Artificial Intelligence Based Multimodality Imaging: A New Frontier in Coronary Artery Disease Management

Figure 1. AI applications to the coronary artery disease (CAD) clinical workflow. The figure describes the stages of the clinical CAD workflow in which AI have found applications. PTP, pre-test probability; CCTA, coronary computed tomography angiography; ICA, invasive coronary angiography.

Figure 2. Localization of epicardial adipose tissue at cardiac CT scan. The figure depicts an example of visualization of the epicardial adipose tissue with a cardiac CT scan. The asterisk identifies the hypodense area of adipose tissue; while the arrow identifies the visceral pericardium.

Figure 3. Tissue characterization with Cardiac Magnetic Resonance (CMR). The figure shows an example of tissue characterization in a patient with a history of antero-septal myocardial infarction. (A) Depicts a transmural myocardial scar (asterisks) in the antero-septal region with concomitant evidence of subendocardial areas of microvascular obstruction (MVO, arrows). (B) Shows the automatic identification and quantification of late gadolinium enhancement and the semi-automatic identification of MVO areas on CMR images.

Figure 4. AI applications to cardiac CT. The figure depicts two examples of AI workflow applied to the automatic analysis of coronary artery stenoses by Coronary Computed Tomography Angiography (CCTA). (A) Schematizes the algorithm proposed by Zreik et al. (72) and composed of a 3D convolutional neural network (CNN) used for coronary artery features extraction and a subsequent recurrent neural network for a two-task classification of plaque phenotype and stenosis degree. (B) Schematizes the algorithm applied by Muscogiuri et al. (68) for the fully automatic CAD-RADS classification of CCTA scans with a CNN.

Figure 5. High risk features of coronary artery plaques. The figure shows clinical examples of high-risk plaque feature. (A) Depicts an example of a Napkin-ring sign. The asterisk identifies the hypodense necrotic core; the arrow identifies the hyperdense ring-like thin cap. (B) Depicts a high-risk coronary plaque with spotty calcifications and low attenuation (i.e., attenuation <30 HU). (C,D) Depict a coronary artery plaque with positive remodeling (i.e., a positive ratio between diameter of the vessel outside the plaque and its internal diameter) in short and long axis, respectively.