The international journal of cardiovascular imaging最新文献

This review explores a range of imaging techniques used in the pre-surgical planning of vascular access, including duplex ultrasound (DUS), digital subtraction angiography (DSA), digital subtraction venography (DSV), CO2 Venography, magnetic resonance angiography (MRA), computed tomography angiography (CTA), and Intravascular ultrasound (IVUS). For each modality, we analyze its technical background, applications, advantages and disadvantages, and comparisons with alternative imaging options. DUS is the most widely used imaging modality in pre-surgical planning due to its low cost, non-invasiveness, absence of ionizing radiation and nephrotoxic contrast agents, and comparable accuracy in pre-access mapping with other methods. DSA and DSV have high sensitivity and specificity to visualize the arterial and venous system and are recommended when central vascular stenosis is suspected, or a simultaneous intervention is anticipated. However, their use is limited due to exposure to contrast agents and ionizing radiation. CO2-based contrast agents provide an alternative for end-stage renal disease (ESRD) patients to preserve residual renal function. MRA provides a noninvasive option with no radiation exposure and superior image resolution, yet the high cost and limited availability restrict their widespread clinical use. CTA, with its short acquisition time and high-resolution imaging, is a vital modality in intricate cases. However, radiation and contrast exposure can pose challenges in this patient population. The newer IVUS modality has a superior ability to central venous outflow obstruction compared to DSA and provides more information regarding vascular geometry and anatomy. Each imaging modality has its unique advantages and disadvantages in this patient cohort. The decision to use a particular imaging must be made on a case-to-case basis. However, following KDOQI guidelines, a combination of a patient's medical history, physical examination, and DUS is a widely accepted standard practice in pre-surgical vascular access planning, with other imaging modalities reserved for selected patients.

Transthoracic echocardiography (TTE) is a frequently requested investigation in patients admitted to hospital with various cardiorespiratory symptoms. With increasing life expectancy, these symptoms might be related to other clinical conditions, necessitating early and prompt diagnosis and subsequent management. We thought to broaden the use of the standard TTE to unmask clinically significant extracardiac findings (ECF). We screened the epigastrium, right upper abdominal quadrant, both flanks, and dorsal lung fields in 6468 consecutive inpatients undergoing TTE looking for aortic dilatation, liver pathology, ascites, pleural effusion and suspicious masses. We detected ECFs in 507 (8%) patients. Pleural effusion was the most commonly detected ECF seen in 86% of patients. ECF findings necessitating shift in the management plan were detected in 23% of patients and included large effusions necessitating drainage, malignant tumors (predominately liver metastases) and empyema. We concluded that routine screening of the liver, pleura, peritoneum and abdominal aorta could add an important piece of clinical information, detect pleural effusion, possible malignancies (mainly liver metastases) and aortic dilatation necessitating further assessment and management of hospitalized patients with various cardiopulmonary symptoms.

Despite the significant burden of disease in Indigenous Peoples globally, the validity of computed tomography (CT) coronary artery calcium (CAC) scoring has been poorly described. Thus, we aimed to identify the prevalence and predictive utility of a CT CAC score > 0 in this population. A systematic search was conducted on MEDLINE, EMBASE, CINAHL, Scopus and Web of Science databases from 1990 to 2022. Primary observational studies that reported CT CAC scores and Indigenous ethnicity were included. The primary outcome was the prevalence of a CT CAC score > 0. The secondary outcome was MACE. Eight studies on CT CAC scoring stratified results according to Indigenous ethnicity (n = 30,845 and 1,677 Indigenous). Prevalence of CT CAC score > 0 was higher in Australian First Nations people than non-Indigenous people [adjusted odds ratios (aOR) 2.36, 95% confidence interval (CI) 1.32-4.23; p = 0.004 and aOR 2.76, 95% CI 1.30-5.87; p = 0.008] but not in Native Americans (aOR 0.70, 95% CI 0.42-1.18) or Indigenous Brazilians (aOR 0.96, 95% CI 0.30-3.11). Two studies assessed the interaction of Indigenous ethnicity on the association between CAC > 0 and MACE. Neither found a significant interaction (p = 0.64 and 0.53). From 2431 studies, eight reported CT CAC scores stratified by Indigenous ethnicity. From limited data, prevalence of CT CAC score > 0 was higher in Australian First Nations people compared to non-Indigenous Australians and CT CAC score > 0 was similarly able to predict MACE in Indigenous Peoples. Future research on CT CAC scoring should stratify outcomes according to Indigenous status to better understand its utility.

