Role Of Multimodality Imaging Research Articles

The role of multimodal imaging in the diagnosis of prosthetic valve and intracardiac device endocarditis: A review.

Infective endocarditis (IE) is a severe cardiac condition associated with substantial morbidity and mortality. Traditionally, the modified Duke's criteria have been used to establish the diagnosis of IE, which includes using transthoracic and transesophageal echocardiography. While echocardiography performs well in diagnosing native valve endocarditis, its diagnostic accuracy decreases in patients with prosthetic valves or implanted cardiac devices such as pacemakers and defibrillators. Given these limitations and advancements in cardiac imaging, including multimodal computed tomography, magnetic resonance imaging, and positron emission tomography, there has been growing interest in the utility of these techniques for diagnosing prosthetic valve endocarditis (PVE) and Cardiovascular implantable electronic device infection (CIEDI). Although numerous studies have investigated the value of these imaging modalities, their findings have been inconsistent. This article aims to reevaluate the role of advanced imaging in diagnosing PVE and CIEDI and its impact on managing prosthetic valves and device-related infective endocarditis. Methods A comprehensive literature search was conducted in PubMed, Cochrane library, Google Scholar, Embase, and other relevant databases. Key terms such as 'infective endocarditis,' 'multimodal imaging,' 'prosthetic valve endocarditis,' '18F-FDG PET,' 'cardiac MRI,' and 'cardiac CT' were used to identify studies that investigated the role of these imaging modalities in diagnosing PVE and CIEDI. Publications with full text including randomized controlled trials, retrospective studies, case reports, case series, reviews of literature, and society guidelines were included.

Cardiac contractility modulation: from molecular patterns to tailored treatment in heart failure subgroups.

Cardiac contractility modulation (CCM) signals are non-excitatory signals that are applied during the myocyte's absolute refractory period. These signals have been demonstrated to have an inotropic effect without increasing myocardial oxygen consumption. This has been observed in both preclinical animal studies and randomized clinical trials. CCM influences the expression of various genes that are abnormally expressed in heart failure: it reverses fetal myocyte gene programming associated with heart failure and regulates the expression of genes associated with calcium cycling and myocardial contractile machinery. Clinical investigations have primarily focused on patients with heart failure and normal QRS duration where CCM has demonstrated its safety and effectiveness in reducing heart failure-related hospitalizations, as well as improving symptoms, functional capacity, and overall quality of life. Currently, for individuals experiencing symptomatic heart failure with an ejection fraction ranging from 25% to 45% and a QRS duration of less than 130 ms, who are not suitable candidates for cardiac resynchronization therapy, CCM offers a viable treatment option. Even though promising results in specific HF subgroups have been published, further studies are needed to understand the role of CCM in tailored treatment for heart failure. Moreover, the role of multimodality imaging in lead placement and prognostic stratification in CCM patients should be further investigated. This review aims to summarize the main pathophysiological evidence related to the use of CCM and to highlight its role as a possible additional weapon in tailored treatment for specific subgroups of patients with heart failure.

Peri-Renal Lymphangiomatosis: About A Case

Renal lymphangiectasia is a rare disorder of the lymphatic system responsible for cystic infiltration of the bilateral perirenal and parapyelic space. The clinical presentation is nonspecific, hence the role of multimodal imaging which can show characteristic lesions allowing a positive diagnosis. We report a case of bilateral lymphangiectasia in a 60-year-old woman presenting with chronic bilateral low back pain with glomerular syndrome, and in whom the diagnosis was made using ultrasound and cross-sectional imaging, computed tomography.

Acute Mesenteric Portal Venous Thrombosis Revealed a Strangulated Hernia: A Case Report

Mesenteric ischemia is a frequent pathology with a variety of etiologies, the consequences of which can range from simple transient alteration of intestinal activity to transmural necrosis. Venous thrombosis is rarer (5% of cases of mesenteric ischemia), is sometimes not very symptomatic but can also be lethal, the clinical presentation is non-specific, hence the role of multimodal imaging in confirming the diagnosis. We present a rare case of mesenteric venous ischemia revealed a strangulated hernia in a 55-year-old man.

The role of multimodality imaging in calcified valves with infective endocarditis.

The role of multimodality imaging in calcified valves with infective endocarditis.

