Letter to the editor: is it time for imaging to level with pathology?
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REVIEW PAPER
Letter to the editor: is it time for imaging to level with pathology? Shihua Zhao1 Received: 29 June 2020 / Accepted: 8 July 2020 © Springer Nature B.V. 2020
Abstract CMR provides pathology-like insights of myocardial abnormality, such as hyperemia, edema, necrosis and fibrosis, which is in-vivo, non-invasive and real-time. Hence, it is most likely to become one alternative tool for mimicking pathology, socalled pathologicalized imaging due to its extraordinary tissue characteristics. This article aims to call for a wider clinical application of CMR with more attention on its tissue characterization value. Keywords Cardiovascular magnetic resonance · Pathology · Tissue characterization
Letter to the editor: It is the right time for imaging mimicking‑pathology Over the past four decades, cardiac imaging modalities have been progressing by leaps and bounds. Following echocardiography and radionuclide imaging, new techniques emerge in endlessly, including digital x-ray,digital subtraction angiography, coronary computed tomography angiography, cardiovascular magnetic resonance (CMR), intravascular ultrasound and optical coherence tomography, which challenge greatly the routine imaging mode based on X-ray plain film and angiography. Contemporary cardiac imaging modalities are gradually being developed from morphology and function to tissue characteristics, even molecular one. It should be recognized that IMAGING is not just limited to diagnosis but plays an important role in the prognosis and risk stratification [1–3]. Pathology has long been regarded as the sole gold standard for the diagnosis of cardiovascular diseases, however, which is being challenged by some imaging modalities that are capable of mirroring histological tissues. CMR is most likely to become one alternative tool for mimicking pathology, so-called pathologicalized imaging due to its extraordinary tissue characteristics. This multi-sequential * Shihua Zhao [email protected] 1
MR Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, P.R. China
and multi-parametric imaging modality can not only provide basic information about cardiac structure and function, but also detect myocardial fibrosis which indicates myocardial infarct and substrates inducing arrhythmia [4, 5]. Late gadolinium enhancement (LGE) can accurately reflect myocardial fibrosis [6]. T2WI and T2 mapping are useful for edema imaging. T1 mapping, extracellular volume (ECV) quantification and diffusion tensor imaging can detect myocardial fibrosis at an early stage, which is of benefit to uncover the pathogenesis of subclinical lesions [7, 8]. In addition, LGE combined with T2 mapping and T2* mapping is valuable for detection of microvascular obstruction and intramyocardial hemorrhage in patients with acute myocardial infarction [9]. Other emerging techniques such as 4D flow and myocardial strain surge to
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