Search Results (963)

Background: This narrative review introduces the “From Plaque to Perfusion” framework, a clinically pragmatic approach that maps multimodality imaging technologies to critical decision points in the acute coronary syndrome (ACS) patient journey. By integrating non-invasive assessment, invasive procedural guidance, and post-event tissue characterisation, this framework provides a structured pathway for deep phenotyping of ACS. Artificial intelligence (AI) is highlighted as an essential enabling layer that enhances diagnostic precision, automates quantification, and supports scalable, data-driven care. Contemporary ACS management pathways, while effective, often leave residual clinical uncertainty. The diagnostic objective has evolved beyond confirming myocardial injury to comprehensively phenotyping the entire ACS cascade: defining the plaque substrate, identifying the culprit mechanism, and quantifying the myocardial consequence. This requires a systematic integration of advanced imaging modalities. Methods: This narrative review is based on a comprehensive literature search of major medical databases (PubMed/MEDLINE, Scopus, Embase, Google Scholar) for high-level evidence, including randomized controlled trials, meta-analyses, and international expert consensus documents published between January 2010 and February 2026. Results: The “From Plaque to Perfusion” framework consists of three core stages. First, non-invasive assessment with coronary computed tomography angiography (CCTA), fractional flow reserve (FFR-CT), and PET-CT defines plaque substrate and vascular inflammation. Second, invasive precision in the catheterization laboratory, guided by optical coherence tomography (OCT) and intravascular ultrasound (IVUS), resolves the culprit mechanism and optimizes percutaneous coronary intervention (PCI). Third, post-event tissue characterization with cardiac magnetic resonance (CMR) quantifies myocardial injury and refines prognosis. AI-driven platforms are shown to enhance each stage by automating analysis, standardizing interpretation, and providing actionable metrics for clinical decisions, including complex scenarios like Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA). Conclusions: The “From Plaque to Perfusion” framework, enabled by AI, reframes ACS imaging as an integrated, mechanism-driven pathway. This approach moves beyond isolated test interpretation toward a scalable model of precision, phenotype-led care that promises to improve diagnostic certainty and personalize patient management. Full article

Background and Objectives: Carotid artery stenosis has traditionally guided therapeutic decision-making; however, plaque morphology and composition are increasingly recognized as more reliable indicators of cerebrovascular risk than luminal narrowing alone. As imaging strategies shift toward vulnerability-based assessment, reproducibility of plaque characterization becomes essential for consistent clinical decision-making. This study aimed to evaluate interobserver agreement in carotid plaque assessment using multidetector computed tomography angiography (MDCTA) and to assess intermodality agreement with duplex ultrasonography (DUS). Materials and Methods: In this single-center study (January–September 2022), 50 patients with ≥60% internal carotid artery stenosis diagnosed by DUS (NASCET criteria), the majority of whom were asymptomatic (90%), were included. MDCTA examinations were independently analyzed by two radiologists, while DUS examinations were evaluated by a third observer. Plaque composition (lipid, fibrous, calcified), surface characteristics (regular, irregular, ulcerated), degree of stenosis, and plaque length were assessed. CT plaque characterization was based on Hounsfield unit (HU) thresholds (<50 HU lipid; 50–120 HU fibrous; >120 HU calcified). Interobserver agreement and intermodality agreement were calculated using Cohen’s kappa coefficient. Results: Good interobserver agreement was observed between the two MDCTA readers (κ = 0.751). Intermodality agreement between MDCTA and DUS was moderate (κ = 0.624 and κ = 0.595). Although significant differences were identified in 3 of 16 HU measurement points, no significant differences were found in overall plaque composition classification between MDCTA observers. DUS yielded significantly higher stenosis values (p = 0.007 and p = 0.005) and greater plaque length measurements (p < 0.0005) compared with MDCTA. Significant differences were also observed in plaque surface assessment between modalities (p = 0.044 and p = 0.033). Conclusions: MDCTA demonstrates good interobserver reproducibility for carotid plaque characterization, while intermodality agreement between MDCTA and DUS is moderate. Minor attenuation measurement differences do not significantly affect plaque classification; however, systematic intermodality differences in stenosis grading, plaque surface evaluation, and plaque length measurement should be considered in clinical decision-making. Full article

