In parallel with the promotion of intravascular imaging during PCI, the rise of photon counting CT has also become a hot topic.
Cardiovascular imaging, which continues to evolve in parallel with interventional and other technologies, has made significant advances over the past year, with artificial intelligence (AI) permeating much imaging research and practice, as well as other achievements. Meanwhile, coronary artery calcium (CAC) remained the cornerstone.
Publicly available data about AI includes: AI-ECG model There is less activation in the cath lab and STEMI is identified more efficiently. both echonet model and one from pan echo The results showed that automation of echocardiography measurements is promising. Data from and Decide on the registry We showed that AI-based coronary plaque analysis can better guide clinical management compared to coronary CT angiography (CCTA) alone in symptomatic patients.
That's just the tip of the iceberg.
Kavitha Chinnaiyan, MD, president of the Society of Cardiovascular Computed Tomography (SCCT) (Corewell Health, Royal Oak, Michigan), emphasized not only the potential for coronary plaque identification and analysis with AI tools, but also the need for standardization across different platforms. “That's going to be the next problem we have to solve,” she told TCTMD. “Does a plaque on one platform also mean a plaque on another platform?”
Excitement is growing all around Photon counting CT It also has the potential to overcome some of the shortcomings of traditional cardiac CT imaging. “M“Right now, more and more data is coming out about its applications and the real technical benefits and all the things it might be able to do in the future. For example, the limitations of cardiac CT include visualization of blood vessels in highly calcified or densely calcified areas or within stents. The overall spatial resolution is much better using photon counting,” said Chinnaiyan.
Affordability issues and the logistics of replacing the current scanners remain to be resolved, she added.
Additionally, plaque imaging dominated this year, especially in conjunction with AI-based tools. “This really blows away clinical evaluation and risk factor stratification,” Chinnaiyan said, adding that calcium scores were a big win in clinical evaluation last month. large scale research— I’m not going anywhere yet.
“There are ethical and environmental concerns about performing contrast-enhanced CT scans and comparing calcium scores in large populations,” she said. “I don't think we have data that suggest, at least conclusively, that quantitative plaque assessment is superior to calcium scores in assessing long-term outcomes.”
actual, CAUGHT-CAD Randomized Trial We have shown how powerful CAC-based management is, especially when compared to usual care.
As always, reimbursement will be a hot topic for cardiovascular imaging devices in 2025. SCCT has supported several advocacy efforts designed to protect cardiac CT reimbursement. This “will also drive the introduction of CT as the first choice for plaque analysis.” [and] “This is a big aspect of cardiac CT and a business problem for cardiac CT,” Chinnaiyan said.
Similarly, during the summer, the American Society of Nuclear Cardiology (ASNC) pushed back The U.S. Centers for Medicare and Medicaid Services has proposed a 57% reduction in pyrophosphate/amyloid imaging.
Other highlights of TCTMD's 2025 imaging coverage spanned a wide range of topics. Researchers at the University of Washington Medical Center Intravascular imaging as a performance indicator For PCI, IVUS or OCT was allowed to be used after a few weeks. Class 1 recommended during PCI in the latest US ACS guidelines. Invasive coronary artery function tests have been shown to show: Safely diagnose microvascular dysfunction Among patients with non-obstructive coronary artery disease (ANOCA).
in sonobadi In sham-controlled trials, ultrasound appeared to make carotid endarterectomy safer. And if you look early, scott hart 2 data We showed that CCTA is better than risk scores alone for encouraging patients to make lifestyle changes. Similarly, researchers proposed adding an annual CCTA. Firefighter physical examination Better identification of CAD even when CAC is zero.
Some novel techniques also made headlines. Four-dimensional flow cardiovascular MRI In addition to treatment of aortic valve stenosis, additional treatment is required. CT-guided PCI. Even in the PCI space, flavor The trial showed that FFR was noninferior to IVUS in the long term to guide the procedure.
In conclusion, Mr. Chinnaiyan praised the achievements of SCCT. achieve 20 years This year's innovation. “We have come a long way,” she said. “Twenty years ago, there was a lot of skepticism about cardiac CT, and many thought it would become a trend. [would] It disappears. ”
There is now a wealth of data to support this field, and “the field is really blossoming and growing explosively.” [with] “We now face the very difficult and challenging task of understanding who to image, when to image, why to image, and whether this changes the management, course, or natural history of the disease.”
