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Xu Z, Tang H, Malhotra S, Dong M, Zhao C, Ye Z, Zhou Y, Xu S, Li D, Wang C, Zhou W. Three-dimensional Fusion of Myocardial Perfusion SPECT and Invasive Coronary Angiography Guides Coronary Revascularization. J Nucl Cardiol 2022; 29:3267-3277. [PMID: 35194752 DOI: 10.1007/s12350-022-02907-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/06/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND SPECT myocardial perfusion imaging (SPECT MPI) and invasive coronary angiography (ICA) provide complementary clinical information in the diagnosis of coronary artery disease (CAD). We have developed an approach for 3D fusion of perfusion data from SPECT MPI and coronary anatomy from ICA. In this study, we aimed to evaluate its clinical value when compared to the traditional side-by-side readings. METHODS Thirty-six CAD patients who had at least one stenosis ≥ 50% were retrospectively enrolled. Based on the presence of a perfusion defect in a territory subtended by a coronary vessel, all vessels were classified as matched, unmatched, or normal groups via both the fusion and side-by-side analysis. The treatments recommended by the fusion and side-by-side analysis were compared with those that the patients received. Major adverse cardiac events (MACE), defined as all-cause death, myocardial infarction, unstable angina requiring hospitalization, and unplanned revascularization, were assessed. RESULTS The overall vessel-based concordance was 78.7% between the fusion and side-by-side analysis. Compared with the side-by-side analysis, 23 coronary arteries (29 equivocal segments) of 19 patients were reclassified via fusion of data. In the matched, unmatched, and normal groups, the numbers of vessels with hemodynamically significant stenosis which caused reversible defect were 37 vs 53, 28 vs 14, and 43 vs 41 (P < .01) when comparing the side-by-side analysis with the fusion, and the revascularization ratios per vessel were 69% vs 88%, 29% vs 10%, and 2% vs 2% between them. During the five-year follow-up, 8 patients (22.2%) experienced MACE. Patients who received the same treatment as the guidance of 3D fusion results (n = 22) had superior outcomes when compared with those who did not (n = 14) (P < .01). CONCLUSIONS Compared with the side-by-side analysis, the 3D fusion of SPECT MPI and ICA provided incremental diagnostic and prognostic value.
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Affiliation(s)
- Zhihui Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Gulou, Nanjing, 210000, China
| | - Haipeng Tang
- School of Computing Sciences and Computer Engineering, University of Southern Mississippi, Hattiesburg, MS, 39406, USA
| | - Saurabh Malhotra
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, 60612, USA
- Division of Cardiology, Rush Medical College, Chicago, IL, 60612, USA
| | - Minghao Dong
- School of Computer and Communication Engineering, Zhengzhou University of Light Industry, Zhengzhou, 450000, Henan, China
| | - Chen Zhao
- Department of Applied Computing, Michigan Technological University, 1400 Townsend Dr, Houghton, MI, 49931, USA
| | - Zekang Ye
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Gulou, Nanjing, 210000, China
| | - Ying Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Gulou, Nanjing, 210000, China
| | - Shun Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Gulou, Nanjing, 210000, China
| | - Dianfu Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Gulou, Nanjing, 210000, China
| | - Cheng Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Gulou, Nanjing, 210000, China.
| | - Weihua Zhou
- Department of Applied Computing, Michigan Technological University, 1400 Townsend Dr, Houghton, MI, 49931, USA.
- Center for Biocomputing and Digital Health, Institute of Computing and Cybersystems, and Health Research Institute, Michigan Technological University, Houghton, MI, 49931, USA.
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Tang H, Bober RR, Zhao C, Zhang C, Zhu H, He Z, Xu Z, Zhou W. 3D fusion between fluoroscopy angiograms and SPECT myocardial perfusion images to guide percutaneous coronary intervention. J Nucl Cardiol 2022; 29:1870-1884. [PMID: 33825145 PMCID: PMC10982818 DOI: 10.1007/s12350-021-02574-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) in stable coronary artery disease (CAD) is commonly triggered by abnormal myocardial perfusion imaging (MPI). However, due to the possibilities of multivessel disease, serial stenoses and variability of coronary artery perfusion distribution, an opportunity exists to better align anatomic stenosis with perfusion abnormalities to improve revascularization decisions. This study aims to develop a multi-modality fusion approach to assist decision-making for PCI. METHODS AND RESULTS Coronary arteries from fluoroscopic angiography (FA) were reconstructed into 3D artery anatomy. Left ventricular (LV) epicardial surface was extracted from SPECT. The artery anatomy and epicardial surface were non-rigidly fused. The accuracy of the 3D fusion was evaluated via both computer simulation and real patient data. Simulated FA and MPI were integrated and then compared with the ground truth from a digital phantom. The distance-based mismatch errors between simulated fluoroscopy and phantom arteries were 1.86 ± 1.43 mm for left coronary arteries (LCA) and 2.21 ± 2.50 mm for right coronary arteries (RCA). FA and SPECT images in 30 patients were integrated and then compared with the ground truth from CT angiograms. The distance-based mismatch errors between the fluoroscopy and CT arteries were 3.84 ± 3.15 mm for LCA and 5.55 ± 3.64 mm for RCA. The presence of the corresponding fluoroscopy and CT arteries in the AHA-17-segment model agreed well with a Kappa value of 0.91 (CI 0.89-0.93) for LCA and a Kappa value of 0.80 (CI 0.67-0.92) for RCA. CONCLUSIONS Our fusion approach is technically accurate to assist PCI decision-making and is clinically feasible to be used in the catheterization laboratory. Future studies are necessary to determine if fusion improves PCI-related outcomes.
