Role of cardiac magnetic resonance imaging in the diagnosis and management of COVID-19 related myocarditis: Clinical and imaging considerations

There is a growing evidence of cardiovascular complications in coronavirusdisease 2019 (COVID-19) patients. As evidence accumulated of COVID-19 mediatedinflammatory effects on the myocardium, substantial attention has beendirected towards cardiovascular imaging modalities that facilitate this diagnosis.Cardiac magnetic resonance imaging (CMRI) is the gold standard for thedetection of structural and functional myocardial alterations and its role inidentifying patients with COVID-19 mediated cardiac injury is growing. Despiteits utility in the diagnosis of myocardial injury in this population, CMRI’s impacton patient management is still evolving. This review provides a framework for theuse of CMRI in diagnosis and management of COVID-19 patients from theperspective of a cardiologist. We review the role of CMRI in the management ofboth the acutely and remotely COVID-19 infected patient. We discuss patientselection for this imaging modality;T1, T2, and late gadolinium enhancementimaging techniques;and previously described CMRI findings in other cardiomyopathieswith potential implications in COVID-19 recovered patients.

Role of cardiac magnetic resonance imaging in troponinemia syndromes

Cardiac magnetic resonance imaging(MRI)is an evolving technology,proving to be a highly accurate tool for quantitative assessment.Most recently,it has been increasingly used in the diagnostic and prognostic evaluation of conditions involving an elevation in troponin or troponinemia.Although an elevation in troponin is a nonspecific marker of myocardial tissue damage,it is a frequently ordered investigation leaving many patients without a specific diagnosis.Fortunately,the advent of newer cardiac MRI protocols can provide additional information.In this review,we discuss several conditions associated with an elevation in troponin such as myocardial infarction,myocarditis,Takotsubo cardiomyopathy,coronavirus disease 2019 related cardiac dysfunction and athlete’s heart syndrome.

Cardiac involvement in hydrocarbon inhalant toxicity--role of cardiac magnetic resonance imaging:A case report

BACKGROUND We report a patient who was diagnosed with toxic myopericarditis secondary to hydrocarbon abuse using cardiac magnetic resonance imaging(CMR).CASE SUMMARY A 25-year-old male presented to emergency department with chest pain for 3 d.Patient also reported sniffing hydrocarbon containing inhalant for the last 1 year.Labs showed elevated troponin and electrocardiography was suggestive of acute pericarditis.Echocardiogram showed left ventricular(LV)ejection fraction(EF)of 40%.Given patient’s troponin elevation and reduced EF,cardiac catheterization was performed which showed normal coronaries.CMR was performed for myocardial infarction with non-obstructive coronary arteries evaluation.CMR showed borderline LV function with edema in mid and apical LV suggestive of myocarditis.CONCLUSION CMR can be used to diagnose toxic myopericarditis secondary to hydrocarbon abuse.

Correlation between myocardial infarction activity assessed by cardiac magnetic resonance imaging and the evolution of cardiac function after PCI

Objective:To investigate the correlation of cardiac magnetic resonance imaging(MRI)in the assessment of myocardial activity in patients with myocardial infarction and the outcome of cardiac function after PCI.Methods:30 patients with myocardial infarction(MI)who had complete clinical and imaging data from July 2016 to December 2018 after PCI were analyzed retrospectively.MR and echocardiogram were performed before and 6 months after PCI,and the parameters related to left ventricular function were measured by post-processing software of MRI workstation.The left ventricular transmural degree of CMR late gadolinium enhancement was compared with the left ventricular wall motion degree of 6-month echocardiography as a standard to judge the viable myocardium.Result:There were 193 left ventricular segmental abnormalities in 30 cases,including 121 viable myocardium and 72 non viable myocardium in CMR-LGE before operation.Six months after PCI,echocardiography showed that 125 of 193 abnormal segments of left ventricle detected by CMR-LGE before PCI were viable myocardium and 68 were non viable myocaridium.The sensitivity and specificity of CMR-LGE to determinate of viable myocardium were 92.0%and 91.1%respectively.The larger the non-viable myocardial area of the left ventricular wall,the worse the recovery of wall motion ability,and there was a negative correlation between them(r=0.416,P<0.05).The first-pass perfusion time in CMR-LEG region was significantly longer than that in normal myocardial region(4.85(+)1.51)s and(3.79(+)1.73)s,respectively.The difference was statistically significant(t=5.191,P<0.05).Conclusion:MRI can evaluate the myocardial activity of myocardial infarction,reflect the range of viable myocardium,and provide imaging basis for clinical treatment and prognosis.

