Hybrid Cardiac Imaging for Clinical Decision-Making : From Diagnosis to Prognosis

Performing any diagnostic test in medicine is always a matter of trying to get the condition of the patient diagnosed properly with the least effort, exposure, discomfort and at the same time with the lowest possible error probability. Pre-test probability is helpful but often imprecise, effectively overestimating the patient's risk profile. In a broader prevention objective, the phases of a disease, its onset, progression, and complications must be taken into account. The negative predictive value, which is so important, has in turn its main limitation in identifying the healthy patient, that is, the one who does not belong to any cluster of patients in which we would act in terms of prevention. In coronary syndromes, the goal is instead to evaluate coronary heart disease, from mild to more extensive and significant forms. For this purpose, it is necessary to use parameters that investigate different and complementary aspects: stenosis, ischemia, the morphology of the atherosclerotic plaque, metabolic processes, in particular vitality and apoptosis, the presence of inflammatory processes. The possibility, already present thanks to Hybrid Imaging, of 'joining’ exams that study different aspects, will allow the patient to be increasingly characterized not only from a diagnostic point of view but also from a prognostic and personalized therapeutic choice. Foreword Towards a One-Stop Shop for the Heart The Hidden Organ From X-Rays to Coronary Angiography Radioisotopes Echocardiography Beyond Röntgen Magnets for the Heart SWOT The Whole is More Than Its Parts The Seminal Textbook Preface Terminology Contents Introduction Definition of Hybrid Imaging Anatomical Imaging Functional Imaging Vulnerable Plaque and Vulnerable Patient Conclusions Part I: Specialists’ Perspectives to Hybrid Cardiac Imaging 1: Hybrid Cardiac Imaging for the Clinical Cardiologist 1.1 Coronary Artery Disease 1.2 Heart Failure 1.3 Hybrid Imaging for Valvular Diseases 1.4 Cardiac Sarcoidosis 1.5 Infiltrative Diseases 1.5.1 Cardiac Amyloidosis 1.5.2 Anderson–Fabry Disease 1.5.3 Infection and Inflammation 1.6 Summary References 2: Hybrid Cardiac Imaging for the Cardiologist with Expertise in Echocardiography 2.1 Introduction 2.2 From Eyeballing to Quantification 2.3 Exposing Information Missed by the Eye 2.4 Hybrid Imaging 2.5 Data Handling: Network Analysis 2.6 Conclusion References 3: Hybrid Cardiac Imaging for the Specialist with Expertise in Cardiac Magnetic Resonance 3.1 Introduction 3.2 Brief Overview of Standalone Cardiac Imaging Modalities 3.3 Hybrid Imaging 3.4 PET/MR Hybrid Imaging 3.4.1 PET/MR in Obstructive CAD 3.4.2 PET/MR for Evaluating Myocardial Viability 3.4.3 PET/MR in Nonischemic Heart Disease 3.4.4 PET/MR in Acute Myocarditis 3.4.5 PET/MR in Cardiac Sarcoidosis 3.5 CT/MR Hybrid Imaging 3.5.1 CT/MR in Obstructive CAD 3.5.2 CT/MR in Nonischemic Heart Disease 3.6 SPECT/MR Hybrid Imaging 3.6.1 SPECT/MR in Obstructive CAD 3.6.2 SPECT/MR in Acute Myocardial Ischemia 3.6.3 SPECT/MR in Nonischemic Heart Disease 3.6.4 SPECT/MR in Myocarditis 3.7 Ultrasound/MR Hybrid Imaging References 4: Hybrid Imaging Using Single Photon Emission Computed Tomography 4.1 Introduction 4.1.1 Hybrid SPECT/CT and PET/CT 4.1.2 SPECT/CT MPI with CAC 4.1.3 SPECT-MPI with CCTA 4.1.4 Other Applications of SPECT/ CT 4.1.5 Current Guidelines 4.1.6 Hybrid Imaging: When and Why? 4.2 Safety 4.2.1 Incidental Findings 4.3 Pitfalls 4.4 Training the Next Generation of Imagers 4.5 Conclusion References 5: Hybrid Cardiac Imaging for the Specialist with Expertise in Computed Tomography 5.1 Introduction 5.1.1 Guidelines 5.1.1.1 Applicability of Cardiac CT—Multiparametric Imaging 5.1.1.2 Applicability of Cardiac CT—Multimodal Imaging 5.1.2 Technical Considerations 5.1.2.1 Cardiac CT Acquisition Modes 5.2 Cardiac CT: Multiparametric