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Affiliation(s)
- Haipeng Tang
- School of Computing Sciences and Computer Engineering, University of Southern Mississippi, Hattiesburg, MS, 39406, USA
| | - Robert R Bober
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, 70121, USA
| | - Chen Zhao
- Department of Applied Computing, Michigan Technological University, 1400 Townsend Dr, Houghton, MI, 49931, USA
| | - Chaoyang Zhang
- School of Computing Sciences and Computer Engineering, University of Southern Mississippi, Hattiesburg, MS, 39406, USA
| | - Huiqing Zhu
- School of Mathematics and Natural Sciences, University of Southern Mississippi, Hattiesburg, MS, 39406, USA
| | - Zhuo He
- Department of Applied Computing, Michigan Technological University, 1400 Townsend Dr, Houghton, MI, 49931, USA
| | - Zhihui Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210000, China.
| | - Weihua Zhou
- Department of Applied Computing, Michigan Technological University, 1400 Townsend Dr, Houghton, MI, 49931, USA.
- Center of Biocomputing and Digital Health, Institute of Computing and Cybersystems, and Health Research Institute, Michigan Technological University, Houghton, MI, 49931, USA.
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3
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Tada T, Osuda K, Nakata T, Muranaka I, Himeno M, Muratsubaki S, Murase H, Sato K, Hirose M, Fukuma T. A novel approach to the selection of an appropriate pacing position for optimal cardiac resynchronization therapy using CT coronary venography and myocardial perfusion imaging: FIVE STaR method (fusion image using CT coronary venography and perfusion SPECT applied for cardiac resynchronization therapy). J Nucl Cardiol 2021; 28:1438-1445. [PMID: 31435883 PMCID: PMC8421301 DOI: 10.1007/s12350-019-01856-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/07/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Nearly one-third of patients with advanced heart failure (HF) do not benefit from cardiac resynchronization therapy (CRT). We developed a novel approach for optimizing CRT via a simultaneous assessment of the myocardial viability and an appropriate lead position using a fusion technique with CT coronary venography and myocardial perfusion imaging. METHODS AND RESULTS The myocardial viability and coronary venous anatomy were evaluated by resting Tc-99m-tetrofosmin myocardial perfusion imaging (MPI) and contrast CT venography, respectively. Using fusion images reconstructed by MPI and CT coronary venography, the pacing site and lead length were determined for appropriate CRT device implantations in 4 HF patients. The efficacy of this method was estimated by the symptomatic and echocardiographic functional parameters. In all patients, fusion images using MPI and CT coronary venograms were successfully reconstructed without any misregistration and contributed to an effective CRT. Before the surgery, this method enabled the operators to precisely identify the optimal indwelling site, which exhibited myocardial viability and had a lead length necessary for an appropriate device implantation. CONCLUSIONS The fusion image technique using myocardial perfusion imaging and CT coronary venography is clinically feasible and promising for CRT optimization and enhancing the patient safety in patients with advanced HF.
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Affiliation(s)
- Tomohiro Tada
- Department of Cardiology, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku, Hakodate, Hokkaido, 040-8611, Japan.
| | - Koichi Osuda
- Division of Clinical Radiology Services, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku, Hakodate, Hokkaido, 040-8611, Japan
| | - Tomoaki Nakata
- Department of Cardiology, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku, Hakodate, Hokkaido, 040-8611, Japan
| | - Ippei Muranaka
- Department of Cardiology, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku, Hakodate, Hokkaido, 040-8611, Japan
| | - Masafumi Himeno
- Department of Cardiology, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku, Hakodate, Hokkaido, 040-8611, Japan
| | - Shingo Muratsubaki
- Department of Cardiology, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku, Hakodate, Hokkaido, 040-8611, Japan
| | - Hiromichi Murase
- Department of Cardiology, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku, Hakodate, Hokkaido, 040-8611, Japan
| | - Kenji Sato
- Department of Cardiology, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku, Hakodate, Hokkaido, 040-8611, Japan
| | - Masanori Hirose
- Department of Cardiology, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku, Hakodate, Hokkaido, 040-8611, Japan
| | - Takayuki Fukuma
- Department of Cardiology, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku, Hakodate, Hokkaido, 040-8611, Japan
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Nordenfur T, Babic A, Bulatovic I, Giesecke A, Günyeli E, Ripsweden J, Samset E, Winter R, Larsson M. Method comparison for cardiac image registration of coronary computed tomography angiography and 3-D echocardiography. J Med Imaging (Bellingham) 2018; 5:014001. [PMID: 29322069 PMCID: PMC5753006 DOI: 10.1117/1.jmi.5.1.014001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/04/2017] [Indexed: 11/17/2022] Open
Abstract
Treatment decision for coronary artery disease (CAD) is based on both morphological and functional information. Image fusion of coronary computed tomography angiography (CCTA) and three-dimensional echocardiography (3DE) could combine morphology and function into a single image to facilitate diagnosis. Three semiautomatic feature-based methods for CCTA/3DE registration were implemented and applied on CAD patients. Methods were verified and compared using landmarks manually identified by a cardiologist. All methods were found feasible for CCTA/3DE fusion.