Seg-CapNet:A Capsule-Based Neural Network for the Segmentation of Left Ventricle from Cardiac Magnetic Resonance Imaging

Deep neural networks(DNNs)have been extensively studied in medical image segmentation.However,existing DNNs often need to train shape models for each object to be segmented,which may yield results that violate cardiac anatomical structure when segmenting cardiac magnetic resonance imaging(MRI).In this paper,we propose a capsulebased neural network,named Seg-CapNet,to model multiple regions simultaneously within a single training process.The Seg-CapNet model consists of the encoder and the decoder.The encoder transforms the input image into feature vectors that represent objects to be segmented by convolutional layers,capsule layers,and fully-connected layers.And the decoder transforms the feature vectors into segmentation masks by up-sampling.Feature maps of each down-sampling layer in the encoder are connected to the corresponding up-sampling layers,which are conducive to the backpropagation of the model.The output vectors of Seg-CapNet contain low-level image features such as grayscale and texture,as well as semantic features including the position and size of the objects,which is beneficial for improving the segmentation accuracy.The proposed model is validated on the open dataset of the Automated Cardiac Diagnosis Challenge 2017(ACDC 2017)and the Sunnybrook Cardiac Magnetic Resonance Imaging(MRI)segmentation challenge.Experimental results show that the mean Dice coefficient of Seg-CapNet is increased by 4.7%and the average Hausdorff distance is reduced by 22%.The proposed model also reduces the model parameters and improves the training speed while obtaining the accurate segmentation of multiple regions.

Fabry Disease: Update, Focusing on Heart Disease by Multimodal Imaging

Fabry disease (FD) is a rare X-linked lysosomal accumulation disorder caused by a deficiency in the enzyme alpha-galactosidase A (Gal A), resulting in excessive storage of glycosphingolipids, particularly globotriaosylceramide (Gb3). This leads to cellular dysfunction in various organs, with cardiovascular compromise being the major cause of morbidity and mortality. This study aimed to provide a comprehensive overview of FD focusing on its genetic, epidemiological, clinical, diagnostic, and therapeutic aspects. This study explored the genetic mutations associated with FD, its epidemiology, clinical phenotypes, cardiac manifestations, diagnostic approaches, and current treatment options. Background: FD is caused by mutations in GLA on the X chromosome, with over 1000 identified variants. Neonatal screening and specific studies have shown an increased incidence of FD. The clinical presentation varies between classic and late phenotypes, with cardiac involvement being a major concern, particularly in late-onset FD. Purpose: This study aimed to summarize the current knowledge on FD, emphasizing cardiac involvement, diagnostic modalities, and treatment options. Methods: A literature review of relevant studies on FD, including genetics, epidemiology, clinical presentation, diagnostic methods, and treatment options, was conducted. Results: Cardiac manifestations of FD included left ventricular hypertrophy (LVH), heart failure, arrhythmias, and sudden death. Diagnostic approaches such as electrocardiography, echocardiography, and cardiac magnetic resonance imaging play crucial roles in the early detection and monitoring of cardiac involvement. Enzyme replacement therapy (ERT) and emerging treatments have shown promise in managing FD, although challenges remain. Conclusions: FD remains a challenging condition in cardiology, with under-diagnosis being a concern. Early detection and specific therapy are essential to improve patient outcomes. Echocardiography and cardiac MRI are valuable tools for diagnosis and follow-up. Despite the advances in treatment, accessibility remains an issue. More research is needed to deepen our understanding of FD and to improve therapeutic strategies.

Diagnostic Dilemma of Intracardiac Mass: Tumor versus Thrombus-Case Series and Systematic Review

Background: The differential diagnosis for intracavitary cardiac masses is limited, typically including vegetations, tumors, or thrombi. Cardiac thrombi can often mimic cardiac tumors on imaging, creating a diagnostic challenge. Primary cardiac tumors are rare and usually benign, whereas most cardiac tumors result from metastases, commonly originating from malignancies in the breast, lung, or melanoma. Aim: This report highlights the importance of distinguishing various cardiac masses based on clinical presentations, clinical courses, and radiological features. Case Presentation: We describe two cases of cardiac masses with unique and diverse clinical features. Each case posed significant diagnostic challenges due to their distinct presentations and clinical progressions. Conclusion: These cases underscore the importance of considering both benign and metastatic origins in the differential diagnosis of intracavitary cardiac masses. Accurate differentiation between thrombi and tumors is crucial for appropriate management and treatment.

