the leading cause of mortality and disability. Early detection and prevention strategies rely heavily on evaluating coronary artery calcification, traditionally assessed using the coronary artery calcium score (CACS). However, CACS is limited by its dependence on strictly fixed tube voltage and slice thickness, sensitivity to changes in scanning parameters, and the need for an additional dedicated coronary calcium scan that increases radiation exposure. Methods: To address these challenges, we developed a novel two-compartment coronary artery calcium score system (TACS) for quantitative calcium assessment. TACS was established and validated using a QRM Thorax phantom scanned on a GE Revolution CT at 70–140 kVp. Volumetric calcium density (VCD) derived from TACS was compared with conventional CACS under varying slice thickness, pitch, and iterative reconstruction algorithms. Additionally, coronary artery calcium scans from 15 patients were retrospectively analyzed to assess correlations between TACS and CACS. Results: TACS demonstrated stable performance across tube voltages, with VCD errors ranging from 3.8% to −19.0% and maintained consistency under different slice thicknesses (23.9% to −2.3%) and reconstruction algorithms, showing near-zero residual percentages. Patient analyses revealed a strong correlation between TACS and CACS (r = 0.932). Conclusions: These findings suggest that TACS provides robust and reliable quantification of coronary calcium, supporting its potential use for opportunistic coronary artery disease screening, particularly in routine CT imaging. Further studies with larger cohorts are warranted to confirm its clinical applicability. Full article
(This article belongs to the Special Issue Advances in Cardiovascular Computed Tomography (CT))
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19 pages, 1798 KB  
Article
Risk Assessment in Cannulation for Minimally Invasive Heart Valve Surgery: The Modified HOSTILE Score
by Jacqueline Kruse, Miriam Silaschi, Michael Celik, Marwan Hamiko, Eissa Alaj, Hossien Alirezaei, Atsushi Sugiura, Enzo Lüsebrink, Sebastian Zimmer and Farhad Bakhtiary
J. Clin. Med. 2026, 15(2), 843; https://doi.org/10.3390/jcm15020843 - 20 Jan 2026
Viewed by 398
Abstract
Objectives: The HOSTILE score was developed to assess femoral access challenges in transcatheter valve therapy. Similar vascular issues arise in femoral cannulation for minimally invasive valve surgery, making CT-based planning essential. We adapted the score for surgical use (MOD-HOSTILE) and evaluated its association [...] Read more.
Objectives: The HOSTILE score was developed to assess femoral access challenges in transcatheter valve therapy. Similar vascular issues arise in femoral cannulation for minimally invasive valve surgery, making CT-based planning essential. We adapted the score for surgical use (MOD-HOSTILE) and evaluated its association with neurological and adverse outcomes. Methods: In this single-center retrospective study, the MOD-HOSTILE score (0–11 points) was calculated for 364 patients undergoing minimally invasive heart valve surgery from 2019 to 2023. Patients were stratified into low (0–2), mild (>2–5), and high (>5–11) score categories. Outcomes included 30-day stroke, other neurological events, and perioperative complications. Results: High MOD-HOSTILE patients were significantly older (70 [64.7–73.0] vs. 61 [60.0–63.0] years; p < 0.01) and had higher surgical risk (EuroSCORE II 1.79 [1.26–2.16] vs. 0.83 [0.75–0.94]; p < 0.01). Neurological complications were more frequent in the high MOD-HOSTILE group, including stroke (8.7% vs. 0.9%; p = 0.02) and hemiplegia (13.0% vs. 0.9%; p < 0.01). Axillary cannulated patients had higher MOD-HOSTILE scores than femoral cannulated patients. Stroke risk was highest in patients with high MOD-HOSTILE score undergoing axillary cannulation (high vs. low MOD-HOSTILE, 18.2% vs. 0%; p = 0.04). Thirty-day mortality was comparable between groups (p = 0.09). MOD-HOSTILE predicted stroke with an AUC of 0.78 (95% CI 0.73–0.82) and OR 1.4 per point (95% CI 1.1–2.0). Conclusions: The MOD-HOSTILE score identifies vascular and neurological risk in minimally invasive valve surgery, with scores ≥5 indicating elevated risk of stroke and delirium. Patients with high scores may benefit from alternative surgical strategies. Full article
(This article belongs to the Special Issue Advances in Cardiovascular Computed Tomography (CT))
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28 pages, 3293 KB  
Article
Assessment of Potential Predictors of Aortic Stenosis Severity Using ECG-Gated Multidetector CT in Patients with Bicuspid and Tricuspid Aortic Valves Prior to TAVI
by Piotr Machowiec, Piotr Przybylski and Elżbieta Czekajska-Chehab
J. Clin. Med. 2026, 15(2), 551; https://doi.org/10.3390/jcm15020551 - 9 Jan 2026
Viewed by 588
Abstract
Background/Objectives: The aim of this study was to evaluate the usefulness of selected predictive parameters obtainable from cardiac multidetector computed tomography for assessing the severity of aortic valve stenosis in patients scheduled for transcatheter aortic valve implantation (TAVI). Methods: A detailed [...] Read more.
