Current Cardiovascular Imaging Reports

Gianchandani, Priyanka Deepak; Zhang, Lili

doi: 10.1007/s12410-025-09611-4pmid: N/A

Purpose of ReviewArtificial intelligence (AI) is expeditiously reshaping healthcare by refining diagnosis, treatment, and patient care. AI, a transformative force in both cardiology and oncology, is now being increasingly explored for its potentials in the arising field of cardio-oncology.Recent FindingsIn the field of Cardio-Oncology, risk prediction and stratification using clinical characteristics, combined with imaging such as electrocardiography, multimodality cardiovascular imaging, and laboratory studies such as biomarkers powered by AI can assist in identifying cardiotoxicity with better precision and efficiency. In addition, surveillance of cardiotoxicity through longitudinal follow-up is an important area that AI can aid to offer improved efficiency, high precision, and consistency when processing high throughput data. Nonetheless, other applications of AI in telemedicine and digital health, translation science, drug discovery, and healthcare education hold significant promise in the domain of cardio-oncology.SummaryIn conclusion, AI can advance the field of cardio-oncology and further research is necessary to assess its current limitations, overcome existing challenges, and transform research into real-life practice.

Medina, Frank A.; Dubosq-Lebaz, Maxime; Kim, Joseph M.; Secemsky, Eric A.

doi: 10.1007/s12410-025-09603-4pmid: N/A

Purpose of ReviewThe purpose of this paper is to review the current role of intravascular imaging (IVI) in the diagnosis and management of peripheral artery disease (PAD) through its application in endovascular interventions of the lower extremities.Recent FindingsIVI, an established adjunctive tool for coronary intervention, has become increasingly used during peripheral endovascular revascularizations. Intravascular ultrasound (IVUS) is the predominant IVI modality used during peripheral intervention. The use of optical coherence tomography (OCT) in the peripheral vasculature is limited. Growing data from retrospective studies, meta-analyses and new clinical trials have demonstrated that IVUS-guidance may improve endovascular procedural and clinical outcomes, such as improved patency and reduced rates of major adverse limb events.SummaryIVI provides unique information of the vasculature before, during, and after endovascular intervention. This allows for accurate vessel measurements and detailed lesion characterization, assisting diagnostic dilemmas and guiding procedures to optimize stent deployment (e.g. sizing, apposition, expansion) and detect complications post-intervention (e.g. dissection, stent fracture). Expert consensus largely supports the implementation of IVI, and IVUS specifically, during endovascular interventions for PAD. However, more robust clinical data evaluating the efficacy, safety, long-term outcomes and cost-effectiveness of IVI modalities are still needed.

Fazzini, Luca; Marchetti, Maria Francesca; Montisci, Roberta

doi: 10.1007/s12410-025-09608-zpmid: N/A

Purpose of ReviewTo analyze the diagnostic utility of cardiac magnetic resonance (CMR) images, including post-contrast sequences and late gadolinium enhancement (LGE) findings in Takotsubo syndrome (TTS).Recent FindingsTTS usually mimics acute coronary syndrome, making differential diagnosis challenging. CMR plays a key role in TTS diagnosis, particularly through T2 weighted/T2 mapping and LGE sequences. While TTS is not characterized by fibrosis replacement, LGE is detected in approximately 25% of cases, raising questions about its interpretation and prognostic relevance.SummaryThis perspective article aims to critically analyze the challenges in LGE interpretation, including patterns, timing, imaging protocols, and pathophysiological mechanisms in TTS. Standardization of CMR protocols and artificial intelligence-based techniques may improve accuracy. Further research is needed to explore the LGE’s impact on TTS prognosis and clinical management.

Paleri, Sarang; Rayner, Clare; Abrahams, Timothy; Vasanthakumar, Sheran; Goel, Vishal; Muthalaly, Rahul; Lin, Andrew; Nerlekar, Nitesh

doi: 10.1007/s12410-025-09605-2pmid: N/A

Purpose of ReviewThis review examines recent developments in computed tomography-derived extracellular volume (CT-ECV) assessment, focusing on acquisition protocols, clinical applications, and emerging technologies.Recent FindingsCT-derived extracellular volume fraction (CT-ECV) has emerged as a robust tool for myocardial characterisation across various cardiac conditions. Recent advancements in technology, including photon-counting detector CT and artificial intelligence integration, have enhanced image quality and workflow efficiency while reducing radiation exposure. CT-ECV demonstrates particular utility in cardiac amyloidosis detection, cancer therapy-related cardiac dysfunction monitoring, and risk stratification in aortic stenosis. The technique boosts the utility of CCTA by adding myocardial tissue characterisation to coronary evaluation. Synthetic ECV calculation and automated post-processing further streamline clinical implementation. While protocol standardisation remains an important goal, CT-ECV’s ability to provide valuable prognostic information positions it as an increasingly important tool in cardiovascular imaging. As evidence accumulates supporting its clinical value, CT-ECV is likely to play a growing role in patient care and research.SummaryCT-ECV has matured into a versatile and powerful tool for myocardial characterisation across a spectrum of cardiac conditions. The integration of cutting-edge technologies, such as photon-counting detector CT and artificial intelligence, has significantly enhanced image quality and streamlined workflow efficiency while simultaneously reducing radiation exposure. This evolution addresses previous limitations and expands the clinical applicability of CT-ECV.