Multi-modality imaging of cardiac amyloidosis: Contemporary update

Cardiac amyloidosis is a heterogeneous and challenging diagnostic disease with poor prognosis that is now being altered by introduction of new therapies.Echocardiography remains the first-line imaging tool, and when disease is suspected on echocardiography, cardiac magnetic resonance imaging and nuclear imaging play critical roles in the non-invasive diagnosis and evaluation of cardiac amyloidosis. Advances in multi-modality cardiac imaging allowing earlier diagnosis and initiation of novel therapies have significantly improved the outcomes in these patients. Cardiac imaging also plays important roles in the risk stratification of patients presenting with cardiac amyloidosis. In the current review, we provide a clinical and imaging focused update, and importantly outline the imaging protocols, diagnostic and prognostic utility of multimodality cardiac imaging in the assessment of cardiac amyloidosis.

Biventricular isolated apical hypoplasia:First-time description of a new cardiac abnormality by multimodality imaging

Left ventricular isolated hypoplasia is a seldom-described cardiac abnormality.Right ventricular hypoplasia is usually associated with congenital anomalies of the pulmonary or the tricuspid valve,whereas biventricular isolated apical hypoplasia has never been described.We report the case of a 48-year-old man with no history of known cardiac disease who was found to have a complex cardiac abnormality characterized by:1)Deficiency of the myocardium within the biventricular apex with adipose tissue infiltration;2)Truncated right ventricle because of an absent trabecular portion of the inflow tract;3)Truncated and spherical left ventricular apex;4)Origin of the mitral papillary muscle in the flattened anterior left ventricular apex.Multimodality imaging was performed to delineate the morphological and functional characteristics of this cardiomyopathy fully.To the best of our knowledge,this is the first description of a new cardiac abnormality characterized by the hypoplasia of the apical region of both ventricles in the absence of valvular or coronary artery disease.

Tricuspid mass-curious case of Li-Fraumeni syndrome: A case report

BACKGROUND Li-Fraumeni syndrome(LFS)is a rare autosomal dominant cancer-predisposing syndrome,which can manifest as a polymorphic spectrum of malignancies.LFS is associated with an early onset in life,with the majority of cases occurring prior to the age of 46.Notwithstanding the infrequency of primary cardiac tumors,it behooves clinicians to remain vigilant in considering the differential diagnosis of such tumors in LFS patients who present with a cardiac mass.This is due to the markedly elevated risk for malignancy in this particular population,far surpassing that of the general populace.CASE SUMMARY Herein,we present a case of a 30-year-old female with LFS who was found to have a tricuspid valve leaflet mass.CONCLUSION This case exemplifies valuable learning points in the diagnostic approach for this exceptionally rare patient population.

Incidental discovery of right ventricular lipoma in a young female associated with ventricular hyperexcitability: An imaging multimodality approach

BACKGROUND Cardiac lipomas are rare benign tumors commonly found in the right atrium or left ventricle.Patients are usually asymptomatic,and clinical presentation depends on location and adjacent structures impairment.Right ventricle lipomas are scarce in the literature.Moreover,the previous published cases were reported in over 18-year-old patients.CASE SUMMARY We report a giant right ventricle lipoma discovered incidentally in a 17-year-old female while performing preoperative work-up.The diagnosis was confirmed by histopathological examination,and a conservative approach was performed.CONCLUSION Multimodal cardiac imaging and histopathological examination are required for a definitive diagnosis.The therapeutic approach depends on clinical presentation.

