Advancements in Cardiac CT Imaging: The Era of Artificial Intelligence

Abstract

In the last decade, artificial intelligence (AI) has influenced the field of cardiac computed tomography (CT), with its scope further enhanced by advanced methodologies such as machine learning (ML) and deep learning (DL). The AI-driven techniques leverage large datasets to develop and train algorithms capable of making precise evaluations and predictions. The realm of cardiac CT is expanding day by day and multiple tools are offered to answer different questions. Coronary artery calcium score (CACS) and CT angiography (CTA) provide high-resolution images that facilitate the detailed anatomical evaluation of coronary plaque burden. New tools such as myocardial CT perfusion (CTP) and fractional flow reserve (FFR_CT) have been developed to add a functional evaluation of the stenosis. Moreover, epicardial adipose tissue (EAT) is gaining interest as its role in coronary artery plaque development has been deepened. Seen the great added value of these tools, the demand for new exams has increased such as the burden on imagers. Due to its ability to fast compute multiple data, AI can be helpful in both the acquisition and post-processing phases. AI can possibly reduce radiation dose, increase image quality, and shorten image analysis time. Moreover, different types of data can be used for risk assessment and patient risk stratification. Recently, the focus of the scientific community on AI has led to numerous studies, especially on CACS and CTA. This narrative review concentrates on AI's role in the post-processing of CACS, CTA, FFR_CT, CTP, and EAT, discussing both current capabilities and future directions in the field of cardiac imaging.

Keywords: artificial intelligence; computed tomography angiography; deep learning; epicardial adipose tissue; machine learning; myocardial fractional flow reserve; myocardial ischemia; myocardial perfusion imaging.

FIGURE 1

Example of an automatic measurement of CACS. Here an unenhanced CT scan is reported (a) along with the automatic segmentation of the coronary artery calcifications (b).

FIGURE 2

Example of CT angiography. In this example, multiple calcified plaques can be appreciated.

FIGURE 3

Rendering of a FFR_CT reconstruction. The results are color‐coded based on the grade of stenosis along the vessel.

FIGURE 4

Example of myocardial dynamic CTP analysis showing a reduction in blood volume in different myocardial segments.