Background/Objectives: The aim of this study was to evaluate the usefulness of selected predictive parameters obtainable from cardiac multidetector computed tomography for assessing the severity of aortic valve stenosis in patients scheduled for transcatheter aortic valve implantation (TAVI). Methods: A detailed retrospective analysis was performed on 105 patients with a bicuspid aortic valve (BAV), selected from a cohort of 1000 patients with BAV confirmed on ECG-gated CT, and on 105 patients with a tricuspid aortic valve (TAV) matched for sex and age. All patients included in both groups had significant aortic stenosis confirmed on transthoracic echocardiography. Results: Across the entire cohort, a trend toward higher aortic valve calcium scores was observed in patients with bicuspid compared to tricuspid aortic valves (4194.8 ± 2748.7 vs. 3335.0 ± 1618.8), although this difference did not reach statistical significance (p = 0.080). However, sex-stratified analysis showed higher calcium scores in males with BAV than with TAV (5596.8 ± 2936.6 vs. 4061.4 ± 1659.8, p = 0.002), with no significant difference observed among females (p > 0.05). Univariate regression analysis showed that the aortic valve calcium score was the strongest statistically significant predictor of aortic stenosis severity in both groups, with R2 = 0.224 for BAV and R2 = 0.479 for TAV. In the multiple regression model without interaction terms, the explanatory power increased to R2 = 0.280 for BAV and R2 = 0.495 for TAV. Conclusions: In patients scheduled for TAVI, linear regression models assess the severity of aortic stenosis more accurately than any individual predictive parameter obtainable from ECG-CT, with the aortic valve Agatston score emerging as the most reliable single CT-derived predictor of stenosis severity in both TAV and BAV subgroups. Full article
(This article belongs to the Special Issue Advances in Cardiovascular Computed Tomography (CT))
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Review

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27 pages, 10049 KB  
Review
Cardiovascular CT in Bicuspid Aortic Valve Disease: A State-of-the-Art Narrative Review of Advances, Clinical Integration, and Future Directions
by Muhammad Ali Jawed, Cagri Ayhan, Robert Byrne, Sandeep Singh Hothi, Sherif Sultan, Mark Spence and Osama Soliman
J. Clin. Med. 2026, 15(3), 1268; https://doi.org/10.3390/jcm15031268 - 5 Feb 2026
Viewed by 1028
Abstract
Bicuspid Aortic Valve (BAV) disease is recognized as the most common congenital heart condition and is frequently associated with complex valvular and aortic disorders. Cardiovascular computed tomography (CT) has become essential for diagnosing BAV, planning procedures, and evaluating patients after treatment. This is [...] Read more.
Bicuspid Aortic Valve (BAV) disease is recognized as the most common congenital heart condition and is frequently associated with complex valvular and aortic disorders. Cardiovascular computed tomography (CT) has become essential for diagnosing BAV, planning procedures, and evaluating patients after treatment. This is largely due to CT’s high spatial resolution and its ability to perform volume imaging effectively. This review provides an up-to-date overview of the increasing role of cardiovascular CT in the management of bicuspid aortic valve (BAV). It covers various aspects, including BAV morphology, optimal sizing for transcatheter aortic valve replacement (TAVR), and post-procedural monitoring. We highlight significant innovations, such as supra-annular sizing techniques and artificial intelligence (AI)-guided analysis, that position CT at the nexus of anatomy, function, and targeted treatment. Additionally, we address controversies concerning inconsistencies in sizing algorithms, recent classification challenges, and radiation exposure. Future development areas include AI predictive tools, radiomic phenotyping, and CT-guided precision medicine. This synthesis aims to provide clinicians and researchers with a high-level guide to the clinical integration of cardiovascular CT and its future in the BAV population. This review provides the most current, comprehensive synthesis on the pivotal role of cardiovascular CT in BAV management, offering a roadmap for integrating advanced imaging into clinical practice and guiding future research priorities. Full article
(This article belongs to the Special Issue Advances in Cardiovascular Computed Tomography (CT))
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