Isolated left ventricular apical hypoplasia:Systematic review and analysis of the 37 cases reported so far

BACKGROUND Isolated left ventricular apical hypoplasia(ILVAH),also known as truncated left ventricle(LV),is a very unusual cardiomyopathy.It is characterised by a truncated,spherical,and non-apex forming LV.The true apex is occupied by the right ventricle.Due to the rarity of the disease,just a few case reports and limited case series have been published in the field.AIM To analysing the so far 37 reported ILVAH cases worldwide.METHODS The electronic databases PubMed and Scopus were investigated from their establishment up to December 13,2022.RESULTS The majority of cases reported occurred in males(52.7%).Mean age at diagnosis was 26.1±19.6 years.More than a third of the patients were asymptomatic(35.1%).The most usual clinical presentation was breathlessness(40.5%).The most commonly detected electrocardiogram changes were T wave abnormalities(29.7%)and right axis deviation with poor R wave progression(24.3%).Atrial fibrillation/flutter was detected in 24.3%.Echocardiography was performed in 97.3%of cases and cardiac MRI in 91.9%of cases.Ejection fraction was reduced in more than a half of patients(56.7%).An associated congenital heart disease was found in 16.2%.Heart failure therapy was administered in 35.1%of patients.The outcome was favorable in the vast majority of patients,with just one death.CONCLUSION ILVAH is a multifaceted entity with a so far unpredictable course,ranging from benign until the elderly to sudden death during adolescence.

Cardiovascular magnetic resonance imaging findings in children with myocarditis

Background Myocarditis is a common,potentially life-threatening disease that presents a wide rang of symptoms in children,as an important underlying etiology of other myocardial diseases such as dilated and arrhythmogenic right ventricular cardiomyopathy.The incidence of nonfatal myocarditis is probably greater than that of the one actually diagnosed,which is the result of the challenges of establishing the diagnosis in standard clinical settings.Currently,no single clinical or imaging finding confirms the diagnosis of myocarditis with absolute certainty.Historically,clinical exam,electrocardiogram （ECG）,serology and echocardiography had an unsatisfactory diagnostic accuracy in myocarditis.Endomyocardial biopsy remains as a widely accepted standard,but may not be suitable for every patient,especially for those with less severe disease.Our aim was to find the changes in cardiovascular magnetic resonance （CMR） imaging of children with myocarditis diagnosed by clinical criteria.Methods We studied 25 children （18 male,7 female; aged from 5-17 years） with diagnosed myocarditis by clinical criteria.CMR included function analyses,T2-weighted imaging,T1-weighted imaging before and after i.v.gadolinium injection （early gadolinium enhancement （EGE） and late gadolinium enhancement （LGE））.Results The T2 ratio was elevated in 21 children （84％,11 in anterolateral （44％）,5 in inferolateral （20％）,and 5 in septum （20％））,EGE was present in 9 children （36％,3 in anterolateral （12％）,4 in inferolateral （20％）,and 2 in septum （8％））,and LGE was present in 5 children （20％,2 in anterolateral （8％）,1 in inferolateral （4％）,1 in septum （4％）,and 1 in midwall of left ventricular （LV） wall）.In 9 children （36％）,two （or more） out of three sequences （T2,EGE,LGE） were abnormal.Conclusions The CMR findings in children with clinically diagnosed myocarditis vary within the groups,including regional or global myocardial signal increase in T2-weighted images,EGE and LGE in T1-weighted images.The T2 ratio elevation is the most common CMR finding.Children with mild cardiac symptoms may also appear serious myocardial injuries.

Congenital Absence of Pericardium:The Largest Systematic Review in the Field on 247 Worldwide Cases(1977-Now)

Background:Congenital absence of pericardium(CAP),also known as pericardial agenesis,represents an uncommon cardiac abnormality and mostly incidental finding.It can be subdivided into complete and partial(left or right-sided)forms.Because of its infrequency,just case reports and a few case series have been released so far.This paper represents the largest systematic review in the field.Nine features(age at diagnosis,type,gender,clinical presentation,electrocardiography,imaging(ultrasounds,CT/MRI),concomitant cardiac defects,and outcome)were analysed.Methods:The electronic database PubMed was investigated from its establishment up to July 15th,2023.Just case reports and case series were included.Animal studies,papers that were not in English,Spanish,and Italian,and those manuscripts not reporting at least seven of the nine analysed features.were ruled out.The analysed data were reported mostly in terms of percentage.Results:One hundred eighty studies were included encompassing 247 patients.More than half of reviewed CAP cases were in males(63.2%).The mean age at diagnosis was 31.8±19.3 years;a range of 32 weeks of gestation-81 years).23.5%of the patients did not report any symptoms.The most common clinical presentations were chest pain(35.2%)and dyspnoea(29.2%).The most commonly seen ECG changes were right axis deviation(28.7%)and right bundle branch block(23.9%).CAP was suspected or diagnosed by echocardiography in 20.1%of cases.The diagnosis was made by CT and/or MRI in 61.9%of cases.CAP was left-sided in 71.2%,complete in 23.1%,and right-sided in 5.7%.A concomitant congenital heart defect was found in 22.7%,especially in the form of atrial septal defect(6.5%)and patency of ductus arteriosus(2.8%).The pericardial repair was required in 12.9% of the incomplete forms of the disease.Never did the complete form require surgical correction.The outcome appeared favourable in the vast majority of cases,with just 18 deaths(7.3%).Discussion:The main limitation of this systematic review is that it is based just on case reports and case series,due to the lack of large studies on CAP.However,it represents the largest analysis in the field.Due to the rarity of CAP establishing an International Registry is recommended.