Imaging 5.2.1 CT Calcium Scoring 5.2.2 Coronary CT Angiography 5.2.3 CT-Derived FFR 5.2.4 CT Volumetry 5.2.5 Dynamic Stress CT Perfusion 5.2.6 CT Late Enhancement 5.2.7 CT Multiparametric Image Fusion 5.3 Cardiac CT: Multimodal Imaging 5.3.1 CT/Echocardiography 5.3.2 CT/SPECT 5.3.3 CT/PET 5.3.4 CT/MRI 5.4 Discussion 5.4.1 Number of Cases Undergoing Cardiac CT Multimodal Imaging 5.4.2 Advantages of Cardiac CT Multimodal Imaging 5.5 Conclusion References 6: Hybrid Cardiac Imaging for the Invasive Cardiologist 6.1 Introduction 6.2 Rationale for Hybrid Invasive Imaging Approach 6.3 Adjuvant Imaging Techniques for Invasive Cardiologist 6.4 Intravasculr Ultrasound (IVUS) 6.4.1 Plaque/Tissue Assessment 6.4.2 Fluid-Dynamic Assessment 6.4.3 Clinical Implication of CA-IVUS Hybrid Imaging 6.5 Optical Coherence Tomography (OCT) 6.5.1 Plaque/Tissue Assessment 6.5.2 Fluid-Dynamic Assessment 6.5.3 Clinical Implication of CA-OCT Hybrid Imaging 6.6 Near-infrared Spectroscopy (NIRS) 6.6.1 Plaque/Tissue Assessment 6.6.2 Fluid-Dynamic Assessment 6.6.3 Clinical Implication of CA-NIRS Hybrid Imaging 6.7 Computed Tomography Coronary Angiography (CTCA) 6.7.1 Plaque/Tissue Assessment 6.7.2 Fluid-Dynamic Assessment 6.7.3 Clinical Implication of CTCA-IVUS-CA Hybrid Imaging 6.8 The Future of Hydrid Invasive Imaging 6.9 Conclusion References 7: Hybrid Cardiac Imaging for the Interventional Cardiologist 7.1 Background 7.1.1 History of CT Development 7.1.2 Usefulness of CT for the Diagnosis of CAD 7.2 Evaluation of Coronary Arteries Using CT Angiography 7.3 CT for Quantitative Plaque Assessment 7.3.1 Comparison Between CT, Quantitative Coronary Analysis, and Invasive Intravascular Imaging 7.4 CCTA-Guided PCI 7.4.1 Precise PCI and Procedural Planning (P4) Algorithm 7.4.2 Diagnostic Evaluation 7.4.3 Catheterization Laboratory Preparation 7.4.4 Online Procedural and PCI Guidance 7.5 Clinical Implications 7.5.1 Future Perspectives 7.6 Conclusion References Part II: Hybrid Imaging in Clinical Practice 8: Systematic Review of Hybrid Cardiac Imaging 8.1 The Point of View of the Cardiologists 8.1.1 Meta-analysis Results 8.1.2 Patients Who Might Benefit from Hybrid Imaging 8.1.3 Perspectives on Hybrid Imaging 8.2 The Point of View of the Radiologists 8.2.1 CAC and SPECT 8.2.2 SPECT and CCTA 8.2.3 PET/MRI 8.2.4 FFRCT and CTP 8.2.5 Plaque Imaging 8.2.6 Radiation Dose Considerations 8.3 Conclusions References 9: Hybrid Cardiac Viability Assessment 9.1 Introduction 9.2 Current Consensus for Myocardial Viability Testing 9.3 Echocardiography 9.4 Single Photon Emission Computed Tomography 9.5 Positron Emission Tomography 9.6 Cardiac Magnetic Resonance 9.7 Hybrid Assessment of Myocardial Viability for Clinical Cases Using Different Imaging Techniques References 10: Hybrid Cardiac Imaging in Clinical Practice: From Diagnosis to Prognosis and Management 10.1 Hybrid Imaging for Coronary Artery Disease 10.2 Hybrid Imaging of Vulnerable Atherosclerotic Lesions 10.3 Hybrid Imaging of Cardiac Infections 10.4 Hybrid Imaging for Infiltrative Cardiomyopathies 10.4.1 Cardiac Sarcoidosis 10.4.2 Cardiac Amyloidosis References 11: Clinical Cases of Hybrid Cardiac Imaging 11.1 Introduction 11.2 Hybrid Assessment for Coronary Artery Disease 11.3 Hybrid Assessment for Non-ischemic Heart Disease 11.4 Closing Remarks References 12: Hybrid Cardiac Imaging: The Role of Machine Learning and Artificial Intelligence 12.1 Introduction 12.1.1 Machine Learning-Based AI 12.1.2 ML in Cardiovascular Imaging Analysis 12.2 ML in the Current Context Hybrid Imaging 12.2.1 Data Pre-processing in Hybrid Imaging 12.2.1.1 Attenuation Map Generation 12.2.1.2 Full-Dose Image Estimation from Low Dose Image 12.2.2 ML in Data Integration and Analysis in Hybrid Imaging 12.3 ML in Decision-Making and Clinical-Evaluation Support 12.4 Future Perspectives and Challenges in ML-Based AI for Cardiovascular Hybrid Imaging 12.5 Conclusion References