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Cardiovascular and Thoracic Imaging: Trends, Perspectives and Prospects

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

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 23982

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Special Issue Editor

Prof. Dr. Mickaël Ohana

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Guest Editor

1. Radiology Department, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
2. IMAGeS team, ICube laboratory, Illkirch-Graffenstaden, France
Interests: cardiovascular non-invasive imaging; ultra-low-dose chest CT; structural heart disease; CT image reconstruction; artificial intelligence in radiology

Special Issue Information

Dear Colleagues,

Radiology is evolving at a fast pace, and the specific field of cardiovascular and thoracic imaging is no stranger to that trend. While it could, at first, seem unusual to gather these two specialties in a common Special Issue, the very fact that many of us are trained and exercise in both is more than a hint to the common grounds these fields are sharing. From the ever-increasing role of artificial intelligence in the reconstruction, segmentation, and analysis of images to the quest of functionality derived from anatomy, their interplay is big, and one innovation developed with the former in mind could prove useful for the latter. If the coronavirus disease 2019 (COVID-19) pandemic has shed light on the decisive diagnostic role of chest CT and, to a lesser extent, cardiac MR, one must not forget the major advances and extensive researches made possible in other areas by these techniques in the past years. With this Special Issue, we aim at encouraging and wish to bring to light state-of-the-art reviews, novel original researches, and ongoing discussions on the multiple aspects of cardiovascular and chest imaging.

Prof. Dr. Mickaël Ohana
Guest Editor

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Keywords

Radiology
Diagnostic Imaging
Multidetector Computed Tomography
Magnetic Resonance Imaging
Cardiac Imaging Techniques
Computed Tomography Angiography
Image Processing, Computer-Assisted

Published Papers (9 papers)

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Research

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10 pages, 2810 KiB

Open AccessArticle

Diagnostic Performance of Extracellular Volume Quantified by Dual-Layer Dual-Energy CT for Detection of Acute Myocarditis

by Salim Aymeric Si-Mohamed, Lauria Marie Restier, Arthur Branchu, Sara Boccalini, Anaelle Congi, Arthur Ziegler, Danka Tomasevic, Thomas Bochaton, Loic Boussel and Philippe Charles Douek

J. Clin. Med. 2021, 10(15), 3286; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10153286 - 26 Jul 2021

Cited by 13 | Viewed by 2159

Abstract

Background: Myocardial extracellular volume (ECV) is a marker of the myocarditis inflammation burden and can be used for acute myocarditis diagnosis. Dual-energy computed tomography (DECT) enables its quantification with high concordance with cardiac magnetic resonance (CMR). Purpose: To investigate the diagnostic performance of myocardial ECV quantified on a cardiac dual-layer DECT in a population of patients with suspected myocarditis, in comparison to CMR. Methods: 78 patients were included in this retrospective monocenter study, 60 were diagnosed with acute myocarditis and 18 patients were considered as a control population, based on the 2009 Lake and Louise criteria. All subjects underwent a cardiac DECT in acute phase consisted in an arterial phase followed by a late iodine enhancement phase at 10 min after injection (1.2 mL/kg, iodinated contrast agent). ECV was calculated using the hematocrit level measured the day of DECT examinations. Non-parametric analyses have been used to test the differences between groups and the correlations between the variables. A ROC curve has been used to identify the optimal ECV cut-off discriminating value allowing the detection of acute myocarditis cases. A p value < 0.05 has been considered as significant. Results: The mean ECV was significantly higher (p < 0.001) for the myocarditis group compared to the control (34.18 ± 0.43 vs. 30.04 ± 0.53%). A cut-off value of ECV = 31.60% (ROC AUC = 0.835, p < 0.001) allows to discriminate the myocarditis with a sensitivity of 80% and a specificity of 78% (positive predictive value = 92.3%, negative predictive value = 53.8% and accuracy = 79.5%). Conclusion: Myocardial ECV enabled by DECT allows to diagnose the acute myocarditis with a cut-off at 31.60% for a sensitivity of 80% and specificity of 78%. Full article

(This article belongs to the Special Issue Cardiovascular and Thoracic Imaging: Trends, Perspectives and Prospects)

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13 pages, 1809 KiB

Open AccessArticle

Impact of Morphotype on Image Quality and Diagnostic Performance of Ultra-Low-Dose Chest CT

by Anne-Claire Ortlieb, Aissam Labani, François Severac, Mi-Young Jeung, Catherine Roy and Mickaël Ohana

