Cardiac and Vascular Imaging: Past, Present and Future

Dear Colleagues,

Cardiac and vascular diseases are among the main causes of morbidity and mortality throughout the world, and can be diagnosed during intrauterine life or in centenarians. Invasive and non-invasive techniques can be performed in order to detect them and evaluate their clinical implications. Transtoracic echocardiography is the first cardiac imaging technique, as well as carotid ultrasound and peripheral arterial and venous color Doppler in vascular imaging. Transesophageal echocardiography allows us to better visualize smaller lesions and to guide surgical procedures. Three-dimensional echocardiography and global longitudinal strain evaluation are recommended in patients with cancer who are having an echocardiogram. Ultra-high-frequency ultrasound is an adjunctive technology that is helpful in both the pre-operative and intra-operative setting for selection of anastomotic targets in lymphatic surgery, and contrast-enhanced ultrasound can enhance pre-operative planning and efficiency of lymphatic venous anastomosis procedures. Intravascular ultrasound is performed in association with direct subtraction angiography to better assess vascular lesions and their clinical repercusssions. Non-contrast computed tomography allows us to evaluate valvular and coronary calcium scores, which provide useful information before valvular surgery and as a prognostic tool, respectively, as well as intramural hematomas. Contrast computed tomography shows cardiac masses and pseudo-masses, valvular diseases, non-calcified coronary atherosclerotic plaques, vascular anomalies, carotid, peripheral and aortic diseases, as well as post-surgical complications. Magnetic resonance imaging is very useful for precise cardiac function assessment, wall thickness, volumes, myocardial mass, and for tissue characterization, detecting fibrosis, scarring, amyloid, glycosphingolipid and iron deposition, thanks to late-gadolinium enhancement, extra-cellular volume fraction assessment, T1 and T2 mapping. High-resolution vascular wall imaging can help detecting inflammatory alterations and wall weakening, such as in intracranial aneurysms assessment and risk of rupture prediction. Single photon emission tomography is performed to evaluate myocardial ischemia, but the latter can also be assessed by computed tomography and magnetic resonance stress perfusion imaging. Positron emission tomography is useful to detect inflammatory and infectious cardiac and vascular diseases. However, when vascular or valvular treatment is needed, angiography is necessary, and nowadays it continues to save a huge number of lives. It allows us to perform endovascular aortic repair, transcatheter aortic valve implantation, endovascular thrombectomy, splenic artery embolization, carotid, coronary, iliac and deep venous stenting, and new devices are produced to simplify and expand endovascular procedures applicability. Coronary stenosis implication can be simply invasively evaluated; however, computed tomography fractional flow reserve analysis combines anatomy and lesion-specific physiology, offering a powerful tool in identifying clinically significant disease. Moreover, new software and ongoing clinical studies are trying to reduce further invasive examinations for diagnostic-only purposes. Four-dimensional flow is an advanced imaging technique to visualize and quantify three-dimensional blood flow patterns over time to provide comprehensive volumetric data, especially in complex blood flow, valvular diseases and congenital heart diseases. Continuous technical advancement and the vast imaging utilization allow us to detect never-described cardiac and vascular anomalies, and to better understand the pathophysiology of frequent diseases. The aim of this Special Issue is to gather research articles and reviews about cardiac and vascular imaging, using well established, recently adopted or new techniques.

Dr. Marcello Chiocchi
Dr. Corrado Tagliati
Guest Editors

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• cardiac imaging
• vascular imaging
• ultrasound
• computed tomography
• magnetic resonance imaging
• single photon emission tomography
• positron emission tomography
• angiography
• non-invasive techniques
• invasive techniques