Objectives: Micro–computed tomography (micro-CT) is a novel, nondestructive, slide-free digital imaging modality that enables the acquisition of high-resolution, volumetric images of intact surgical tissue specimens. The aim of this systematic mapping review is to provide a comprehensive overview of the available literature on clinical applications of micro-CT tissue imaging and to assess its relevance and readiness for pathology practice.Methods: A computerized literature search was performed in the PubMed, Scopus, Web of Science, and CENTRAL databases. To gain insight into regulatory and financial considerations for performing and examining micro-CT imaging procedures in a clinical setting, additional searches were performed in medical device databases.Results: Our search identified 141 scientific articles published between 2000 and 2021 that described clinical applications of micro-CT tissue imaging. The number of relevant publications is progressively increasing, with the specialties of pulmonology, cardiology, otolaryngology, and oncology being most commonly concerned. The included studies were mostly performed in pathology departments. Current micro-CT devices have already been cleared for clinical use, and a Current Procedural Terminology (CPT) code exists for reimbursement of micro-CT imaging procedures.Conclusions: Micro-CT tissue imaging enables accurate volumetric measurements and evaluations of entire surgical specimens at microscopic resolution across a wide range of clinical applications.

Background: Acute myocardial infarction (AMI) remains the leading cause of mortality worldwide. The majority of patients who suffer an AMI have a history of at least one of the standard modifiable risk factors (SMuRFs): smoking, hypertension, dyslipidemia, and diabetes mellitus. However, emerging scientific evidence recognizes a clinically significant and increasing proportion of patients presenting with AMI without any SMuRF (SMuRF-less patients). To date, there are no adequate data to define specific risk factors or biomarkers associated with the development of AMIs in these patients. Methods: The ‘‘Beyond-SMuRFs Study’’ is a prospective, non-interventional cohort trial designed to enroll patients with AMI and no previous coronary intervention history, who undergo coronary angiography in two academic hospitals in Thessaloniki, Greece. The rationale of the study is to investigate potential relations between SMuRF-less AMIs and the clinical, laboratory and imaging profile of patients, by comparing parameters between patients with and without SMuRFs. Complete demographic and comprehensive clinical data will be recorded, Venous blood samples will be collected before coronary angiography and the following parameters will be measured: total blood count, standard biochemistry parameters, coagulation tests, hormone levels, glycosylated hemoglobin, N- terminal pro-B-type natriuretic peptide and high-sensitivity troponin T levels- as well as serum levels of novel atherosclerosis indicators and pro-inflammatory biomarkers. Furthermore, all participants will undergo a complete and comprehensive transthoracic echocardiographic assessment according to a pre-specified protocol within 24 h from admission. Among others, 2D-speckle-tracking echocardiographic analysis of cardiac chambers and non-invasive calculation of myocardial work indices for the left ventricle will be performed. Moreover, all patients will be assessed for angiographic parameters and the complexity of coronary artery disease using the SYNTAX score. Multivariable linear and logistic regression models will be used to phenotypically characterize SMuRF-less patients and investigate independent clinical, laboratory, echocardiographic and angiographic biomarkers-predictors of SMuRF-less status in AMI.The first patient was enrolled in March 2022 and completion of enrollment is expected until December 2023. Discussion: The ‘‘Beyond-SmuRFs’’ study is an ongoing prospective trial aiming to investigate potential clinical, laboratory and imaging biomarkers associated with the occurrence of AMIs in SMuRF-less patients. The configuration of these patients’ profiles could lead to the development of personalized risk-stratification models predicting the occurrence of cardiovascular events in SΜuRF-less individuals. Trial Registration: ClinicalTrials.gov Identifier: NCT05535582 / September 10, 2022.

Tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) is a non-invasive surrogate of right ventricular-pulmonary arterial (RV-PA) coupling, studied in chronic RV pressure overload syndromes. However, its prognostic utility in patients with acute myocardial infarction (AMI) that may cause acute RV pressure overload remains unexplored. To determine predictors of RV-PA uncoupling in patients with first AMI and examine whether it could improve risk stratification for cardiovascular in-hospital mortality after revascularization. Three-hundred consecutive patients with first AMI were prospectively studied (age 61.2±11.8, 24% females). An echocardiogram was performed 24 hours after successful revascularization and TAPSE/PASP was evaluated. Cardiovascular in-hospital mortality was recorded. The optimal cutoff value of TAPSE/PASP to determine cardiovascular in-hospital mortality was 0.49 mm/mmHg. RV-PA uncoupling was considered for patients with TAPSE/PASP ≤0.49 mm/mmHg. Left ventricular ejection fraction (LVEF) was independently associated with RV-PA uncoupling. A total of 23 (7.7%) patients died in-hospital despite successful revascularization. TAPSE/PASP was independently associated with in-hospital mortality, after adjustment for Global Registry of Cardiovascular Events (GRACE) risk score and LVEF (Odds Ratio 0.14, 95% Confidence Intervals [0.03-0.56], P-value 0.007). The prognostic value of a baseline model including GRACE risk score and NT-pro-BNP (χ² 26.55) was significantly improved by adding LVEF ≤40 % (χ² 44.71, P-value <0.001), TAPSE ≤17 mm (χ² 75.42, P-value <0.001) and TAPSE/PASP ≤0.49 mm/mmHg (χ² 101.74, P-value <0.001) for predicting cardiovascular in-hospital mortality. RV-PA uncoupling, assessed by echocardiographic TAPSE/PASP ≤0.49 mm/mmHg 24 hours after revascularization, may improve risk stratification for cardiovascular in-hospital mortality post first AMI.