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Affiliation(s)
- Tim Nordenfur
- KTH Royal Institute of Technology, Department of Medical Engineering, Stockholm, Sweden.,Karolinska Institute, Department of Clinical Sciences, Stockholm, Sweden
| | - Aleksandar Babic
- GE Vingmed Ultrasound, Oslo, Norway.,University of Oslo, Department of Informatics, Oslo, Norway
| | - Ivana Bulatovic
- Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - Anders Giesecke
- Karolinska Hospital, Department of Emergency Medicine, Stockholm, Sweden
| | - Elif Günyeli
- Danderyd Hospital, Department of Cardiology, Stockholm, Sweden
| | - Jonaz Ripsweden
- Karolinska Institute, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden
| | - Eigil Samset
- GE Vingmed Ultrasound, Oslo, Norway.,University of Oslo, Department of Informatics, Oslo, Norway
| | - Reidar Winter
- Karolinska Institute, Department of Clinical Sciences, Stockholm, Sweden.,Danderyd Hospital, Department of Cardiology, Stockholm, Sweden
| | - Matilda Larsson
- KTH Royal Institute of Technology, Department of Medical Engineering, Stockholm, Sweden
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5
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Fusion of CT coronary angiography and whole-heart dynamic 3D cardiac MR perfusion: building a framework for comprehensive cardiac imaging. Int J Cardiovasc Imaging 2017; 34:649-660. [DOI: 10.1007/s10554-017-1260-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022]
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Gräni C, Benz DC, Possner M, Clerc OF, Mikulicic F, Vontobel J, Stehli J, Fuchs TA, Pazhenkottil AP, Gaemperli O, Kaufmann PA, Buechel RR. Fused cardiac hybrid imaging with coronary computed tomography angiography and positron emission tomography in patients with complex coronary artery anomalies. CONGENIT HEART DIS 2016; 12:49-57. [PMID: 27539240 DOI: 10.1111/chd.12402] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/01/2016] [Accepted: 07/15/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To provide data on the value of fused cardiac hybrid imaging with coronary computed tomography angiography (CCTA) and positron emission tomography myocardial perfusion imaging (PET-MPI) in patients with complex coronary artery anomalies (CCAA). DESIGN/SETTING This is a retrospective, single-center study. PATIENTS Seven consecutive patients with CCAA (mean 57 ± 7 y, 86% were male) who underwent clinically indicated hybrid CCTA/PET-MPI between 2005 and 2015 in our clinic were included. The findings from both modalities and fused cardiac hybrid imaging were evaluated in these patients. RESULTS Out of the seven patients with CCAA, two patients had Bland-White-Garland anomaly, two patients showed a coronary artery fistula, two patients showed a "single right," and one patient showed a "single left" coronary artery. Semiquantitative fused hybrid CCTA/PET-MPI depicted inferolateral scar matching the territory of a nonanomalous vessel with significant concomitant coronary artery disease (CAD) in one patient only. In contrast, analysis of quantitative myocardial blood flow (MBF) as assessed by fused hybrid CCTA/PET-MPI revealed abnormally reduced flow capacities in the territories subtended by the anomalous vessels in 4 patients. CONCLUSIONS In this case series of middle-aged patients with CCAA, perfusion defects as assessed by semiquantitative PET-MPI were rare and attributable to concomitant CAD rather than to the anomalous vessel itself. By contrast, impaired MBF as assessed by quantitative hybrid CCTA/PET-MPI was revealed in the majority of patients in the vessel territories subtended by the anomalous coronary artery itself. Fused hybrid CCTA/PET-MPI incorporating information on morphology and on semiquantitative and quantitative myocardial perfusions may provide added value for the management of patients with CCAA.
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Affiliation(s)
- Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Fran Mikulicic
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Jan Vontobel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Julia Stehli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
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7
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Piccinelli M, Faber TL, Arepalli CD, Appia V, Vinten-Johansen J, Schmarkey SL, Folks RD, Garcia EV, Yezzi A. Automatic detection of left and right ventricles from CTA enables efficient alignment of anatomy with myocardial perfusion data. J Nucl Cardiol 2014; 21:96-108. [PMID: 24185581 PMCID: PMC5207024 DOI: 10.1007/s12350-013-9812-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 10/15/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Accurate alignment between cardiac CT angiographic studies (CTA) and nuclear perfusion images is crucial for improved diagnosis of coronary artery disease. This study evaluated in an animal model the accuracy of a CTA fully automated biventricular segmentation algorithm, a necessary step for automatic and thus efficient PET/CT alignment. METHODS AND RESULTS Twelve pigs with acute infarcts were imaged using Rb-82 PET and 64-slice CTA. Post-mortem myocardium mass measurements were obtained. Endocardial and epicardial myocardial boundaries were manually and automatically detected on the CTA and both segmentations used to perform PET/CT alignment. To assess the segmentation performance, image-based myocardial masses were compared to experimental data; the hand-traced profiles were used as a reference standard to assess the global and slice-by-slice robustness of the automated algorithm in extracting myocardium, LV, and RV. Mean distances between the automated and the manual 3D segmented surfaces were computed. Finally, differences in rotations and translations between the manual and automatic surfaces were estimated post-PET/CT alignment. The largest, smallest, and median distances between interactive and automatic surfaces averaged 1.2 ± 2.1, 0.2 ± 1.6, and 0.7 ± 1.9 mm. The average angular and translational differences in CT/PET alignments were 0.4°, -0.6°, and -2.3° about x, y, and z axes, and 1.8, -2.1, and 2.0 mm in x, y, and z directions. CONCLUSIONS Our automatic myocardial boundary detection algorithm creates surfaces from CTA that are similar in accuracy and provide similar alignments with PET as those obtained from interactive tracing. Specific difficulties in a reliable segmentation of the apex and base regions will require further improvements in the automated technique.