Background and Objectives: Visceral artery aneurysms (VAAs) are rare but potentially catastrophic vascular abnormalities, particularly in pregnant patients or women of childbearing age. Rupture is often fatal for both mother and fetus, with mortality rates exceeding 70% in some series. While most VAAs are found incidentally, a subset may present acutely with nonspecific abdominal or flank pain, making early recognition and appropriate referral essential. This review article aims to provide General Practitioners (GPs) and emergency department (ED) clinicians with a practical approach to the recognition, investigation, initial management, and escalation pathways for VAAs. Results: Physiological and hormonal adaptations in pregnancy heighten aneurysm rupture risk. Despite this, imaging is frequently delayed. Computed tomography angiography (CTA) remains the gold standard for diagnosis and is safe in pregnancy when clinically justified, with fetal radiation exposure well below teratogenic thresholds. Guidelines from major vascular societies uniformly recommend repairing VAAs in pregnancy or women planning pregnancy irrespective of aneurysm size, and treating pseudoaneurysms urgently in all patients. Endovascular intervention is first-line where anatomy permits, while open or hybrid approaches remain essential in unstable presentations. The manuscript outlines practical steps for ED and GP settings, including haemodynamic stabilization, early obstetric involvement, transfer considerations for rural environments, reproductive counselling, and post-repair surveillance. Conclusions: With an increasing number of abdominal scans being performed in primary and tertiary settings, there is an associated increased volume of incidental findings that require work-up. This article outlines a practical investigation and management strategy for clinicians presented with VAAs, including in high-risk cohorts, emphasizing early imaging, inter-specialty coordination, and guideline-supported thresholds for intervention. Full article

Intramyocardial coronary artery course is a rare anatomical variant that can be increasingly recognized with coronary computed tomography angiography (CCTA). We present the case of a 22-year-old male who underwent CCTA for evaluation of chest pain. Imaging demonstrated an unusual course of the left anterior descending artery (LAD), which traversed toward the right ventricular cavity over an approximately 21 mm segment. Multiplanar reconstructions and three-dimensional volume-rendered images clearly depicted the intramyocardial trajectory of the vessel. Although usually asymptomatic, recognition of this variant is important because intramyocardial coronary arteries may be vulnerable to injury during intracardiac procedures. This case highlights the role of CCTA in accurately characterizing a rare intracavitary LAD course with clear delineation of its intramyocardial-to-intracavitary trajectory toward the right ventricle using multiplanar and three-dimensional reconstructions. Full article

Background: This study aims to evaluate the prevalence, spectrum, and coexistence of anatomical variations in the major branches of the abdominal aorta using Multidetector Computed Tomography (MDCT) angiography, with a specific emphasis on analyzing sex-related differences in a large-scale cohort. Methods: A retrospective analysis was conducted on 1174 patients (63.8% male, 36.2% female; mean age 60.54) who underwent abdominal CT angiography between January 2023 and June 2024. Images were acquired using a 128-slice MDCT scanner and reconstructed for detailed vascular assessment. Statistical comparisons between genders were performed using Chi-square and Fisher–Freeman–Halton tests, with p < 0.05 considered significant. Results: The celiac trunk (93.3%), superior mesenteric artery (SMA) (97.1%), and inferior mesenteric artery (IMA) (98.5%) predominantly showed classical patterns. However, significant sex-related differences were identified. Females exhibited significantly higher rates of classical patterns for the celiac trunk (96.2% vs. 91.7%), IMA (99.1% vs. 98.1%), right hepatic artery (RHA) (91.5% vs. 82.6%), and left hepatic artery (LHA) (95.8% vs. 85.4%). Conversely, males showed a higher prevalence of complex variations, including replaced/accessory hepatic arteries and the absence of the common hepatic artery. The number of right and left renal arteries was similar between sexes and did not show a significant difference, while horseshoe kidney was detected only in males. Conclusions: Abdominal vascular structures adhere to classical anatomy more frequently in females, while males exhibit greater morphological variability. These findings emphasize the necessity of gender-specific preoperative vascular mapping to optimize surgical outcomes and reduce morbidity. Full article

