Chapter 7 - Contemporary advances in medical imaging

Abstract

Contemporary advances in imaging technology have revolutionized the field of cardiovascular disease with improved detection of disease states coupled with innovative therapeutic interventions. As a result, clinicians have a plethora of diagnostic tools including echocardiography, cardiac computed tomography (CT), cardiac magnetic resonance (CMR), and nuclear imaging. Echocardiography is widely available and provides a comprehensive assessment of cardiac anatomy, function, and hemodynamics. Complementary to echocardiography, CMR provides accurate cardiac volumes, function, and noninvasive hemodynamic assessment of valvular disease and flows. Innovations in cardiac CT have provided the ability to noninvasively image the coronary arteries, as well as cardiac structures that are useful in preprocedural planning for cardiac surgery or transcatheter heart interventions. Nuclear imaging has previously been the mainstay of ischemia assessment in coronary artery disease using exercise or vasodilator testing. Advances in CT-fractional flow reserve, CMR with scar imaging, and positron emission tomography (PET) with coronary flow reserve provide an ability to detect ischemia while extracting vital prognostic data for each patient. Recent advances in technetium-99m pyrophosphate, PET, and CMR have improved the ability to noninvasively detect cardiomyopathies such as cardiac amyloidosis, sarcoidosis, and inflammatory or infiltrative diseases. Nevertheless, each imaging modality is complementary to each other and often a multimodality patient-specific approach is needed. Furthermore, the integration of artificial intelligence within a clinical workflow allows for a safer, time and cost-effective approach to clinical practice and management.