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Affiliation(s)
- Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University, 101 Woodruff Circle, Room 1203C, Atlanta, GA, 30322, USA,
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Slomka PJ, Berman DS, Germano G. Applications and software techniques for integrated cardiac multimodality imaging. Expert Rev Cardiovasc Ther 2014; 6:27-41. [DOI: 10.1586/14779072.6.1.27] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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9
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Cardiac hybrid SPECT/CTA imaging to detect "functionally relevant coronary artery lesion": a potential gatekeeper for coronary revascularization? Ann Nucl Med 2013; 28:88-93. [PMID: 24343677 DOI: 10.1007/s12149-013-0790-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 10/17/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Combination of both morphological and functional information has gained more and more appreciation with the concept of "functionally relevant coronary artery lesion (FRCAL)" and "functional revascularization". This has paved the way for non-invasive single-photon emission computed tomography (SPECT)/computed tomography angiography (CTA) hybrid imaging. We aimed at assessing the value of cardiac hybrid imaging on the detection of FRCAL and its potential as a gatekeeper for invasive examination and treatment. METHODS In Two hundred and thirty-eight patients with known or suspected coronary artery disease (CAD) underwent CTA and myocardial perfusion imaging (MPI) using SPECT on a dual system scanner in one session before treatment. 78 patients underwent invasive coronary angiography (CAG) within 1 month. Detection of FRCAL by the combination of SPECT/CTA was compared with SPECT/CAG, which served as a standard of reference. According to the both combination results, treatment decision (revascularization or medical treatment) was chosen in the catheterization laboratory. RESULTS Sensitivity, specificity, accuracy, positive and negative prediction rate by SPECT/CTA vs. SPECT/CAG for the detection of flow-limiting coronary stenosis on patient- and vessel-based analysis were 94.33, 72.00, 87.18, 87.71, 85.71 % and 88.71, 92.44, 91.45, 80.89, 95.78 %, respectively. No revascularization procedures were performed in patients without flow-limiting stenosis. However, more than one-third (25/67, 37 %) of revascularized vessels were not associated with ischemia on MPI. CONCLUSIONS The cardiac SPECT/CTA hybrid imaging can accurately detect FRCAL and thereby it may be used as a gatekeeper for CAG and revascularization procedures.
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Kirişli HA, Gupta V, Shahzad R, Al Younis I, Dharampal A, Geuns RJV, Scholte AJ, de Graaf MA, Joemai RM, Nieman K, van Vliet L, van Walsum T, Lelieveldt B, Niessen WJ. Additional Diagnostic Value of Integrated Analysis of Cardiac CTA and SPECT MPI Using the SMARTVis System in Patients with Suspected Coronary Artery Disease. J Nucl Med 2013; 55:50-7. [DOI: 10.2967/jnumed.113.119842] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Piccinelli M, Garcia E. Multimodality image fusion for diagnosing coronary artery disease. J Biomed Res 2013; 27:439-51. [PMID: 24285942 PMCID: PMC3841469 DOI: 10.7555/jbr.27.20130138] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 09/16/2013] [Indexed: 11/17/2022] Open
Abstract
Coronary artery disease (CAD) is one of the leading causes of death in the US and a substantial health-care burden in all industrialized societies. In recent years we have witnessed a constant strive towards the development and the clinical application of novel or improved detection methods as well as therapies. Particularly, noninvasive imaging is a decisive component in the cardiovascular field. Image fusion is the ability of combining into a single integrated display the anatomical as well as the physiological data retrieved by separated modalities. Clinical evidence suggests that it represents a promising strategy in CAD assessment and risk stratification by significantly improving the diagnostic power of each modality independently considered and of the traditional side-by-side interpretation. Numerous techniques and approaches taken from the image registration field have been implemented and validated in the context of CAD assessment and management. Although its diagnostic power is widely accepted, additional technical developments are still needed to become a routinely used clinical tool.
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Affiliation(s)
- Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University, Atlanta 30322, GA, USA.
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12
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Advances in Cardiac SPECT and PET Imaging: Overcoming the Challenges to Reduce Radiation Exposure and Improve Accuracy. Can J Cardiol 2013; 29:275-84. [DOI: 10.1016/j.cjca.2012.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 09/27/2012] [Accepted: 10/04/2012] [Indexed: 11/22/2022] Open
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Ghadri JR, Fiechter M, Fuchs TA, Scherrer A, Stehli J, Gebhard C, Klaser B, Gaemperli O, Luscher TF, Templin C, Kaufmann PA. Registry for the Evaluation of the PROgnostic value of a novel integrated imaging approach combining Single Photon Emission Computed Tomography with coronary calcification imaging (REPROSPECT). Eur Heart J Cardiovasc Imaging 2012; 14:374-80. [DOI: 10.1093/ehjci/jes224] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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14
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Plass A, Emmert MY, Gaemperli O, Alkadhi H, Kaufmann P, Falk V, Grünenfelder J. The potential value of hybrid positron emission tomography/dual-source computed tomography imaging in coronary bypass surgery. Heart Surg Forum 2012; 14:E283-90. [PMID: 21997649 DOI: 10.1532/hsf98.20111045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND We evaluated how comprehensive assessment of coronary artery lesions and their hemodynamic relevance by means of hybrid positron emission tomography (PET) and computed tomography (CT) imaging would affect decision-making in coronary artery bypass surgery (CABG), compared with using invasive coronary angiography (ICA) alone. METHODS After undergoing ICA, 27 patients (21 men and 6 women; mean SD age, 66 ± 10 years) planned for cardiac surgery were scheduled for myocardial perfusion stress/rest evaluation with [13N]ammonia PET and CT coronary angiography. Only ICA was available to the surgeon. Postoperatively, the performed CABG was compared with the hypothetical strategy based on hybrid PET/CT findings (regional coronary flow reserve [CFR], myocardial perfusion defects). Procedures included CABG (n = 18) alone, CABG combined with valve replacement (n = 6), and CABG combined with isolated valve replacement (n = 3). A total of 56 bypass grafts (28 venous and 28 arterial) and 66 distal anastomoses were placed. RESULTS CT evaluation showed 93% concordance (66/71) with ICA regarding significant stenoses, with sensitivity, specificity, positive predictive value, and negative predictive value of 93.1%, 98.7%, 94.4%, and 98.4%, respectively. In the PET scan, 16 patients had 1 ischemic region, and 12 patients had 1 scar region, including 5 patients who presented with mixed conditions (scar and ischemia). One patient had a completely normal myocardium. Compared with the performed surgery, PET/CT fusion evaluation showed that of the performed anastomoses, 48% had documented ischemia (with a CFR <2 in 86%), 38% were nonischemic (although a CFR value <2 was found in 78%), and 14% had scar tissue (fixed perfusion defect). CONCLUSIONS Although <50% of bypasses were placed to areas with myocardial ischemia, the CFR was low in the majority of nonischemic regions, a finding that may have important prognostic relevance. PET/CT fusion imaging could potentially influence planning for CABG and provide incremental prognostic information.