J. Clin. Med. 2021, 10(15), 3284; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10153284 - 26 Jul 2021

Cited by 2 | Viewed by 1956

Abstract

Objectives: The image quality of an Ultra-Low-Dose (ULD) chest CT depends on the patient’s morphotype. We hypothesize that there is a threshold beyond which the diagnostic performance of a ULD chest CT is too degraded. This work assesses the influence of morphotype (Body Mass Index BMI, Maximum Transverse Chest Diameter MTCD and gender) on image quality and the diagnostic performance of a ULD chest CT. Methods: A total of 170 patients from three prior prospective monocentric studies were retrospectively included. Renewal of consent was waived by our IRB. All the patients underwent two consecutive unenhanced chest CT acquisitions with a full dose (120 kV, automated tube current modulation) and a ULD (135 kV, fixed tube current at 10 mA). Image noise, subjective image quality and diagnostic performance for nine predefined lung parenchyma lesions were assessed by two independent readers, and correlations with the patient’s morphotype were sought. Results: The mean BMI was 26.6 ± 5.3; 20.6% of patients had a BMI > 30. There was a statistically significant negative correlation of the BMI with the image quality (ρ = −0.32; IC95% = (−0.468; −0.18)). The per-patient diagnostic performance of ULD was sensitivity, 77%; specificity, 99%; PPV, 94% and NPV, 65%. There was no statistically significant influence of the BMI, the MTCD nor the gender on the per-patient and per-lesion diagnostic performance of a ULD chest CT, apart from a significant negative correlation for the detection of emphysema. Conclusions: Despite a negative correlation between the BMI and the image quality of a ULD chest CT, we did not find a correlation between the BMI and the diagnostic performance of the examination, suggesting a possible use of the ULD protocol in obese patients. Full article

(This article belongs to the Special Issue Cardiovascular and Thoracic Imaging: Trends, Perspectives and Prospects)

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13 pages, 1905 KiB

Open AccessArticle

Compressed Sensing Real-Time Cine Reduces CMR Arrhythmia-Related Artifacts

by Benjamin Longère, Paul-Edouard Allard, Christos V Gkizas, Augustin Coisne, Justin Hennicaux, Arianna Simeone, Michaela Schmidt, Christoph Forman, Solenn Toupin, David Montaigne and François Pontana

J. Clin. Med. 2021, 10(15), 3274; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10153274 - 24 Jul 2021

Cited by 7 | Viewed by 2585

Abstract

Background and objective: Cardiac magnetic resonance (CMR) is a key tool for cardiac work-up. However, arrhythmia can be responsible for arrhythmia-related artifacts (ARA) and increased scan time using segmented sequences. The aim of this study is to evaluate the effect of cardiac arrhythmia on image quality in a comparison of a compressed sensing real-time (CS_rt) cine sequence with the reference prospectively gated segmented balanced steady-state free precession (Cine_ref) technique regarding ARA. Methods: A total of 71 consecutive adult patients (41 males; mean age = 59.5 ± 20.1 years (95% CI: 54.7–64.2 years)) referred for CMR examination with concomitant irregular heart rate (defined by an RR interval coefficient of variation >10%) during scanning were prospectively enrolled. For each patient, two cine sequences were systematically acquired: first, the reference prospectively triggered multi-breath-hold Cine_ref sequence including a short-axis stack, one four-chamber slice, and a couple of two-chamber slices; second, an additional single breath-hold CS_rt sequence providing the same slices as the reference technique. Two radiologists independently assessed ARA and image quality (overall, acquisition, and edge sharpness) for both techniques. Results: The mean heart rate was 71.8 ± 19.0 (SD) beat per minute (bpm) (95% CI: 67.4–76.3 bpm) and its coefficient of variation was 25.0 ± 9.4 (SD) % (95% CI: 22.8–27.2%). Acquisition was significantly faster with CS_rt than with Cine_ref (Cine_ref: 556.7 ± 145.4 (SD) s (95% CI: 496.7–616.7 s); CS_rt: 23.9 ± 7.9 (SD) s (95% CI: 20.6–27.1 s); p < 0.0001). A total of 599 pairs of cine slices were evaluated (median: 8 (range: 6–14) slices per patient). The mean proportion of ARA-impaired slices per patient was 85.9 ± 22.7 (SD) % using Cine_ref, but this was figure was zero using CS_rt (p < 0.0001). The European CMR registry artifact score was lower with CS_rt (median: 1 (range: 0–5)) than with Cine_ref (median: 3 (range: 0–3); p < 0.0001). Subjective image quality was higher in CS_rt than in Cine_ref (median: 3 (range: 1–3) versus 2 (range: 1–4), respectively; p < 0.0001). In line, edge sharpness was higher on CS_rt cine than on Cine_ref images (0.054 ± 0.016 pixel⁻¹ (95% CI: 0.050–0.057 pixel⁻¹) versus 0.042 ± 0.022 pixel⁻¹ (95% CI: 0.037–0.047 pixel⁻¹), respectively; p = 0.0001). Conclusion: Compressed sensing real-time cine drastically reduces arrhythmia-related artifacts and thus improves cine image quality in patients with arrhythmia. Full article