Hypertrophic cardiomyopathy secondary to deficiency in lysosomeassociated membrane protein-2: A case report

BACKGROUND Danon disease(DD),in which mutations in the X-linked lysosome-associated membrane protein-2(LAMP-2)gene result in hypertrophic cardiomyopathy,is a rare disease,reported primarily in small samples or cases.However,with the development of cardiac magnetic resonance imaging and genetic technology in recent years,the number of reports has increased.CASE SUMMARY We report a case of DD in an adolescent male patient,confirmed by genetic testing.The patient was admitted to our hospital with complaints of a three-year history of chest tightness and shortness of breath.His preliminary clinical diagnosis is hypertrophic cardiomyopathy.Our report includes the patient’s clinical course from hospital admission to death,step-by-step diagnosis,treatment course,and noninvasive imaging features.We highlight how a noninvasive diagnostic approach,based solely on clinical and imaging“red flags”for DD,can be used to achieve a diagnosis of DD with a high degree of confidence.CONCLUSION DD is a very dangerous cardiomyopathy,and it is necessary to achieve early diagnosis and treatment.

Prognostic Value of Feature-Tracking Circumferential Strain in Dilated Cardiomyopathy Patients with Severely Reduced Ejection Fraction Incremental to Late Gadolinium Enhancement

Myocardial fiber deformation measurements have been reported to be associated with adverse outcomes in patients with acute heart failure and those with myocardial infarction.However,few studies have addressed the prognostic value of global circumferential strain(GCS)in dilated cardiomyopathy(DCM)patients with severely impaired systolic function.This study aimed to evaluate the prognostic value of cardiac magnetic resonance(CMR)-derived GCS in DCM patients with severely reduced ejection.Consecutive DCM patients with severely reduced ejection fraction(EF<35%)who underwent CMR were included.GCS was calculated from CMR cine images.The clinical endpoint was a composite of all-cause mortality,heart transplantation,implantable cardioverter defibrillator(ICD)implantation and aborted sudden cardiac death(SCD).A total of 129 patients with a mean EF of 15.33%(11.36%–22.27%)were included.During a median follow-up of 518 days,endpoint events occurred in 50 patients.Patients with GCS≥the median(−5.17%)had significantly reduced event-free survival as compared with those with GCS<the median(P<0.01).GCS was independently associated with adverse events after adjusting for clinical and imaging risk factors including extent of late gadolinium enhancement(LGE)(P<0.05).Adding GCS into the model including the extent of LGE resulted in significant improvements in the C-statistic(from 0.706 to 0.742;P<0.05)with a continuous net reclassification improvement(NRI)of 29.71%.It was concluded that GCS derived from CMR could be useful for risk stratification in DCM patients with severely reduced EF,which may increase common imaging risk factors including LGE.

A Multi-Scale Network with the Encoder-Decoder Structure for CMR Segmentation

Cardiomyopathy is one of the most serious public health threats.The precise structural and functional cardiac measurement is an essential step for clinical diagnosis and follow-up treatment planning.Cardiologists are often required to draw endocardial and epicardial contours of the left ventricle(LV)manually in routine clinical diagnosis or treatment planning period.This task is time-consuming and error-prone.Therefore,it is necessary to develop a fully automated end-to-end semantic segmentation method on cardiac magnetic resonance(CMR)imaging datasets.However,due to the low image quality and the deformation caused by heartbeat,there is no effective tool for fully automated end-to-end cardiac segmentation task.In this work,we propose a multi-scale segmentation network(MSSN)for left ventricle segmentation.It can effectively learn myocardium and blood pool structure representations from 2D short-axis CMR image slices in a multi-scale way.Specifically,our method employs both parallel and serial of dilated convolution layers with different dilation rates to capture multi-scale semantic features.Moreover,we design graduated up-sampling layers with subpixel layers as the decoder to reconstruct lost spatial information and produce accurate segmentation masks.We validated our method using 164 T1 Mapping CMR images and showed that it outperforms the advanced convolutional neural network(CNN)models.In validation metrics,we archived the Dice Similarity Coefficient(DSC)metric of 78.96%.