Cardiovascular magnetic resonance (CMR) has been studied as an alternative to endomyocardial biopsy (EMB) in orthotopic heart transplant recipients (OHTRs), particularly through breath-hold myocardial T1 and T2 mapping sequences. We aimed to assess the diagnostic performance of the novel free-breathing multiparametric saturation-recovery single-shot acquisition (mSASHA) mapping technique to identify acute cardiac allograft rejection (ACAR) non-invasively against EMB. This retrospective study included n = 21 consecutive OHTRs with suspected ACAR who underwent both a 1.5T CMR scan with mSASHA mapping and an EMB within 5.4 (1.2-14.8) days, and n = 20 healthy controls who underwent CMR with mSASHA mapping. Conventional breath-holding T2-prepared balanced steady-state free precession (T2p-bSSFP) T2 mapping was also acquired. CAR was EMB defined as histological rejection (HR) (acute cellular rejection of ≥ 1 R or acute antibody-mediated rejection of ≥ 1). Overall, n = 21 OHTRs (9 females) with a mean age of 43.2 ± 16.2 years and a median time of 5.4 (1.2-14.8) years since transplantation were included in the study, alongside n = 20 healthy controls. HR was present in n = 9 patients. The HR group showed significantly higher septal mSASHA T2 values compared to the non-HR (n = 12) group (53 ± 6 ms vs. 47 ± 4 ms, p = 0.014). Receiver operator characteristics analysis showed an area under the curve of 0.79 (95% confidence interval 0.59-0.98, p = 0.028) and an optimal cut-off value of 50 ms (sensitivity of 67%, specificity of 75%) for identifying patients with HR using septal mSASHA T2 values. There was at least a moderate correlation of septal and global mSASHA T1 and T2 values (n = 21) with MOLLI T1 (n = 17) and T2p-bSSFP T2 (n = 18) values (r > 0.6, p ≤ 0.003). OHTR patients without HR showed higher septal (T1: 1256 ± 42 ms vs. 1201 ± 46 ms, p = 0.002; T2: 47 ± 4 ms vs. 43 ± 2 ms, p = 0.003) and global mSASHA (T1: 1250 ± 58 ms vs. 1201 ± 45 ms, p = 0.013; T2: 48 ± 5 ms vs. 43 ± 2 ms, p = 0.009) values compared to normal controls (n = 20). In the control group, native mSASHA T1 and T2 values were higher in females (n = 9) than in males. Free-breathing mSASHA T2 mapping may be useful in identifying histological changes associated with ACAR, overcoming the challenges of breath holding and with good diagnostic performance.

Cardiomyopathies are a heterogeneous group of myocardial disorders characterized by mechanical and/or electrical dysfunction, typically occurring without significant coronary artery disease, hypertension, valvular, or congenital heart disease. According to current ESC guidelines, cardiovascular magnetic resonance (CMR) is a class I recommendation for the initial evaluation of patients with suspected cardiomyopathy, given its ability to provide comprehensive morphological and tissue characterization. CMR, however, may be precluded in patients owing to device incompatibility, claustrophobia, or arrhythmia- and motion-related image degradation. In this context, cardiac computed tomography (CCT), traditionally used for assessing coronary artery disease, has emerged as a valuable alternative. Technological advancements have enabled CCT to deliver not only detailed anatomical information but also functional and tissue-specific insights. The recent consensus document from the European Association of Cardiovascular Imaging underscore the expanding clinical applications of CCT, highlighting its potential role in the diagnostic work-up and phenotypic classification of cardiomyopathies. In this review, we summarize the current evidence supporting the use of CCT in patients with suspected cardiomyopathy, outline its clinical strengths and limitations, and discuss emerging developments such as artificial intelligence and radiomics, which could further enhance its diagnostic and prognostic value.