Endovascular aneurysm repair (EVAR) is a widely used minimally invasive treatment for abdominal aortic aneurysms. However, postoperative type II endoleak (T2EL) remains a relevant complication associated with a risk of aneurysm rupture and the need for repeated imaging follow-up, resulting in exposure to ionizing radiation. Identification of biological factors predisposing to T2EL may improve risk stratification. This pilot study aimed to investigate whether disturbances in hemostasis are associated with early T2EL development after EVAR. A total of 103 patients treated with EVAR for symptomatic or asymptomatic abdominal aortic aneurysms in a tertiary vascular center were prospectively enrolled. Blood samples were collected preoperatively and one month postoperatively to assess fibrinogen, prothrombin fragment F1+2 (F1+2), thrombin–antithrombin complex (TAT), tissue plasminogen activator antigen (tPA), plasminogen activator inhibitor-1 (PAI-1) activity, and platelet activity. Computed tomography angiography (CTA) during follow-up was used to detect endoleaks and calculate their volume. Patients with T2EL had significantly lower levels of prothrombin fragment F1+2 and higher PAI-1 activity compared with patients without endoleak. No significant association was observed between the analyzed biomarkers and endoleak volume. These findings suggest that reduced thrombin generation and impaired fibrinolysis may contribute to endoleak formation after EVAR and warrant further investigation in larger, confirmatory studies. Full article

Rupture of Intracranial Aneurysms (IAs) is the leading cause of non-traumatic intracranial hemorrhage. Early detection of aneurysms prior to rupture or their prompt identification in cases of intracranial hemorrhage is critical and guides treatment strategies. The development of artificial intelligence tools to automate the labor-intensive detection and analysis of IAs is an active research field, but it depends on the availability of large, well-curated datasets for robust model training, validation, and testing. Collaborative data sharing is essential for advancing this field, yet remains relatively uncommon. Here, we present a collection of 172 Computed Tomography Angiography (CTA) scan series—a widely available and commonly used modality for the diagnosis of IAs—supplemented with structured metadata. The dataset comprises 90 scans from healthy patients and 82 scans from patients with IAs of diverse shapes, sizes, and anatomical locations, annotated and validated by two experts. The annotations include 122 surface mesh models in STL format. This openly accessible dataset is intended to support the development of automated segmentation or classification tools, medical image analysis, and assessment of disease progression risks through morphometric and hemodynamic evaluations. Full article

Transcatheter aortic valve implantation (TAVI) has become the predominant treatment strategy for severe aortic stenosis across all surgical risk categories. The coexistence of coronary artery disease (CAD) in 40–75% of TAVI candidates has traditionally mandated pre-procedural invasive coronary angiography (ICA). However, computed tomography coronary angiography (CTCA), which is already integral to TAVI planning for annular sizing and access route evaluation, offers the potential to assess coronary anatomy simultaneously. Accumulating evidence demonstrates that CTCA possesses excellent sensitivity (90–97%) and high negative predictive value (94–99%) for excluding significant proximal CAD, potentially serving as a reliable gatekeeper to avoid unnecessary ICA in a substantial proportion of patients. This approach is particularly attractive given the questionable benefit of routine pre-emptive coronary revascularization in stable TAVI candidates, as demonstrated by the ACTIVATION and NOTION-3 trials. This review synthesizes the current evidence on the diagnostic performance of CTCA, clinical outcomes with CT-guided strategies, technical considerations and limitations, and the evolving paradigm of coronary assessment in the contemporary TAVI era. We propose a practical algorithm integrating CTCA as a first-line screening tool, reserving ICA for patients with suspected significant proximal disease, thereby optimizing resource utilization while maintaining patient safety. Full article

We describe a case of a 3-year-old girl with neurofibromatosis type 1 presenting with arterial hypertension, in whom multimodal vascular imaging identified significant right renal artery stenosis. The patient was successfully treated with percutaneous transluminal renal angioplasty; however, post-procedural Doppler ultrasound revealed a transient vascular fistula. Changes in renal arterial inflow during the procedure may have temporarily altered pressure gradients, facilitating the opening of communication involving pre-existing compensatory collateral vessels. This case illustrates the diagnostic value of multimodal vascular imaging in pediatric hypertension and highlights a rare, self-limiting post-interventional vascular phenomenon. Full article

