Advanced CT Technologies for Cardiac Tissue Characterization Current State-of-the-Art

Advances in computed tomography (CT) technology have made it possible to perform non-invasive imaging with detailed characterization and quantification of the myocardium. Cardiac CT (CCT) has emerged as a technique useful for providing deeper insights into cardiovascular diseases, as a valuable alternative when cardiac magnetic resonance imaging or echocardiography are contraindicated, technically unfeasible, inconclusive, or non-diagnostic. Cardiac tissue characterization by the advances in CT technology lead to differentiate myocardial tissue types with high resolution. CCT allows the assessment of tissue properties such as myocardial perfusion, fibrosis and fat infiltration, which are critical in diagnosing ischemic heart disease, microvascular obstruction, heart failure, cardiomyopathies, and other cardiac conditions 1. Thin surgical complications and prosthesis studies are possible through high resolution scanners, allowing to detect HALT, pannus, thrombosis, endocarditis, abscesses and other characterizations. The use of contrast agents, along with advanced imaging techniques such as photon-counting CT, allows for high-resolution imaging of tissue heterogeneity, making it a valuable tool for non-invasive evaluation. Dual-energy computed tomography (DECT) has emerged as a transformative tool in the non-invasive assessment of cardiac tissue, enabling a more precise characterization of myocardial structures and pathologies. Employing two distinct energy levels, it provide unique advantages in tissue differentiation through the energy-dependent attenuation of various tissues, allowing for better delineation of tissue properties such as fat, fibrosis, calcification, and water content, improving also quantitative imaging and iodine mapping. Furthermore, new methodologies like CT-based tissue characterization models and artificial intelligence algorithms are enhancing the accuracy of differentiating normal and pathological cardiac tissues. The integration of cardiac CT with other imaging modalities, such as cardiac magnetic resonance (CMR), is also highlighted as a promising approach for comprehensive cardiac tissue assessment in several clinical settings. [*] Aim and scope of the Special Issue: This paper reviews the current techniques for cardiac tissue characterization using CT, explores the role of texture analysis, and discusses the challenges in achieving precise tissue differentiation, outlining the current applications and future perspective of cardiac CT in myocardial tissue characterization.