Medical Radiology: Current Progress

Abstract

Recently, medical radiology has undergone significant improvements in patient management due to advancements in image acquisition by the last generation of machines, data processing, and the integration of artificial intelligence. In this way, cardiovascular imaging is one of the fastest-growing radiological subspecialties. In this study, a compressive review was focused on addressing how and why CT and MR have gained a I class indication in most cardiovascular diseases, and the potential impact of tissue and functional characterization by CT photon counting, quantitative MR mapping, and 4-D flow. Regarding rectal imaging, advances in cancer imaging using diffusion-weighted MRI sequences for identifying residual disease after neoadjuvant chemoradiotherapy and [18F] FDG PET/MRI were provided for high-resolution anatomical and functional data in oncological patients. The results present a large overview of the approach to the imaging of diffuse and focal liver diseases by US elastography, contrast-enhanced US, quantitative MRI, and CT for patient risk stratification. Italy is currently riding the wave of these improvements. The development of large networks will be crucial to create high-quality databases for patient-centered precision medicine using artificial intelligence. Dedicated radiologists with specific training and a close relationship with the referring clinicians will be essential human factors.

Keywords: cardiovascular imaging; computed tomography; liver imaging; magnetic resonance imaging; rectal imaging; ultrasound.

Figure 1

MDCT curved multiplanar reformat reconstruction of the left anterior descending artery (A) and respective coronary angiography (B) in a 52-year-old male, with positive exercise stress test for inducible ischemia, scheduled for revascularization, showing diffuse calcific and non-calcific plaques with mild stenosis (orange arrow—(A)) and severe stenosis with markers of instability (yellow arrow—(A)), the same findings were confirmed at coronary angiography (B).

Figure 2

Curved multiplanar reformat reconstruction of the left anterior descending artery (left), left circumflex (middle), and right coronary artery (right), showing patent coronary arteries without stenosis in a 46-year-old female with hypertension and familiarity with coronary artery disease complaining of chest pain with an EKG doubtful for ischemia in the emergency room.

Figure 3

M, 51 years old, with negative cardiovascular history, underwent CMR 3 months after COVID-19 pneumonia. T1 (A) and T2 (B) mapping global values turned out to be high considering our ranges, but were normal according to the literature. The diagnosis of acute/subacute inflammation at non ischemic pattern was, therefore, possible, and was also confirmed during the segmental evaluation (the green and red circles identify pathological segmental values considering the ranges of our institute and those in the literature, respectively).

Figure 4

Patient with normal ejection fraction (quantitative evaluation 60%) and altered global strain values, compared to references obtained in our center from 50 healthy volunteers. Representation of longitudinal strain in (A) (−19.0%, [n.v. −15.53 ± 1.5]), circumferential strain on middle-short axis view in (B) (−19.6% [n.v. −16.3 ± 1.8]), radial long axis strain in (C) (37.6% [n.v. 26.53 ± 3.8]), and radial short axis strain on middle-short axis view in (D) (35.2% [n.v. 25.75 ± 4.1]), all in systolic phase.

Figure 5

Parasagittal reconstruction status post-Bentall procedure in a patient with type A aortic dissection (sec Stanford) with thrombosis of the true lumen, caudal to the superior mesenteric artery.

Figure 6

Cine SSFP sequences of parasagittal thoracic aorta in a patient with aortic regurgitation in the bicuspid valve with para–axial sections orthogonal to the long axis of the vessel at aortic sinuses (orange), sinustubular junction (blue), tubular ascending aorta (yellow), medium transverse arch in bovine trunk (green), isthmus (red), and diaphragmatic aorta (white). The flowmetric curve in aortic sinuses by 2D phase contrast (below).

Figure 7

(A) T2-weighted axial oblique MRI of T3b rectal cancer (white arrow—(A)) before chemoradiotherapy. (B) After neoadjuvant therapy, a reduction in the rectal tumor can be appreciated (white arrow—(B)) with fibrotic hypointense T2-weighted areas in the lesion but (C) with signs of signal restriction in high b value DWI sequences (white arrow—(C)). The MRI was scored as T2 mrTRG3 (more than 50% of intra-tumoral fibrosis), and it was confirmed at histopathology.

Figure 8

PET/MRI staging of T3 rectal cancer (arrows) shows hypermetabolism in both the PET image (A) and the fused PET/MR image (B), as well as a rectal wall thickening in the MR image (C). Restaging PET/MRI after chemo-radiotherapy shows no hypermetabolism on PET (D) and fused PET/MR images (E), and a T2 hypointense thickening of the rectal wall on MR image (F). The lesion was scored as a complete response (ycT0N0) and confirmed at histopathology after transanal local excision.

Figure 9

Patient in the lung transplant check-list for idiopathic lung fibrosis. (A). The T2*curve demonstrates mild steatosis with a fat fraction of 9.58% and hyperferritinemia (>6000 mcg/mL). (B). T2* multiecho BB sequence with TE = 0.93 ms with the green ROI used to develop the curve in (A).