Sawalha, Khalid; Gautam, Nitesh; Gupta, Neelesh; Kaul, Risheek; Jambhekar, Kedar; Hassanin, Ahmed; Dhar, Gaurav; Al’Aref, Subhi J.

doi: 10.1007/s12410-025-09604-3pmid: N/A

Purpose of ReviewHypoattenuated leaflet thickening (HALT) has emerged as an important post-procedural finding after transcatheter aortic valve replacement (TAVR). HALT is characterized by localized thickening of the leaflets of bioprosthetic valves due to thrombus deposition, potentially leading to leaflet dysfunction and reduced mobility.Recent FindingsAlthough initially thought to be clinically silent, HALT has now been linked with subclinical valve thrombosis and carries implications for valve durability, as well as patient outcomes, including stroke and heart failure. The introduction of advanced and multidimensional imaging techniques, particularly multi-detector computed tomography (MDCT), has led to a greater understanding of the pathophysiology of HALT, allowing for detailed visualization and assessment of leaflet morphology, function, and mobility.SummaryThis review article explores the current understanding of HALT, its pathophysiology, risk factors, clinical relevance, and the role of multimodal imaging for establishing an accurate diagnosis. We also discuss technical considerations in managing HALT, including anticoagulation strategies, their role in preventing thrombus formation and improving long-term outcomes. Additionally, we highlight the ongoing debate regarding optimal follow-up and therapeutic strategies to balance HALT-related risks with the broader clinical benefits of TAVR.

Simonetti, Fiorenzo; Cassese, Salvatore; Carassia, Claudia; Lenz, Tobias; Blum, Edna; Alvarez Covarrubias, Hector A.; Taniguchi, Yousuke; Pellegrini, Costanza; Rheude, Tobias; Pinieck, Susanne; Voll, Felix; Kastrati, Adnan; Joner, Michael; Xhepa, Erion

doi: 10.1007/s12410-025-09606-1pmid: N/A

Purpose of ReviewThe scope of this review is to provide an up-to-date overview of the current evidence on the role of intravascular imaging (IVI) in the diagnosis, management and outcomes of patients presenting with stent failure and to highlight evidence gaps and future perspectives in this field.Recent FindingsBased on the results of several large, randomized, prospective trials, there is convincing evidence to support IVI imaging guidance of percutaneous coronary intervention (PCI) procedures, particularly in the setting of complex coronary lesions, in order to reduce the occurrence of hard clinical endpoints, including cardiac death, target lesion revascularization and stent failure. On the other hand, due to their ability to identify underlying mechanisms leading to the occurrence of stent failure, current guidelines and consensus statements strongly advocate the use of IVI in this setting. However, specific evidence supporting this recommendation relies primarily on observational studies, of either prospective or retrospective nature, while randomized, prospective trials evaluating the prognostic value of IVI in the management of stent failure are virtually absent. However, based on findings of observational studies, several ongoing randomized trials, primarily in patients presenting with ISR, are evaluating the role of IVI in guiding treatment modalities, in an attempt to develop personalized IVI-based treatment approaches.SummaryDespite the high performance of current-generation drug-eluting stents (DES), widespread adoption of PCI in patient cohorts characterized by increasing age and coronary lesion complexity contributes to the occurrence of stent failure, which is associated with substantial morbidity and mortality. Identifying and addressing the root causes leading to the occurrence of stent failure represent central, indispensable steps in the treatment of patients presenting with this condition, while coronary angiography has considerable intrinsic limitations in this regard. On the other hand, due to the high spatial resolution and improved ability to identify relevant pathogenetic mechanisms, incorporation of IVI modalities in the management of patients presenting with stent failure, has the potential to enable tailored therapeutic approaches, thereby personalizing treatment algorithms. Indeed, a growing body of evidence supports the use of IVI modalities as a tool to improve acute procedural results as well as to reduce the risk of recurrence in patients presenting with stent failure.

Occhipinti, Giovanni; Brugaletta, Salvatore

doi: 10.1007/s12410-025-09610-5pmid: N/A

Purpose of Review This chapter summarizes the role of optical coherence tomography (OCT) in guiding percutaneous coronary intervention (PCI), highlighting its impact on lesion assessment, optimal stent sizing and placement, and post-procedural optimization. Recent Findings OCT has shown to improve procedural and long-term clinical outcomes over angiography alone. It offers high-resolution imaging that enables precise plaque characterization, including fibrous, lipid-rich, and calcific morphologies, with direct implications for lesion preparation. Accurate measurement of vessel size and lesion length enables stent selection and landing zone identification. After stent deployment, OCT identifies suboptimal results such as underexpansion, malapposition, edge dissections, and tissue prolapse, guiding immediate optimization. The use of OCT is now endorsed with a Class Ia recommendation by European and U.S. guidelines. Summary By enabling anatomy-based procedural planning and results assessment, OCT has transformed PCI into a more precise procedure. Its use contributes to reduced complications, improved stent placement, and better long-term outcomes.