E13620 Background: Breast-conserving surgery (BCS) followed by radiotherapy requires adequate removal of the malignancy with a negative margin. Accurate pathologic margin status is not available intraoperatively and is found to be positive in up to 20% of cases, necessitating re-excision. Specimen mammography (SM), used to find a biopsy marker, may assist with margin status but is only 55% sensitive for Intraoperative margin assessment (IMA). IMA methods are being increasingly investigated. Because micro-computed tomography (micro-CT) produces three-dimensional volumetric images, we aimed to evaluate the diagnostic sensitivity of micro-CT for IMA. Methods: We performed a systematic review according to the PRISMA guidelines by querying Scopus, MEDLINE, EMBASE, PubMed, and Google Scholar through 12/21/22. (https://osf.io/342h8). Studies evaluating the applications of micro-CT scanning in breast cancer were included for systematic review, and those reporting the diagnostic indices of micro-CT for IMA compared to histopathologic results were incorporated in a study-level meta-analysis. A random effects coefficient binary regression model was used when a high level of heterogeneity was observed. Results: Of the 2920 studies, 18 studies were selected. IMA was reported in 7 studies (388 specimens), tumor size in 3 studies, microcalcifications in 12 studies, and sentinel lymph node assessment in 1 study. Half of the studies were performed in the USA; the participant’s ages ranged from 33 to 82 years, and the tumor size was between 0.8 and 55.8mm. Image procurement time ranged from 4 to 30 minutes. A pooled diagnostic sensitivity of 0.67 (95% CI: 0.48 – 0.82) and specificity of 0.75 (95% CI: 0.63 – 0.84) was revealed, and the pooled accuracy was calculated based on the normal-error estimation as 0.76 (95% CI: 0.69 – 0.83) for IMA by micro-CT compared to the histopathological evaluation. Conclusions: Micro-CT can create 3D images of the internal structure and vasculature in less than 30 minutes and detects up to 67% of positive margins intraoperatively, preventing a future reoperation. Although the results of this review are promising, due to the high level of heterogeneity, further investigations should be pursued as to how and who should report the images and whether micro-CT may have a role in IMA. [Table: see text]

Background: The etiology of acute myocardial infarction (AMI) in patients without history of standard modifiable risk factors (SMuRFs) remains unclear. Simultaneously, evidence suggests that mental health status (MHS) contributes to the pathogenesis of AMI and worsens its outcomes. Methods: This analysis of the prospective “Beyond-SMuRFs” (NCT05535582) study included 650 consecutive patients with AMI who had available data on self-reported MHS before AMI, calculated by the SF36-Questionnaire mental component summary (MCS). Poor MHS was defined as MCS ≤ 50. Multivariable logistic-regression and Cox-regression analyses were implemented to investigate poor MHS as a potential predictor of SMuRF-less AMIs and compare all-cause mortality based on SMuRF-less and MH status, respectively. Results: Of 650 patients with AMI (mean age 62.6 ± 12.1 years), 288 (44.3%) had MCS ≤ 50 and 128 (19.7%) were SMuRF-less patients. Three out of four SMuRF-less patients reported an MCS ≤ 50 (n = 96, 75%), a significantly higher percentage than the corresponding percentage in patients with SMuRFs (n = 192, 36.8%; p < 0.01). The multivariable logistic regression model showed that MCS ≤ 50 was an independent predictor of SMuRF-less AMI [aOR = 0.95; 95% CI (0.94–0.96)]. Time-to-event analysis for all-cause mortality showed that patients with MCS > 50 had lower mortality rates than those with poor MHS (aHR, 3.61 [95% CI, 2.02 to 6.43], p < 0.01). Higher risk for all-cause mortality was also observed in SMuRF-less patients with poor MHS compared to patients with at least one SMuRF and good MHS [aHR, 4.52 (95% CI, 0.94–21.73)]. Conclusions: Poor MHS was an independent predictor of the occurrence of SMuRF-less AMI and predictive of higher mortality in patients with and without SMuRFs.