(This article belongs to the Special Issue Cardiovascular and Thoracic Imaging: Trends, Perspectives and Prospects)

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10 pages, 387 KiB

Open AccessArticle

Interstitial Lung Abnormalities Detected by CT in Asbestos-Exposed Subjects Are More Likely Associated to Age

by François Laurent, Ilyes Benlala, Gael Dournes, Celine Gramond, Isabelle Thaon, Bénédicte Clin, Patrick Brochard, Antoine Gislard, Pascal Andujar, Soizick Chammings, Justine Gallet, Aude Lacourt, Fleur Delva, Christophe Paris, Gilbert Ferretti and Jean-Claude Pairon

J. Clin. Med. 2021, 10(14), 3130; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10143130 - 15 Jul 2021

Cited by 3 | Viewed by 2389

Abstract

Objective: the aim of this study was to evaluate the association between interstitial lung abnormalities, asbestos exposure and age in a population of retired workers previously occupationally exposed to asbestos. Methods: previously occupationally exposed former workers to asbestos eligible for a survey conducted between 2003 and 2005 in four regions of France, underwent chest CT examinations and pulmonary function testing. Industrial hygienists evaluated asbestos exposure and calculated for each subject a cumulative exposure index (CEI) to asbestos. Smoking status information was also collected in this second round of screening. Expert radiologists performed blinded independent double reading of chest CT-scans and classified interstitial lung abnormalities into: no abnormality, minor interstitial findings, interstitial findings inconsistent with UIP, possible or definite UIP. In addition, emphysema was assessed visually (none, minor: emphysema <25%, moderate: between 25 and 50% and severe: >50% of the lung). Logistic regression models adjusted for age and smoking were used to assess the relationship between interstitial lung abnormalities and occupational asbestos exposure. Results: the study population consisted of 2157 male subjects. Interstitial lung abnormalities were present in 365 (16.7%) and emphysema in 444 (20.4%). Significant positive association was found between definite or possible UIP pattern and age (OR adjusted =1.08 (95% CI: 1.02–1.13)). No association was found between interstitial abnormalities and CEI or the level of asbestos exposure. Conclusion: presence of interstitial abnormalities at HRCT was associated to aging but not to cumulative exposure index in this cohort of former workers previously occupationally exposed to asbestos. Full article

(This article belongs to the Special Issue Cardiovascular and Thoracic Imaging: Trends, Perspectives and Prospects)

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11 pages, 19285 KiB

Open AccessArticle

Long-Term Imaging Follow-Up in DIPNECH: Multicenter Experience

by Cécile Chung, Sébastien Bommart, Sylvain Marchand-Adam, Mathieu Lederlin, Ludovic Fournel, Marie-Christine Charpentier, Lionel Groussin, Marie Wislez, Marie-Pierre Revel and Guillaume Chassagnon

J. Clin. Med. 2021, 10(13), 2950; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10132950 - 30 Jun 2021

Cited by 4 | Viewed by 2540

Abstract

Diffuse pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare pre-invasive disease whose pathophysiology remains unclear. We aimed to assess long-term evolution in imaging of DIPNECH, in order to propose follow-up recommendations. Patients with histologically confirmed DIPNECH from four centers, evaluated between 2001 and 2020, were enrolled if they had at least two available chest computed tomography (CT) exams performed at least 24 months apart. CT exams were analyzed for the presence and the evolution of DIPNECH-related CT findings. Twenty-seven patients, mostly of female gender (n = 25/27; 93%) were included. Longitudinal follow-up over a median 63-month duration (IQR: 31–80 months) demonstrated an increase in the size of lung nodules in 19 patients (19/27, 70%) and the occurrence of metastatic spread in three patients (3/27, 11%). The metastatic spread was limited to mediastinal lymph nodes in one patient, whereas the other two patients had both lymph node and distant metastases. The mean time interval between baseline CT scan and metastatic spread was 70 months (14, 74 and 123 months). Therefore, long-term annual imaging follow-up of DIPNECH might be appropriate to encompass the heterogeneous longitudinal behavior of this disease. Full article