Ezegwu, Olisa; Doukky, Rami

doi: 10.1007/s12410-025-09602-5pmid: N/A

Purpose of ReviewSingle photon emission computed tomography (SPECT) and positron emission tomography (PET) cardiac imaging have evolved, providing innumerable data points for the clinician reader to analyze to achieve accurate diagnosis and guide management. The advent of artificial intelligence (AI) could play a pivotal role in better harnessing these data and improving nuclear cardiology workflows. In this review, we explored the current applications of AI in various aspects of nuclear cardiology.Recent FindingsInnovative studies have explored the use of AI, particularly deep learning models, to identify ideal patient candidates for stress-only imaging to reduce radiation exposure and acquisition time. Furthermore, there is published evidence that deep learning can provide efficient methods to achieve reliable image segmentation, attenuation correction, and image registration. In addition, AI-based disease diagnosis and risk prediction models have been shown to perform similarly if not better than expert readers in some settings. Beyond coronary artery disease, there are promising results of deep learning algorithms to improve diagnostic imaging for cardiac sarcoidosis and amyloidosis.SummaryRecent advancements in AI models provide an opportunity to refine the nuclear cardiology workflow ranging from patient selection to disease prediction and reporting. Promising results from these early studies need to be replicated in larger heterogenous patient populations to demonstrate generalizability prior to widespread adoption in clinical practice.

Mannarino, Teresa; Assante, Roberta; Zampella, Emilia; D’Antonio, Adriana; Nappi, Carmela; Candice, Fabrizio; Di Donna, Erica; Volpicelli, Annacarmela; Panico, Mariarosaria; Toscano, Guglielmo; Acampa, Wanda; Cuocolo, Alberto

doi: 10.1007/s12410-025-09607-0pmid: N/A

Purpose of ReviewThis review critically evaluates the most recent literature on the role of various imaging modalities, including echocardiography, computed tomography (CT), cardiac magnetic resonance imaging (CMR), single-photon emission tomography (SPECT) and fluorodeoxyglucose positron emission tomography (FDG-PET) in cardiac sarcoidosis (CS) detection and management. The review also discusses emerging advancements, such as artificial intelligence (AI) integration and hybrid imaging techniques.Recent FindingsCS is a challenging disease to diagnose due to its heterogeneous presentation and often subtle cardiac involvement. Multimodality imaging plays a crucial role in the contemporary work-up of CS, allowing for more accurate diagnosis, risk stratification, and treatment monitoring.SummaryCurrent imaging techniques, including echocardiography, CMR, SPECT, FDG-PET and hybrid modalities such as PET/CT and PET/MR offer complementary information on myocardial inflammation, fibrosis, and functional impairment, thereby enhancing diagnostic confidence and guiding management decisions. Additionally, emerging applications of artificial intelligence and machine learning are showing promise in automating image interpretation, improving diagnostic precision, and supporting personalized risk stratification. The integration of advanced imaging with AI-driven tools represents a future direction for optimizing clinical outcomes in patients with cardiac sarcoidosis.

Verma, Beni Rai; Chaturvedi, Abhishek; Ha, Edward T.; Sood, Abhinav; Galo, Jason; Ben-Dor, Itsik; Case, Brian; Mintz, Gary S.; Waksman, Ron; Hashim, Hayder

doi: 10.1007/s12410-025-09609-ypmid: N/A

PurposeIntravascular ultrasound (IVUS) provides a comprehensive real-time assessment of coronary artery lesions, can guide its treatment strategies during percutaneous coronary intervention (PCI) and ensure optimization after intervention. Despite this, use of IVUS remains low, likely from lack of appropriate training or perceived complexity in performing and interpreting the images, which in turn prohibits patients from availing its benefit.Recent FindingsOur narrative review article aims to summarize the recent and existing published literature on IVUS during PCI, serving as a guiding tool for the operators. The clinical benefit of IVUS use during PCI for acute or chronic coronary syndrome, complex lesions, concomitant renal dysfunction and even stent optimization has been found to be incremental. These findings are based on the clinical trials and various studies demonstrating superiority of IVUS guided PCI as compared to angiographic guided PCI. Though over the years, IVUS recommendations have evolved, incorporated into clinical guidelines it usage continues to encounter certain challenges which are also addressed.SummaryIn this review article, we summarize the evidence supporting the use of IVUS during PCI for a wide array of coronary artery disease, the challenges it encounters and also the future directions of its use.