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High-Resolution Cardiac Positron Emission Tomography/Computed Tomography for Small Animals
Published on: December 16, 2022
Imaging biomarkers in cardiac CT: moving beyond simple coronary anatomical assessment
Giulia Cundari1, Livia Marchitelli1, Giacomo Pambianchi1
1Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
Insights
Cardiac CT angiography (CCTA) is key for ruling out coronary artery disease (CAD). New CT imaging biomarkers offer advanced risk stratification and personalized medicine for CAD patients.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Cardiac computed tomography angiography (CCTA) is the standard non-invasive tool for excluding obstructive coronary artery disease (CAD).
- Existing biomarkers like coronary calcium scoring and segment stenosis score assess CAD severity and atherosclerotic burden.
- Novel CT imaging features are emerging to evaluate inflammation, plaque instability, and cardiovascular risk.
Purpose of the Study:
- To explore the expanding role of cardiac CT imaging biomarkers in assessing coronary artery disease.
- To highlight advancements in non-invasive evaluation of myocardial ischemia, microvascular damage, and hemodynamic impact.
- To discuss the potential of novel CT features for risk stratification and personalized medicine in CAD.
Main Methods:
- Utilizes cardiac computed tomography angiography (CCTA) for non-invasive assessment.
- Incorporates established biomarkers: coronary calcium scoring, segment involvement score, segment stenosis score, Leaman-score.
- Employs advanced techniques: myocardial perfusion imaging, CT-based fractional flow reserve (FFR-CT), analysis of epicardial/perivascular adipose tissue, plaque radiomics, and extracellular volume (ECV) quantification.
Main Results:
- CCTA effectively rules out obstructive CAD.
- Various CT imaging biomarkers provide insights into global CAD severity, atherosclerotic burden, and inflammation.
- Novel features like adipose tissue characteristics and plaque radiomics show promise for identifying plaque instability.
- CT-based FFR-CT non-invasively assesses the hemodynamic significance of coronary stenoses.
- Myocardial tissue characterization using ECV and radiomics may predict arrhythmogenic risk and cardiovascular events.
Conclusions:
- Cardiac CT imaging, through established and novel biomarkers, offers comprehensive phenotyping of individual CAD profiles.
- These advancements expand the potential of CCTA for risk stratification and personalized medicine approaches in cardiovascular care.
- The integration of diverse CT-derived biomarkers promises to refine patient management and improve outcomes in coronary artery disease.
Abstract:
Cardiac computed tomography angiography (CCTA) is considered the standard non-invasive tool to rule-out obstructive coronary artery disease (CAD). Moreover, several imaging biomarkers have been developed on cardiac-CT imaging to assess global CAD severity and atherosclerotic burden, including coronary calcium scoring, the segment involvement score, segment stenosis score and the Leaman-score. Myocardial perfusion imaging enables the diagnosis of myocardial ischemia and microvascular damage, and the CT-based fractional flow reserve quantification allows to evaluate non-invasively hemodynamic impact of the coronary stenosis. The texture and density of the epicardial and perivascular adipose tissue, the hypodense plaque burden, the radiomic phenotyping of coronary plaques or the fat radiomic profile are novel CT imaging features emerging as biomarkers of inflammation and plaque instability, which may implement the risk stratification strategies. The ability to perform myocardial tissue characterization by extracellular volume fraction and radiomic features appears promising in predicting arrhythmogenic risk and cardiovascular events. New imaging biomarkers are expanding the potential of cardiac CT for phenotyping the individual profile of CAD involvement and opening new frontiers for the practice of more personalized medicine.
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