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Affiliation(s)
- Andre Plass
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
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15
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Gupta V, Kirişli HA, Hendriks EA, van der Geest RJ, van de Giessen M, Niessen W, Reiber JHC, Lelieveldt BPF. Cardiac MR perfusion image processing techniques: a survey. Med Image Anal 2012; 16:767-85. [PMID: 22297264 DOI: 10.1016/j.media.2011.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 12/14/2011] [Accepted: 12/15/2011] [Indexed: 02/05/2023]
Abstract
First-pass cardiac MR perfusion (CMRP) imaging has undergone rapid technical advancements in recent years. Although the efficacy of CMRP imaging in the assessment of coronary artery diseases (CAD) has been proven, its clinical use is still limited. This limitation stems, in part, from manual interaction required to quantitatively analyze the large amount of data. This process is tedious, time-consuming, and prone to operator bias. Furthermore, acquisition and patient related image artifacts reduce the accuracy of quantitative perfusion assessment. With the advent of semi- and fully automatic image processing methods, not only the challenges posed by these artifacts have been overcome to a large extent, but a significant reduction has also been achieved in analysis time and operator bias. Despite an extensive literature on such image processing methods, to date, no survey has been performed to discuss this dynamic field. The purpose of this article is to provide an overview of the current state of the field with a categorical study, along with a future perspective on the clinical acceptance of image processing methods in the diagnosis of CAD.
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Affiliation(s)
- Vikas Gupta
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
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Simultaneous Assessment of Myocardial Scar and Coronary Arteries Using Navigator-Gated 3-Dimensional Fat-Suppressed Delayed-Enhancement MRI at 3.0 T. J Comput Assist Tomogr 2012; 36:72-6. [DOI: 10.1097/rct.0b013e3182455cca] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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17
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Abstract
The present review provides an overview of the role of cardiac positron emission tomography in the diagnosis and management of cardiovascular disease. It expands on the relative advantages and disadvantages over other imaging modalities as well as the available evidence supporting its value in the diagnosis and management of patients with coronary artery disease, the assessment of myocardial viability, and evaluation of the cardiac sympathetic nervous system. Furthermore, the recent developments, such as the implementation of high-end computed tomography devices to form hybrid systems, and the advances of molecular imaging probes in experimental applications are briefly discussed.
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Affiliation(s)
- Oliver Gaemperli
- MRC Clinical Sciences Centre, Imperial College, Hammersmith Hospital Campus, London, United Kingdom.
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Pazhenkottil AP, Nkoulou RN, Ghadri JR, Herzog BA, Küest SM, Husmann L, Wolfrum M, Goetti R, Buechel RR, Gaemperli O, Lüscher TF, Kaufmann PA. Impact of cardiac hybrid single-photon emission computed tomography/computed tomography imaging on choice of treatment strategy in coronary artery disease. Eur Heart J 2011; 32:2824-9. [PMID: 21804107 PMCID: PMC3214723 DOI: 10.1093/eurheartj/ehr232] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS Cardiac hybrid imaging by fusing single-photon emission computed tomography (SPECT) myocardial perfusion imaging with coronary computed tomography angiography (CCTA) provides important complementary diagnostic information for coronary artery disease (CAD) assessment. We aimed at assessing the impact of cardiac hybrid imaging on the choice of treatment strategy selection for CAD. METHODS AND RESULTS Three hundred and eighteen consecutive patients underwent a 1 day stress/rest (99m)Tc-tetrofosmin SPECT and a CCTA on a separate scanner for evaluation of CAD. Patients were divided into one of the following three groups according to findings in the hybrid images obtained by fusing SPECT and CCTA: (i) matched finding of stenosis by CCTA and corresponding reversible SPECT defect; (ii) unmatched CCTA and SPECT finding; (iii) normal finding by both CCTA and SPECT. Follow-up was confined to the first 60 days after hybrid imaging as this allows best to assess treatment strategy decisions including the revascularization procedure triggered by its findings. Hybrid images revealed matched, unmatched, and normal findings in 51, 74, and 193 patients. The revascularization rate within 60 days was 41, 11, and 0% for matched, unmatched, and normal findings, respectively (P< 0.001 for all inter-group comparisons). CONCLUSION Cardiac hybrid imaging with SPECT and CCTA provides an added clinical value for decision making with regard to treatment strategy for CAD.
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Affiliation(s)
- Aju P Pazhenkottil
- Department of Radiology, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
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Abstract
CT coronary angiography and myocardial perfusion scintigraphy are both established noninvasive techniques for the diagnosis of coronary artery disease (CAD). Cardiac hybrid imaging consists of the combination (or fusion) of both modalities and allows obtaining complementary morphological (coronary anatomy, stenoses) and functional (myocardial perfusion) information in a single image. The increased availability of these techniques in clinical practice has also raised a controversy with regard to which patients should undergo such integrated examinations. The feasibility and clinical value of hybrid imaging has been documented in small cohort studies and selected series of patients. The incremental value of the hybrid technique arises from the spatial co-registration of perfusion defects with coronary stenoses. This allows an assessment of the hemodynamic relevance of coronary stenoses and the determination of the need for revascularization procedures in each individual artery. Thus, it can be anticipated that the ongoing efforts to reduce radiation exposure and the increasing clinical interest will further pave the way for an ever-increasing use of cardiac hybrid imaging in clinical practice.
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Affiliation(s)
- Oliver Gaemperli
- Kardiovaskuläres Zentrum, Abteilung Herzbildgebung, Universitätsspital Zürich, Rämistrasse 100, Zürich, Switzerland.