Background/Objectives: Risk stratification in asymptomatic carotid stenosis has traditionally relied on the degree of luminal narrowing; however, plaque vulnerability may better predict cerebrovascular events. Ipsilateral silent brain lesions (SBLs) are considered surrogate markers of stroke risk. This study aimed to identify carotid plaque features on duplex ultrasound (DUS) and computed tomography angiography (CTA), as well as circulating biomarkers, associated with ipsilateral SBL in patients with clinically asymptomatic ≥70% internal carotid artery stenosis. Methods: This prospective observational study with cross-sectional imaging analysis included 316 clinically asymptomatic patients with ≥70% carotid stenosis treated between January 2022 and October 2024. All patients underwent cranial non-contrast CT for SBL detection, DUS plaque characterization (according to the Gray–Weale classification and plaque surface morphology), and CTA analysis, including plaque surface, composition, length, and attenuation values categorized according to Schroeder’s criteria (<50 HU lipid-rich; 51–120 HU fibrous; >120 HU calcified). Demographic, clinical, and laboratory parameters, including inflammatory biomarkers, were recorded. Multivariate logistic regression was performed to identify independent predictors of SBL. Results: SBL were detected in 72 patients (22.8%). On DUS, SBL were significantly associated with Gray–Weale class II plaques, heterogeneous composition, and irregular or ulcerated surfaces (all p < 0.001). On CTA, lipid-rich plaques (<50 HU), ulcerated surfaces, heterogeneous morphology, and lower median plaque density were significantly more frequent in the SBL group (all p < 0.001). In multivariate analysis, independent predictors of SBL were male sex (OR 2.2; 95% CI 1.2–5.7; p = 0.029), Gray–Weale class II plaques (p = 0.002), lipid-rich plaque morphology (OR 21.39; 95% CI 6.86–66.76; p < 0.001), and ulcerated plaque surface on CTA (OR 20.62; 95% CI 7.37–57.68; p < 0.001). Conclusions: Specific ultrasound and CT plaque characteristics were associated with ipsilateral silent brain lesions in patients with asymptomatic ≥70% carotid stenosis. A multiparametric imaging approach may improve risk stratification beyond stenosis severity alone. Full article

Background: Intramyocardial bridge (MB) is a coronary anomaly characterized by a segment of the artery tunneling within the myocardium. While often asymptomatic, it may lead to ischemic events. Despite traditional disqualification from competitive sports, 2023 guidelines now permit participation for athletes with MBs that do not meet specific high-risk morphological criteria. This study aims to evaluate a novel combined provocative test, integrating Cardiopulmonary Exercise Testing (CPET) and stress echocardiography for the assessment of myocardial deformation (twist), to assess the functional impact of MB in asymptomatic athletes. Methods: This cross-sectional case–control study included 18 participants (nine cases with “significant” MB diagnosed via Computed Tomography (CT) coronary angiography and nine healthy, trained controls), aged 18–78 years. All subjects underwent evaluation at our facility for competitive certification. Assessment protocols included resting echocardiography, Global Longitudinal Strain (GLS), and Cardiopulmonary Exercise Testing (CPET) to quantify exercise capacity and dynamic myocardial function. Results: No significant differences in echocardiographic parameters were observed between groups at rest. However, during exercise, athletes with MB demonstrated a significant reduction in GLS and ventricular twist compared to the control group. These findings indicate a notable loss of apical reserve in the MB cohort during physical stress. Conclusions: The integration of CPET and myocardial deformation analysis provides an effective diagnostic tool for identifying functional impairment in asymptomatic athletes with MB. This combined approach offers a superior follow-up strategy for managing athletes who may be at risk for ischemic events despite lack of clinical symptoms. Full article

Background: Endovascular aneurysm repair (EVAR) requires lifelong imaging surveillance because endoleaks, aneurysm sac expansion, and severe adverse events occur in up to one-third of the patients. Conventional follow-up based on sac diameter and visual assessment may fail to detect early microstructural changes that precede clinical deterioration. Methods: This narrative review summarizes the current evidence on texture-based radiomics and artificial intelligence (AI) applied to computed tomography (CT) and CT angiography (CTA) for post-EVAR outcome prediction and surveillance. Original studies evaluating radiomic features and AI-based models for endoleak detection, aneurysm sac behavior, and EVAR-related adverse events were included and qualitatively synthesized. Results: Ten studies were included. Radiomic features describing texture heterogeneity, gray-level nonuniformity, entropy, and spatial complexity were extracted from the aneurysm sac, intraluminal thrombus, and perivascular adipose tissue. Machine learning and deep learning models achieved good to excellent performance, with reported AUC values ranging from 0.78 to 0.95 for predicting endoleaks, sac expansion, and severe adverse events. Texture-based radiomics consistently outperformed morphology-only assessments and showed complementary value to deep learning, including applications on non-contrast CT. Conclusions: CT texture radiomics combined with AI represents an emerging research approach with potential relevance for post-EVAR surveillance, although current evidence remains limited. By capturing tissue heterogeneity beyond conventional morphology, radiomics may enable the earlier detection of complications and support risk-adapted follow-up. However, the heterogeneity of methods limited external validation, and reproducibility issues remain major barriers to clinical translation. Full article