(This article belongs to the Special Issue Cardiovascular and Thoracic Imaging: Trends, Perspectives and Prospects)

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15 pages, 2690 KiB

Open AccessArticle

60-S Retrogated Compressed Sensing 2D Cine of the Heart: Sharper Borders and Accurate Quantification

by Benjamin Longère, Christos V. Gkizas, Augustin Coisne, Lucas Grenier, Valentina Silvestri, Julien Pagniez, Arianna Simeone, Justin Hennicaux, Michaela Schmidt, Christoph Forman, Solenn Toupin, David Montaigne and François Pontana

J. Clin. Med. 2021, 10(11), 2417; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10112417 - 29 May 2021

Cited by 4 | Viewed by 2420

Abstract

Background and objective: Real-time compressed sensing cine (CS_rt) provides reliable quantification for both ventricles but may alter image quality. The aim of this study was to assess image quality and the accuracy of left (LV) and right ventricular (RV) volumes, ejection fraction and mass quantifications based on a retrogated segmented compressed sensing 2D cine sequence (CS_rg). Methods: Thirty patients were enrolled. Each patient underwent the reference retrogated segmented steady-state free precession cine sequence (SSFP_ref), the real-time CS_rt cine and the segmented retrogated prototype CS_rg sequence providing the same slices. Functional parameters quantification and image quality rating were performed on SSFP_ref and CS_rg images sets. The edge sharpness, which is an estimate of the edge spread function, was assessed for the three sequences. Results: The mean scan time was: SSFP_ref = 485.4 ± 83.3 (SD) s (95% CI: 454.3–516.5) and CS_rg = 58.3 ± 15.1 (SD) s (95% CI: 53.7–64.2) (p < 0.0001). CS_rg subjective image quality score (median: 4; range: 2–4) was higher than the one provided by CS_rt (median: 3; range: 2–4; p = 0.0008) and not different from SSFP_ref overall quality score (median: 4; range: 2–4; p = 0.31). CS_rg provided similar LV and RV functional parameters to those assessed with SSFP_ref (p > 0.05). Edge sharpness was significantly better with CS_rg (0.083 ± 0.013 (SD) pixel⁻¹; 95% CI: 0.078–0.087) than with CS_rt (0.070 ± 0.011 (SD) pixel⁻¹; 95% CI: 0.066–0.074; p = 0.0004) and not different from the reference technique (0.075 ± 0.016 (SD) pixel⁻¹; 95% CI: 0.069–0.081; p = 0.0516). Conclusions: CS_rg cine provides in one minute an accurate quantification of LV and RV functional parameters without compromising subjective and objective image quality. Full article

(This article belongs to the Special Issue Cardiovascular and Thoracic Imaging: Trends, Perspectives and Prospects)

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13 pages, 1749 KiB

Open AccessArticle

Right Ventricular Volume and Function Assessment in Congenital Heart Disease Using CMR Compressed-Sensing Real-Time Cine Imaging

by Benjamin Longère, Julien Pagniez, Augustin Coisne, Hedi Farah, Michaela Schmidt, Christoph Forman, Valentina Silvestri, Arianna Simeone, Christos V Gkizas, Justin Hennicaux, Emma Cheasty, Solenn Toupin, David Montaigne and François Pontana