A Case Report of Aberrant Origin of the Right Coronary Artery from thePulmonary Artery in an Adult Male: The Role of Multi-modality Imaging

Background: The normal anatomy of the coronary arteries consists of the right coronary artery and the left main coronary artery, which originate from the right and left sinuses of Valsalva in the aortic root separately. In general, congenital anomalies of the coronary artery are uncommon in adults. The ectopic origin of a coronary artery from the pulmonary trunk is part of a group of infrequent coronary artery anomalies. The Anomalous origin of the Right Coronary Artery from the Pulmonary Artery (ARCAPA) is thought to be an extremely rare congenital coronary artery anomaly. Most of our knowledge and experience about this congenital coronary malformation is derived from published case reports and series. Case Presentation: We have, herein, reported the case of a 68-year-old male who was discovered to have ARCAPA after he presented to our center with chest pain. The patient underwent multiple invasive and non-invasive diagnostic imaging modalities, including an echocardiogram, a coronary angiogram, a multislice-gated coronary computed tomographic angiogram, and stress perfusion cardiovascular magnetic resonance imaging. The clinical decision was to continue with conservative non-surgical management along with close follow-up. Conclusion: The ARCAPA anomaly is considered to be one of the rare congenital coronary artery variances that can be discovered in late adulthood as a patient may remain asymptomatic for many decades.

The role of multimodality imaging in the selection and management of patients treated with cytoreductive surgery and HIPEC.

Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is the mainstay of potentially curative surgical treatment for malignancies that have spread to peritoneal surfaces. This surgical procedure is however associated with high morbidity and appropriate patient selection and planning is therefore essential. Available multimodality imaging techniques include CT with oral and intravenous contrast, MRI including use of dedicated peritoneal protocol and FDG-PET/CT. These used with the correct technique, read by specialist radiologists and discussed under the auspices of a dedicated multidisciplinary team, can help to improve outcomes. We demonstrate that imaging not only provides information about peritoneal disease burden but more importantly want to shift the reader's focus to disease distribution. Our examples highlight how imaging helps avoid futile surgery by identifying patients with disease in unfavourable sites and show the strength and limitations of the various imaging modalities. We share how MR imaging can help identify multifocal and often occult sites including widespread miliary disease. Our examples provide a comprehensive overview demonstrating how imaging can help plan surgery by identifying patients who may need splenic vaccinations, counselling for stoma, egg harvesting and input from surgeons with other specialist expertise greatly increasing likelihood of achieving complete cytoreduction.

Unraveling the Enigma of Moderate Aortic Stenosis: Challenges and Future Prospects.

According to current guidelines, only clinical surveillance is recommended for patients with moderate aortic valve stenosis (AS), while aortic valve replacement may be considered in patients undergoing surgery for other indications. Recent studies have shown that moderate AS is associated with a high risk of adverse cardiovascular events, including death, especially in patients with left ventricular dysfunction. In this context, multimodality imaging can help to improve the accuracy of moderate AS diagnosis and to assess left ventricular remodeling response. This review discusses the natural history of this valve disease and the role of multimodality imaging in the diagnostic process, summarizes current evidence on the medical and non-medical management, and highlights ongoing trials on valve replacement.

The Role of Multimodality Imaging (CT & MR) as a Guide to the Management of Chronic Coronary Syndromes.

Chronic coronary syndrome (CCS) is one of the leading cardiovascular causes of morbidity, mortality, and use of medical resources. After the introduction by international guidelines of the same level of recommendation to non-invasive imaging techniques in CCS evaluation, a large debate arose about the dilemma of choosing anatomical (with coronary computed tomography angiography (CCTA)) or functional imaging (with stress echocardiography (SE), cardiovascular magnetic resonance (CMR), or nuclear imaging techniques) as a first diagnostic evaluation. The determinant role of the atherosclerotic burden in defining cardiovascular risk and prognosis more than myocardial inducible ischemia has progressively increased the use of a first anatomical evaluation with CCTA in a wide range of pre-test probability in CCS patients. Functional testing holds importance, both because the role of revascularization in symptomatic patients with proven ischemia is well defined and because functional imaging, particularly with stress cardiac magnetic resonance (s-CMR), gives further prognostic information regarding LV function, detection of myocardial viability, and tissue characterization. Emerging techniques such as stress computed tomography perfusion (s-CTP) and fractional flow reserve derived from CT (FFRCT), combining anatomical and functional evaluation, appear capable of addressing the need for a single non-invasive examination, especially in patients with high risk or previous revascularization. Furthermore, CCTA in peri-procedural planning is promising to acquire greater importance in the non-invasive planning and guiding of complex coronary revascularization procedures, both by defining the correct strategy of interventional procedure and by improving patient selection. This review explores the different roles of non-invasive imaging techniques in managing CCS patients, also providing insights into preoperative planning for percutaneous or surgical myocardial revascularization.