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Flotats A, Knuuti J, Gutberlet M, Marcassa C, Bengel FM, Kaufmann PA, Rees MR, Hesse B. Hybrid cardiac imaging: SPECT/CT and PET/CT. A joint position statement by the European Association of Nuclear Medicine (EANM), the European Society of Cardiac Radiology (ESCR) and the European Council of Nuclear Cardiology (ECNC). Eur J Nucl Med Mol Imaging 2011; 38:201-12. [PMID: 20717824 DOI: 10.1007/s00259-010-1586-y] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Improvements in software and hardware have enabled the integration of dual imaging modalities into hybrid systems, which allow combined acquisition of the different data sets. Integration of positron emission tomography (PET) and computed tomography (CT) scanners into PET/CT systems has shown improvement in the management of patients with cancer over stand-alone acquired CT and PET images. Hybrid cardiac imaging either with single photon emission computed tomography (SPECT) or PET combined with CT depicts cardiac and vascular anatomical abnormalities and their physiologic consequences in a single setting and appears to offer superior information compared with either stand-alone or side-by-side interpretation of the data sets in patients with known or suspected coronary artery disease (CAD). Hybrid systems are also advantageous for the patient because of the single short dual data acquisition. However, hybrid cardiac imaging has also generated controversy with regard to which patients should undergo such integrated examination for clinical effectiveness and minimization of costs and radiation dose, and if software-based fusion of images obtained separately would be a useful alternative. The European Association of Nuclear Medicine (EANM), the European Society of Cardiac Radiology (ESCR) and the European Council of Nuclear Cardiology (ECNC) in this paper want to present a position statement of the institutions on the current roles of SPECT/CT and PET/CT hybrid cardiac imaging in patients with known or suspected CAD.
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Affiliation(s)
- Albert Flotats
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni M. Claret, 167, 08025, Barcelona, Spain.
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21
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Abstract
Computed tomography coronary angiography (CTCA) and myocardial perfusion imaging techniques (single photon emission computed tomography, SPECT, or positron emission tomography, PET) are established non-invasive modalities for the diagnosis of coronary artery disease (CAD). Cardiac hybrid imaging consists of the combination (or 'fusion') of both modalities and allows obtaining complementary morphological (coronary anatomy, stenoses) and functional (myocardial perfusion) information in a single setting. However, hybrid cardiac imaging has also generated controversy with regard to which patients should undergo such integrated examinations for clinical effectiveness and minimization of costs and radiation dose. The feasibility and clinical value of hybrid imaging has been documented in small cohort studies and selected series of patients. Hybrid imaging appears to offer superior diagnostic and prognostic information compared with stand-alone or side-by-side interpretation of data sets. Particularly in patients with multivessel disease, the hybrid approach allows identification of flow-limiting coronary lesions and thereby provides useful information for the planning of revascularization procedures. Furthermore, integration of the detailed anatomical information from CTCA with the high molecular sensitivity of SPECT and PET may be useful to evaluate targeted molecular and cellular abnormalities in the future. While currently still restricted to specialized cardiac centres, the ongoing efforts to reduce radiation exposure and the increasing clinical interest will further pave the way for an increasing use of cardiac hybrid imaging in clinical practice.
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Affiliation(s)
- Oliver Gaemperli
- Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland.
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22
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Image fusion of coronary CT angiography and cardiac perfusion MRI: a pilot study. Eur Radiol 2010; 20:1174-9. [PMID: 20204639 DOI: 10.1007/s00330-010-1746-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 12/11/2009] [Accepted: 01/24/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To develop a tool for the image fusion of computed tomography coronary angiography (CTCA) and cardiac magnetic resonance imaging (CMR). METHODS Surface representations and volume-rendered images from fused CTCA/CMR data of five patients with significant coronary artery disease (CAD) on CTCA and perfusion deficits on CMR were generated using a newly developed software prototype. The spatial relationship of significant coronary artery stenosis at CTCA and myocardial defects at CMR was evaluated. RESULTS Registration of CTCA and CMR images was possible in all patients. The comprehensive three-dimensional visualisation of fused CTCA and CMR data accurately demonstrated the relationship between coronary artery stenoses and myocardial defects in all patients. CONCLUSION The introduced tool enables image fusion of CTCA and CMR data sets and allows for correct superposition of the coronary arteries derived from CTCA onto the corresponding myocardial segments derived from CMR. The method facilitates the comprehensive assessment of the functionally relevant CAD by the exact allocation of culprit coronary stenoses to corresponding myocardial defects at a low radiation dose.
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Fricke H, Elsner A, Weise R, Bolte M, Hoff JVD, Burchert W, Domik G, Fricke E. Quantitative myocardial perfusion PET combined with coronary anatomy derived from CT angiography: Validation of a new fusion and visualisation software. Z Med Phys 2009; 19:182-8. [DOI: 10.1016/j.zemedi.2009.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Matsuo S, Nakajima K, Akhter N, Wakabayashi H, Taki J, Okuda K, Kinuya S. Clinical usefulness of novel cardiac MDCT/SPECT fusion image. Ann Nucl Med 2009; 23:579-86. [PMID: 19572098 DOI: 10.1007/s12149-009-0279-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 05/26/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND We evaluated the relationship between computed tomography angiography (CTA) and SPECT, and assessed to determine the clinical usefulness of the fusion image using CTA and myocardial perfusion imaging (MPI). METHODS Forty-one consecutive patients [after coronary artery bypass operation (n = 13) and suspected stenosis (n = 28)] underwent MPI and CTA. SPECT/CTA fused images were generated. RESULTS In total, 687 segments including bypass graft in 164 coronary arteries were analyzed. Myocardial ischemia on MPI was observed in 11 patients among 28 with CTA abnormalities, one had both ischemia and infarction, and 7 had only infarction. Segment-based analysis showed that ischemia was found in 14 segments (24%) among 59 stenoses on CTA. Forty stenotic segments (69%) were not associated with perfusion abnormality. The rest 5 stenotic segments were considered equivocal (8%). A fusion image made it possible to associate perfusion defects with its corresponding coronary artery in 4 out of 5 equivocal lesions on side-by-side analysis. Patients with incremental diagnostic information on SPECT/CTA fusion (n = 4) had significant smaller coronary diameter than that of not-improved coronary vessels (2.0 +/- 0.4 vs. 3.9 +/- 0.4 mm, p = 0.001). CONCLUSION Cardiac fusion imaging accurately diagnosed functionally relevant coronary stenosis. SPECT/CTA fusion images in coronary artery disease may provide added diagnostic information on functional relevance of coronary artery disease.