J. Clin. Med. 2021, 10(9), 1930; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10091930 - 29 Apr 2021

Cited by 3 | Viewed by 1907

Abstract

Background and objective: To evaluate the reliability of compressed-sensing (CS) real-time single-breath-hold cine imaging for quantification of right ventricular (RV) function and volumes in congenital heart disease (CHD) patients in comparison with the standard multi-breath-hold technique. Methods: Sixty-one consecutive CHD patients (mean age = 22.2 ± 9.0 (SD) years) were prospectively evaluated during either the initial work-up or after repair. For each patient, two series of cine images were acquired: first, the reference segmented multi-breath-hold steady-state free-precession sequence (SSFP_ref), including a short-axis stack, one four-chamber slice, and one long-axis slice; then, an additional real-time compressed-sensing single-breath-hold sequence (CS_rt) providing the same slices. Two radiologists independently assessed the image quality and RV volumes for both techniques, which were compared using the Wilcoxon test and paired Student’s t test, Bland–Altman, and linear regression analyses. The visualization of wall-motion disorders and tricuspid-regurgitation-related signal voids were also analyzed. Results: The mean acquisition time for CS_rt was 22.4 ± 6.2 (SD) s (95% CI: 20.8–23.9 s) versus 442.2 ± 89.9 (SD) s (95% CI: 419.2–465.2 s) for SSFP_ref (p < 0.001). The image quality of CS_rt was diagnostic in all examinations and was mostly rated as good (n = 49/61; 80.3%). There was a high correlation between SSFP_ref and CS_rt images regarding RV ejection fraction (49.8 ± 7.8 (SD)% (95% CI: 47.8–51.8%) versus 48.7 ± 8.6 (SD)% (95% CI: 46.5–50.9%), respectively; r = 0.94) and RV end-diastolic volume (192.9 ± 60.1 (SD) mL (95% CI: 177.5–208.3 mL) versus 194.9 ± 62.1 (SD) mL (95% CI: 179.0–210.8 mL), respectively; r = 0.98). In CS_rt images, tricuspid-regurgitation and wall-motion disorder visualization was good (area under receiver operating characteristic curve (AUC) = 0.87) and excellent (AUC = 1), respectively. Conclusions: Compressed-sensing real-time cine imaging enables, in one breath hold, an accurate assessment of RV function and volumes in CHD patients in comparison with standard SSFP_ref, allowing a substantial improvement in time efficiency. Full article

(This article belongs to the Special Issue Cardiovascular and Thoracic Imaging: Trends, Perspectives and Prospects)

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Review

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18 pages, 6985 KiB

Open AccessReview

Spectral Photon-Counting CT Technology in Chest Imaging

by Salim Aymeric Si-Mohamed, Jade Miailhes, Pierre-Antoine Rodesch, Sara Boccalini, Hugo Lacombe, Valérie Leitman, Vincent Cottin, Loic Boussel and Philippe Douek

J. Clin. Med. 2021, 10(24), 5757; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10245757 - 09 Dec 2021

Cited by 45 | Viewed by 5246

Abstract

The X-ray imaging field is currently undergoing a period of rapid technological innovation in diagnostic imaging equipment. An important recent development is the advent of new X-ray detectors, i.e., photon-counting detectors (PCD), which have been introduced in recent clinical prototype systems, called PCD computed tomography (PCD-CT) or photon-counting CT (PCCT) or spectral photon-counting CT (SPCCT) systems. PCD allows a pixel up to 200 microns pixels at iso-center, which is much smaller than that can be obtained with conventional energy integrating detectors (EID). PCDs have also a higher dose efficiency than EID mainly because of electronic noise suppression. In addition, the energy-resolving capabilities of these detectors allow generating spectral basis imaging, such as the mono-energetic images or the water/iodine material images as well as the K-edge imaging of a contrast agent based on atoms of high atomic number. In recent years, studies have therefore been conducted to determine the potential of PCD-CT as an alternative to conventional CT for chest imaging. Full article

(This article belongs to the Special Issue Cardiovascular and Thoracic Imaging: Trends, Perspectives and Prospects)

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11 pages, 542 KiB

Open AccessReview

Chronic Lung Allograft Dysfunction Post Lung Transplantation: A Review of Computed Tomography Quantitative Methods for Detection and Follow-Up

by Trieu-Nghi Hoang-Thi, Guillaume Chassagnon, Thong Hua-Huy, Veronique Boussaud, Anh-Tuan Dinh-Xuan and Marie-Pierre Revel

J. Clin. Med. 2021, 10(8), 1608; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10081608 - 10 Apr 2021

Cited by 4 | Viewed by 1991

Abstract

Chronic lung allograft dysfunction (CLAD) remains the leading cause of morbidity and mortality after lung transplantation. The term encompasses both obstructive and restrictive phenotypes, as well as mixed and undefined phenotypes. Imaging, in addition to pulmonary function tests, plays a major role in identifying the CLAD phenotype and is essential for follow-up after lung transplantation. Quantitative imaging allows for the performing of reader-independent precise evaluation of CT examinations. In this review article, we will discuss the role of quantitative imaging methods for evaluating the airways and the lung parenchyma on computed tomography (CT) images, for an early identification of CLAD and for prognostic estimation. We will also discuss their limits and the need for novel approaches to predict, understand, and identify CLAD in its early stages. Full article

(This article belongs to the Special Issue Cardiovascular and Thoracic Imaging: Trends, Perspectives and Prospects)

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