The role of multimodal imaging in characterization and monitoring of choroidal neovascularization secondary to angioid streaks.

To characterize and monitor choroidal neovascularisation (CNV) secondary to angioid streaks (AS) using multimodal imaging and to compare the results with conventional fluorescein angiography (FA). A total of 11 eyes with CNV secondary to AS were included in this retrospective study. Multimodal morphological and functional assessment, including spectral-domain optical coherence tomography (SD-OCT), spectral-domain optical coherence tomography angiography (SD-OCTA), and fundus autofluorescence (FAF), were used to assess for evidence of CNV activity and compared with conventional FA. Morphological features of CNV were analyzed and treatment was continuously monitored using SD-OCT and SD-OCTA. Our results showed that SD-OCTA provided reliable results for the detection of secondary CNV in AS that were comparable to conventional FA. With SD-OCTA, a total of 13 CNVs were detected in 11 eyes and analyzed by means of outer retinal choriocapillaris depth (ORCC) segmentation and the corresponding B-scans. Twelve of the 13 CNVs were classified as active and therefore required treatment. For treatment monitoring during intravitreal therapy (IVT), SD-OCTA was found to be a valuable diagnostic tool over a mean follow-up of 76 weeks. Our study demonstrates that SD-OCTA can be routinely used to identify ill-defined CNV without dye-based angiography, especially in cases of CNV secondary to AS, where Bruch's membrane (BM) defects limit the diagnostic value of FA. Our results showed that non-invasive multimodal imaging facilitates sufficient CNV monitoring and treatment guidance. Further studies are warranted to provide more evidence in this rare retinal disease.

(797) - The Role of Multimodal Imaging in Guiding Myocardial Recovery: A Case of LVAD Explantation Following Concurrent Lymphocytic and COVID-19 Myocarditis

(797) - The Role of Multimodal Imaging in Guiding Myocardial Recovery: A Case of LVAD Explantation Following Concurrent Lymphocytic and COVID-19 Myocarditis

Giant Coronary Artery Aneurysm Associated with Extraluminal Migration of Stent: Role of Multimodal Imaging

Abstract Extraluminal migration of a drug-eluting intracoronary stent into pericardial space with or without aneurysm formation is a rare complication. It is usually symptomatic although rare asymptomatic cases have been described. Herein, we report a 49-year-old male who presented with atypical chest pain 9 years after intracoronary stent implantation in the right coronary artery and the ramus intermediate branch. Echocardiographic examination showed a 7.4 cm × 3.8 cm large oblong cystic mass along the lateral wall of the left ventricle with inward bulging of the adjacent segments. Computed tomography and invasive coronary angiography showed this mass to be a partly thrombosed giant oblong coronary aneurysm arising from the bifurcation of the left main coronary artery with extraluminal migration of the stent from the ramus branch.

Aneurysmatic Patient Presenting with ST-Elevation Myocardial Infarction: Role of Multimodality Imaging in Emergency Setting—A Case Report

Aneurysmatic Patient Presenting with ST-Elevation Myocardial Infarction: Role of Multimodality Imaging in Emergency Setting—A Case Report

Role of multimodality imaging in the assessment of mechanical prosthetic heart valve dysfunction

Role of multimodality imaging in the assessment of mechanical prosthetic heart valve dysfunction

The Role of Multimodality Imaging in Patients with Congenital Heart Disease and Infective Endocarditis.

Infective endocarditis (IE) represents an important medical challenge, particularly in patients with congenital heart diseases (CHD). Its early and accurate diagnosis is crucial for effective management to improve patient outcomes. Multimodality imaging is emerging as a powerful tool in the diagnosis and management of IE in CHD patients, offering a comprehensive and integrated approach that enhances diagnostic accuracy and guides therapeutic strategies. This review illustrates the utilities of each single multimodality imaging, including transthoracic and transoesophageal echocardiography, cardiac computed tomography (CCT), cardiovascular magnetic resonance imaging (CMR), and nuclear imaging modalities, in the diagnosis of IE in CHD patients. These imaging techniques provide crucial information about valvular and intracardiac structures, vegetation size and location, abscess formation, and associated complications, helping clinicians make timely and informed decisions. However, each one does have limitations that influence its applicability.