This systematic review explores the role of cross-sectional imaging modalities-computed tomography angiography (CTA) and magnetic resonance angiography (MRA)-in the preoperative planning of dialysis vascular access for patients with end-stage renal disease (ESRD). A systematic search was conducted using PubMed and Cochrane databases, yielding 45 studies meeting inclusion criteria. These modalities are particularly valuable in cases of complex vascular anatomy, central venous stenosis, and prior surgical interventions. Findings emphasize the advantages of CTA for detailed anatomical mapping and MRA for cases requiring soft-tissue contrast or preservation of renal function. Representative clinical cases illustrate how imaging findings directly influence surgical and endovascular decision-making, optimizing patient outcomes. This manuscript describes the role of cross-sectional imaging for dialysis circuit vascular access interventions including representative clinical examples.

Objectives: Transthoracic echocardiography (TTE) is the standard modality for grading aortic stenosis (AS) severity. Transesophageal echocardiography (TOE) allows direct aortic valve area (AVA) planimetry (AVA_TOE), while computed tomography angiography (CTA) offers a non-invasive alternative (AVA_CTA). This study aimed to evaluate the correlation between AVA measurements across modalities and to determine a diagnostic AVA_CTA threshold for severe AS.

Methods: This retrospective study included a single-center derivation cohort of 176 patients (mean age 80.0 ± 7.7 years, 52.8% male) with moderate to severe AS who underwent full-cycle CTA, TTE, and TOE. AVA_CTA was measured by two independent raters. Correlation with AVA_TOE and other parameters was assessed. Receiver operating characteristic (ROC) analysis was used to define an optimal AVA_CTA threshold for severe AS, which was validated in a multi-center cohort of 407 patients (mean age 80.9 ± 6.7 years, 52.8% male) with comparable characteristics.

Results: Mean AVA_CTA was 0.96 ± 0.28 cm² with a high interrater reliability (IRR = 0.84), compared to a mean AVA_TOE of 0.88 ± 0.26 cm² (Pearson's r = 0.73). ROC analysis identified 0.96 cm² as the optimal AVA_CTA threshold for diagnosing severe AS (AUC = 0.846; sensitivity = 71.7%; specificity = 89.8%) compared to TOE grading. This threshold yielded good diagnostic performance in the validation cohort (AUC = 0.817; sensitivity = 78.2%; specificity = 72.6%).

Conclusions: AVA_CTA demonstrated high reliability, showing a strong correlation with AVA_TOE. The 0.96 cm² threshold, defined in the derivation cohort, performed well in the validation cohort for assessing aortic stenosis severity.

Quantification of the calcific burden is valuable in percutaneous coronary intervention (PCI) planning and in research to assess its changes after pharmacotherapies targeting plaque progression. In intravascular ultrasound (IVUS) images this analysis is currently performed manually and time consuming. To overcome these limitations, we introduce a deep-learning (DL) method for seamless detection of the calcific tissue. IVUS images from 197 vessels were analysed by an expert who identified the presence of calcium, and these estimations were used to train a DL model for fast detection of calcific deposits. The output of the model was tested in a set of 30 vessels against the estimations of the two experts. Comparison was performed at a frame-, lesion- and segment level. In total 26,211 frames were included in the training and 5,138 in the test set. The estimations of the DL method for the presence of calcium were similar to the experts (kappa 0.842 and 0.848, p < 0.001), while the correlation between the DL approach and the two experts for the arc of calcium (0.946 and 0.947, p < 0.001) and calcific area (0.745 and 0.706, p < 0.001) were high. Lesion- (0.971 and 0.990, p < 0.001) and segment-level analysis (0.980 and 0.981, p < 0.001) demonstrated a high correlation between the method and the two experts for calcific burden. The proposed DL method is able to accurately detect the calcific tissue and quantify its burden. These features render it useful in research and are expected to facilitate its application in the clinical workflows to guide PCI.