We present computed tomography angiography images of a rare pseudoaneurysm of the left brachial artery, a complication of idiopathic injury to the artery caused by an osteochondral exostosis of the left humerus. A 22-year-old Caucasian man with no significant medical history was admitted to the emergency department due to sudden, intense pain in his left arm, numbness, and pallor of his left forearm and hand. The patient’s consulting vascular surgeon referred him to the computed tomography (CT) laboratory for a computed tomography angiography (CTA) of the arteries of his left upper limb. In the CTA examination, at the level of the proximal segment of the left brachial artery, an excess of contrast was visualized, measuring up to approximately 1.5 × 1.2 cm in cross-sections and up to approximately 0.7 cm in the craniocaudal dimension. The CTA image was suggestive of a pseudoaneurysm of the left brachial artery. Laterally, the pseudoaneurysm was adjacent to the apex of the imaged osteochondral exostosis on the medial surface of the proximal shaft of the left humerus. A surgical procedure was performed to repair the pseudoaneurysm of the left brachial artery, including removal of the bony exostosis of the left humerus. In summary, relatively common, benign bone lesions can occasionally result in serious vascular complications. CTA is the gold standard for diagnosing these complications. Full article

Moyamoya disease (MMD) is a chronic, progressive cerebrovascular disorder characterized by steno-occlusive changes in the intracranial internal carotid arteries and the development of fragile collateral networks. Imaging plays a pivotal role in diagnosis, disease staging, and management, yet the expanding range of available imaging modalities has resulted in heterogeneous evidence that remains difficult to synthesize. This scoping review aimed to systematically map and critically appraise imaging-based diagnostic approaches used in MMD, summarizing their diagnostic performance, clinical utility, and limitations. A comprehensive literature search was conducted across major databases, and original studies evaluating imaging modalities in human MMD were included. Thirty-three studies published between 1995 and 2023 were analyzed, encompassing digital subtraction angiography, magnetic resonance imaging and angiography, perfusion and functional MRI, computed tomography-based techniques, nuclear medicine, ultrasound, neurophysiological methods, and emerging artificial intelligence applications. Digital subtraction angiography remains the diagnostic reference standard, particularly for disease confirmation and surgical planning. However, noninvasive modalities provide critical complementary information. Magnetic resonance-based techniques offer multiparametric assessment of vascular morphology, hemodynamics, vessel wall pathology, and parenchymal injury. Computed tomography angiography and perfusion imaging provide accessible alternatives with high sensitivity for vascular changes, while functional and neurophysiological methods contribute additional hemodynamic and regional assessments. Artificial intelligence applications show promising diagnostic performance but remain in early validation stages. The evidence base is limited by methodological heterogeneity, inconsistent reference standards, incomplete reporting of diagnostic accuracy metrics, and a scarcity of longitudinal and multimodal studies. Collectively, the findings support a multimodal imaging strategy in MMD, integrating structural and functional information to inform diagnosis and management. Future research should prioritize standardized protocols, longitudinal designs, and clinically validated imaging biomarkers to enable evidence-based diagnostic pathways. Full article

Introduction: Ischemic stroke in young adults is uncommon and is frequently associated with rare etiologies, including autoimmune diseases and vasculitis. Takayasu arteritis (TA) is a chronic inflammatory large-vessel arteriopathy involving the aorta and its major branches and may result in cerebral ischemia due to arterial stenosis or thrombosis. Case Presentation: We report the case of a 26-year-old woman with a history of suspected rheumatoid arthritis and Lyme disease who presented with acute left-sided hemiparesis and dysarthria. At admission, large-vessel vasculitis had not yet been suspected, and the patient was treated according to standard acute stroke protocols. Computed tomography angiography (CTA) revealed occlusion of the right middle cerebral artery bifurcation and the right common carotid artery, with inflammatory changes involving the brachiocephalic trunk and subclavian arteries. Intravenous thrombolysis (iv rtPA) was followed by mechanical thrombectomy (MT), resulting in neurological improvement. Outcome: Further diagnostic work-up confirmed TA, and immunosuppressive therapy with cyclophosphamide and infliximab was initiated. Conclusion: This case underscores the importance of considering inflammatory large-vessel disease in young patients presenting with acute ischemic stroke and illustrates that endovascular reperfusion may be feasible in this clinical setting. Full article