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Affiliation(s)
- Shinro Matsuo
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa 920-8641, Japan.
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25
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Kaufmann PA, Gaemperli O. Combining CT and nuclear: a winning hybrid team. J Nucl Cardiol 2009; 16:170-2. [PMID: 19127395 DOI: 10.1007/s12350-008-9048-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 12/11/2008] [Indexed: 10/21/2022]
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Integrated assessment of coronary anatomy and myocardial perfusion using a retractable SPECT camera combined with 64-slice CT: initial experience. Eur Radiol 2008; 19:845-56. [DOI: 10.1007/s00330-008-1214-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 08/22/2008] [Accepted: 09/02/2008] [Indexed: 02/04/2023]
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Petretta M, Costanzo P, Acampa W, Imbriaco M, Ferro A, Filardi PP, Cuocolo A. Noninvasive assessment of coronary anatomy and myocardial perfusion: going toward an integrated imaging approach. J Cardiovasc Med (Hagerstown) 2008; 9:977-86. [PMID: 18799959 DOI: 10.2459/jcm.0b013e328306f311] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Many noninvasive imaging techniques are available for the evaluation of patients with known or suspected chronic coronary artery disease. Among these, computed tomography-based techniques allow the quantification of coronary atherosclerotic calcium and noninvasive imaging of coronary arteries, whereas nuclear cardiology is the most widely used noninvasive approach for the assessment of myocardial perfusion. The available single-photon emission computed tomography flow agents are characterized by a cardiac uptake proportional to myocardial blood flow. In addition, different positron emission tomography tracers may be used for the quantitative measurement of myocardial blood flow and coronary flow reserve. Extensive research is currently being performed in the development of noninvasive coronary angiography and myocardial perfusion imaging using cardiac magnetic resonance. Finally, new multimodality imaging systems have been recently developed, bringing together anatomical and functional information. This review sought to provide a description of the relative merits of noninvasive imaging techniques in the assessment of coronary anatomy and myocardial perfusion in patients with known or suspected coronary artery disease.
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Affiliation(s)
- Mario Petretta
- Department of Clinical Medicine, Cardiovascular and Immunological Sciences, University Federico II, Italy
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28
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Gaemperli O, Schepis T, Kalff V, Namdar M, Valenta I, Stefani L, Desbiolles L, Leschka S, Husmann L, Alkadhi H, Kaufmann PA. Validation of a new cardiac image fusion software for three-dimensional integration of myocardial perfusion SPECT and stand-alone 64-slice CT angiography. Eur J Nucl Med Mol Imaging 2007; 34:1097-106. [PMID: 17245532 DOI: 10.1007/s00259-006-0342-9] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 11/17/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE Combining the functional information of SPECT myocardial perfusion imaging (SPECT-MPI) and the morphological information of coronary CT angiography (CTA) may allow easier evaluation of the spatial relationship between coronary stenoses and perfusion defects. The aim of the present study was the validation of a novel software solution for three-dimensional (3D) image fusion of SPECT-MPI and CTA. METHODS SPECT-MPI with adenosine stress/rest 99mTc-tetrofosmin was fused with 64-slice CTA in 15 consecutive patients with a single perfusion defect and a single significant coronary artery stenosis (>or=50% diameter stenosis). 3D fused SPECT/CT images were analysed by two independent observers with regard to superposition of the stenosed vessel onto the myocardial perfusion defect. Interobserver variability was assessed by recording the X, Y, Z coordinates for the origin of the stenosed coronary artery and the centre of the perfusion defect and measuring the distance between the two landmarks. RESULTS SPECT-MPI revealed a fixed defect in seven patients, a reversible defect in five patients and a mixed defect in three patients and CTA documented a significant stenosis in the respective subtending coronary artery. 3D fused SPECT/CT images showed a match of coronary lesion and perfusion defect in each patient and the fusion process took less than 15 min. Interobserver variability was excellent for landmark detection (r = 1.00 and r = 0.99, p < 0.0001) and very good for the 3D distance between the two landmarks (r = 0.94, p < 0.001). CONCLUSION 3D SPECT/CT image fusion is feasible, reproducible and allows correct superposition of SPECT segments onto cardiac CT anatomy.
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Affiliation(s)
- Oliver Gaemperli
- Nuclear Cardiology, Cardiovascular Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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Comprehensive Cardiovascular Image Analysis Using MR and CT at Siemens Corporate Research. Int J Comput Vis 2006. [DOI: 10.1007/s11263-006-7937-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sprague K, Drangova M, Lehmann G, Slomka P, Levin D, Chow B, deKemp R. Coronary x-ray angiographic reconstruction and image orientation. Med Phys 2006; 33:707-18. [PMID: 16878574 DOI: 10.1118/1.2143352] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We have developed an interactive geometric method for 3D reconstruction of the coronary arteries using multiple single-plane angiographic views with arbitrary orientations. Epipolar planes and epipolar lines are employed to trace corresponding vessel segments on these views. These points are utilized to reconstruct 3D vessel centerlines. The accuracy of the reconstruction is assessed using: (1) near-intersection distances of the rays that connect x-ray sources with projected points, (2) distances between traced and projected centerlines. These same two measures enter into a fitness function for a genetic search algorithm (GA) employed to orient the angiographic image planes automatically in 3D avoiding local minima in the search for optimized parameters. Furthermore, the GA utilizes traced vessel shapes (as opposed to isolated anchor points) to assist the optimization process. Differences between two-view and multiview reconstructions are evaluated. Vessel radii are measured and used to render the coronary tree in 3D as a surface. Reconstruction fidelity is demonstrated via (1) virtual phantom, (2) real phantom, and (3) patient data sets, the latter two of which utilize the GA. These simulated and measured angiograms illustrate that the vessel center-lines are reconstructed in 3D with accuracy below 1 mm. The reconstruction method is thus accurate compared to typical vessel dimensions of 1-3 mm. The methods presented should enable a combined interpretation of the severity of coronary artery stenoses and the hemodynamic impact on myocardial perfusion in patients with coronary artery disease.
