How innovations in medical imaging can help detect heart disease

Research published in the Journal of the American College of Cardiology found more atherosclerosis (i.e., fatty plaque buildup in the arteries) in people who get less than six hours of sleep a night. Medical imaging was key to the finding, as the study utilized imaging techniques that helped researchers identify signs of artery disease that wouldn’t have otherwise been obvious to doctors.

The more tools we have at our disposal in fighting heart disease the better; it still remains the leading cause of death in the United States. According to the CDC, someone dies of a heart attack in the US every 40 seconds. They also report that heart disease costs the US economy roughly $229 billion due to healthcare services, medicines and loss of productivity – which pales in comparison to the human cost.

Looking at the global impact, the World Health Organization says cardiovascular diseases are also the leading cause of death worldwide, representing some 18 million deaths a year.

The international science and medical community are addressing the scourge of heart disease in myriad ways, from developing new surgical procedures and medical devices to establishing more effective nutritional and medicinal interventions. But medical imaging itself is advancing in ways that can help the medical community improve its response to the heart health crisis.

The area of cardiac imaging has seen numerous innovations in recent years, providing radiologists with better image quality to facilitate faster and more accurate readings. Today’s medical imaging is making it possible for doctors to see in 3D, providing never-before-possible views of the heart and vascular system. These advances are improving the diagnostic and prognostic abilities of doctors to help patients who are entering heart failure; and also to identify and assess heart problems much earlier.

As a position paper from the Heart Failure Association of the European Society of Cardiology states, this is a time of major “paradigm shifts” in medical imaging, from two-dimensional to three-dimensional echocardiography, rest-to-stress assessments, and other notable changes in methods and techniques.

Advances in CT scans and MRI technology are often what we think of when imagining the latest innovations in medical imaging. While incredibly important, x-rays might seem somewhat limited to the outside observer – and not at all what you would expect to be helpful with heart issues, where the examination of tissue is important.

However, a team at University Hospitals and Case Western Reserve University has been working on a technique that would enable the detection of heart disease through a chest x-ray. Rather than just using one beam of energy, like a standard chest x-ray, their technique uses dual energy technology.

“Dual energy technology has a way to send two different x-ray beams of different energies,” explains Robert Gilkeson, MD. “Through a lot of complicated physics, you can highlight and visualize certain tissues. Using the digital subtraction, material decomposition technique, a bone/calcium image can be computed which suppresses the soft tissue component.” This means they can spot calcified structures in the coronary arteries.

This could prove an excellent screening tool for detecting heart disease. X-rays are easier to administer, less expensive, and have an even lower radiation dose than a CT, meaning that more people would be able to get screened (including in places with limited resources for medical imaging).

There is still a lot of work to be done. For instance, for diagnosing atherosclerosis, the chief cause of heart attacks and strokes, MRIs could be the ideal imaging choice. MRIs are well-positioned to characterize plaque in the arteries non-invasively because they don’t use ionizing radiation (allowing for repeated examinations) and because of their “excellent soft tissue contrast”.

However, researchers do believe there are technical challenges to overcome before vessel wall MRIs can fulfil this function to their best ability. Fortunately, there are promising techniques in development for higher-quality atherosclerosis imaging – such as high spatial resolution, high signal-to-noise imaging, and quantitative T1/T2 mapping for improved plaque characterization – that will one day enable doctors to peer into vessels to catch the warning signs of heart disease much earlier.

Even though it’s well known that heart disease affects so many people, it still has a way of sneaking up on individuals. There are not always clear indicators prior to a heart attack or stroke; sometimes people mistake the signs as symptoms of something else.

The ability to use medical imaging in a routine and cost-effective manner to catch heart disease early could have a massive impact, making the research into better imaging techniques absolutely vital.