Rare Case Series of Atrial Masses with Diagnostic Fallacies and the Role of Multimodality Imaging in Evaluation and Management

Rare Case Series of Atrial Masses with Diagnostic Fallacies and the Role of Multimodality Imaging in Evaluation and Management

A Rare Case of New-Onset Atrial Fibrillation Presenting as Biatrial Inflammation Seen on 18F-FDG-PET

Isolated atrial myocarditis, a rare clinical entity, is presented in this case report as the diagnosis in a patient with new-onset atrial fibrillation. Our findings emphasize the potential for atrial arrhythmias and their unusual presentation; the role of multimodal imaging, especially 18F-FDG-PET/CT, in diagnosis; and considerations for long-term treatment strategies.

The Role of Multimodality Imaging in Pediatric Cardiomyopathies.

Cardiomyopathies are a heterogeneous group of myocardial diseases representing the first cause of heart transplantation in children. Diagnosing and classifying the different phenotypes can be challenging, particularly in this age group, where cardiomyopathies are often overlooked until the onset of severe symptoms. Cardiovascular imaging is crucial in the diagnostic pathway, from screening to classification and follow-up assessment. Several imaging modalities have been proven to be helpful in this field, with echocardiography undoubtedly representing the first imaging approach due to its low cost, lack of radiation, and wide availability. However, particularly in this clinical context, echocardiography may not be able to differentiate from cardiomyopathies with similar phenotypes and is often complemented with cardiovascular magnetic resonance. The latter allows a radiation-free differentiation between different phenotypes with unique myocardial tissue characterization, thus identifying the presence and extent of myocardial fibrosis. Nuclear imaging and computed tomography have a complementary role, although they are less used in daily clinical practice due to the concern related to the use of radiation in pediatric patients. However, these modalities may have some advantages in evaluating children with cardiomyopathies. This paper aims to review the strengths and limitations of each imaging modality in evaluating pediatric patients with suspected or known cardiomyopathies.

The Role of Multimodal Imaging in Pathological Response Prediction of Locally Advanced Cervical Cancer Patients Treated by Chemoradiation Therapy Followed by Radical Surgery.

This study aimed to develop predictive models for pathological residual disease after neoadjuvant chemoradiation (CRT) in locally advanced cervical cancer (LACC) by integrating parameters derived from transvaginal ultrasound, MRI and PET/CT imaging at different time points and time intervals. Patients with histologically proven LACC, stage IB2-IVA, were prospectively enrolled. For each patient, the three examinations were performed before, 2 and 5 weeks after treatment ("baseline", "early" and "final", respectively). Multivariable logistic regression models to predict complete vs. partial pathological response (pR) were developed and a cost analysis was performed. Between October 2010 and June 2014, 88 patients were included. Complete or partial pR was found in 45.5% and 54.5% of patients, respectively. The two most clinically useful models in pR prediction were (1) using percentage variation of SUVmax retrieved at PET/CT "baseline" and "final" examination, and (2) including high DWI signal intensity (SI) plus, ADC, and SUVmax collected at "final" evaluation (area under the curve (95% Confidence Interval): 0.80 (0.71-0.90) and 0.81 (0.72-0.90), respectively). The percentage variation in SUVmax in the time interval before and after completing neoadjuvant CRT, as well as DWI SI plus ADC and SUVmax obtained after completing neoadjuvant CRT, could be used to predict residual cervical cancer in LACC patients. From a cost point of view, the use of MRI and PET/CT is preferable.

Role of Multimodality Imaging in Transcatheter Structural Interventions.

Cardiac imaging is the backbone for safe and optimal transcatheter structural interventions. Transthoracic echocardiogram is the initial modality to assess valvular disorders, while transesophageal echocardiogram is best to delineate the mechanism of valvular regurgitation, preprocedural assessment for transcatheter edge-to-edge repair, and for intraprocedural guidance. Cardiac computed tomography is the modality of choice for assessing calcifications, maneuvering multiplaner reconstruction of different cardiac structures, preprocedural planning for various transcatheter valve replacement, and assessing for hypoattenuated leaflet thickening and reduced leaflet motion. Cardiac magnetic resonance imaging is best known for most accurate volumetric assessment of valvular regurgitation and chamber size quantification. Cardiac positron emission tomography is the only modality that could assess active infection through using fluorine 18 fluorodeoxyglucose radiotracer.