Atrial fibrillation in the elderly： predisposing factors and management

In the last twenty years, new imaging techniques to assess atrial function and to predict the risk of recurrence of atrial fibrillation after treatment have been developed. The present review deals with the role of these techniques in the detection of structural and functional changes of the atrium and diagnosis of atrial remodeling, particularly atrial fibrosis. Echocardiography allows the detection of anatomical, functional changes and deformation of the atrial wall during the phases of the cardiac cycle. For this, adequate acquisition of atrial images is necessary using speckle tracking imaging and interpretation of the resulting strain and strain rate curves. This allows to predict new-onset atrial fibrillation and recurrences. Its main limitations are inter-observer variability, the existence of different software manufacturers, and the fact that the software used were originally developed for the evaluation of the ventricular function and are now applied to the atria. Cardiac magnetic resonance, using contrast enhancement with gadolinium, plays a key role in the visualization and quantification of atrial fibrosis. This is the established method for in vivo visualization of myocardial fibrotic tissue. The non-invasive evaluation of atrial fibrosis is associ- ated with the risk of recurrence of atrial fibrillation and with electro-anatomical endocardial mapping. We discuss the limitations of these techniques, derived from the difficulty of demonstrating the correlation between fibrosis imaging and histology, and poor intra- and inter- observer reproducibility. The sources of discordance are described, mainly due to image acquisition and processing, and the challenges ahead in an attempt to eliminate differences between operators.

Clinical and anatomic predictors of need for repeat atrial fibrillation ablation

AIM To identify predictors of need for repeat procedures after initial atrial fibrillation(AF) ablation. METHODS We identified a cohort undergoing first time AF ablation at our institution from January 2004 to February 2014 who had cardiac magnetic resonance(CMR) imaging performed prior to ablation. Clinical variables and anatomic characteristics(determined from CMR) were assessed as predictors of need for repeat ablation. The decision regarding need for and timing of repeat ablation was at the discretion of the treating physician. RESULTS From a cohort of 331 patients, 142 patients(43%) underwent repeat ablation at a mean of 13.6 ± 18.4 mo afterthe index procedure. Both male gender(81% vs 71%, P = 0.05) and lower ejection fraction(57.4% ± 10.3% vs 59.8% ± 9.4%, P = 0.04) were associated with need for repeat ablation. On pre-ablation CMR, mean pulmonary vein(PV) diameters were significantly larger in all four PVs among patients requiring repeat procedures. In multivariate analysis, increased right superior PV diameter significantly predicted need for repeat ablation(odds ratio 1.08 per millimeter increase in diameter, 95%CI: 1.00-1.16, P = 0.05). There were also trends toward significance for increased left and right inferior PV sizes among those requiring repeat procedures.CONCLUSION Increased PV size predicts the need for repeat AF ablation, with each millimeter increase in PV diameter associated with an approximately 5%-10% increased risk of requiring repeat procedures.

Augmentation of literature review of COVID-19 radiology

We suggest an augmentation of the excellent comprehensive review article titled“Comprehensive literature review on the radiographic findings,imaging modalities,and the role of radiology in the coronavirus disease 2019(COVID-19)pandemic”under the following categories:(1)“Inclusion of additional radiological features,related to pulmonary infarcts and to COVID-19 pneumonia”;(2)“Amplified discussion of cardiovascular COVID-19 manifestations and the role of cardiac magnetic resonance imaging in monitoring and prognosis”;(3)“Imaging findings related to fluorodeoxyglucose positron emission tomography,optical,thermal and other imaging modalities/devices,including‘intelligent edge’and other remote monitoring devices”;(4)“Artificial intelligence in COVID-19 imaging”;(5)“Additional annotations to the radiological images in the manuscript to illustrate the additional signs discussed”;and(6)“A minor correction to a passage on pulmonary destruction”.