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Affiliation(s)
- Kevin Sprague
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Nakaura T, Utsunomiya D, Shiraishi S, Tomiguchi S, Honda T, Ogawa H, Awai K, Yamashita Y. Three-Dimensional Cardiac Image Fusion Using New CT Angiography and SPECT Methods. AJR Am J Roentgenol 2005; 185:1554-7. [PMID: 16304012 DOI: 10.2214/ajr.04.1401] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to develop a method of fused images of coronary CT angiography and myocardial perfusion SPECT. CONCLUSION Four patients with ischemic heart disease underwent 3D volume-rendering fused images using a conversion program and volume-rendering fusion function of a computer workstation. The fusion images clearly showed the relationship of relevant coronary arteries and the abnormal perfusion territory in all patients and were useful for the evaluation of coronary artery disease.
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Affiliation(s)
- Takeshi Nakaura
- Department of Radiology, Kumamoto University School of Medicine, 1-1-1, Honjo, Kumamoto, Kumamoto 860-8556, Japan
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Nakajo H, Kumita SI, Cho K, Kumazaki T. Three-dimensional registration of myocardial perfusion SPECT and CT coronary angiography. Ann Nucl Med 2005; 19:207-15. [PMID: 15981674 DOI: 10.1007/bf02984607] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In this study, we describe a new technique for three-dimensional registration of CT coronary angiography (CTCA) and gated myocardial perfusion SPECT. METHODS Twelve patients with known or suspected CAD who underwent CTCA and gated SPECT were enrolled retrospectively. Coronary arteries and their branches were traced using CTCA data manually and reconstructed in three-dimensions. Gated SPECT data were registered and mapped to a left ventricle binary model extracted from CTCA data using manual, rigid and nonrigid registration methods. RESULTS Three-dimensional reconstruction and volume visualization of both modalities were successfully achieved for all patients. All 3 registration methods gave better quality based on visual inspection, and nonrigid registration gave significantly better results than the other registration methods (p < 0.05). The cost function for three-dimensional registration using nonrigid registration (235.3 +/- 13.9) was significantly better than those of manual and rigid registration (218.5 +/- 15.3 and 223.7 +/- 17.0, respectively). Inter-observer reproducibility error was within acceptable limits for all methods, and there were no significant difference among the methods. CONCLUSION This technique of image registration may assist the integration of information from gated SPECT and CTCA, and may have clinical application for the diagnosis of ischemic heart disease.
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Affiliation(s)
- Hidenobu Nakajo
- Department of Radiology, Center for Advanced Medical Technology, Nippon Medical School, Tokyo, Japan
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Swingen C, Seethamraju RT, Jerosch-Herold M. An approach to the three-dimensional display of left ventricular function and viability using MRI. Int J Cardiovasc Imaging 2004; 19:325-36. [PMID: 14598902 DOI: 10.1023/a:1025450211508] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Cardiac MRI was performed in human volunteers to determine the magnitude of the misregistration (MSR) of cardiac landmarks due to variability in the diaphragm position for repeated breath-holds. Seven normal volunteers underwent MR imaging of the left ventricle (LV) to evaluate the magnitude of the endocardial centroid MSR. The MSR for a mid-ventricle short-axis image was 3.01 +/- 1.68 mm through-plane and 4.16 +/- 1.62 mm in-plane. A second order polynomial fit through the LV centroid coordinates minimized the in-plane component of the MSR error. Short-axis cine images, corrected for MSR, provided high-resolution 2D data from which an accurate anatomical model of the LV was generated. Anatomical landmarks were used to register parametric maps of myocardial perfusion and viability to the three-dimensional (3D) model, with the corresponding parameters displayed as color-encoded values on the endo- and epicardial surfaces of the LV. Registration of regional wall motion, perfusion and viability to the 3D model was performed for three patients with a history of cardiovascular disease. The proposed 3D reconstruction technique allows visualization in 3D of the LV anatomy, in combination with parametric mapping of its functional status.
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Affiliation(s)
- Cory Swingen
- Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA
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Sturm B, Powell KA, Stillman AE, White RD. Registration of 3D CT angiography and cardiac MR images in coronary artery disease patients. Int J Cardiovasc Imaging 2003; 19:281-93. [PMID: 14598896 DOI: 10.1023/a:1025481929472] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A method for the registration of 3D cardiac CT angiography (CTA) and magnetic resonance (MR) data sets based on their myocardial epicardial surfaces is introduced. The approach relies on temporally registered data sets obtained based on the electrocardiogram recorded during the CTA acquisition and the timing characteristics of the MR acquisition. The myocardial epicardial surfaces were identified in the reformatted CTA and MR data sets using a 3D semi-automated segmentation algorithm. This algorithm was implemented, evaluated on clinical data, and compared to a set of manual outlines during the course of this study. The registration of the CTA and MR data sets was based on the iterative closest point algorithm, which minimizes the distance between the surfaces defined by the epicardial outlines in each data set. The proposed technique was applied to data obtained from 11 patients with coronary artery disease. The CTA data was reformatted based on the registration results and the location of the MR imaging planes. The resulting CTA-MR image pairs were evaluated qualitatively by two experts, who graded the majority of the cases as either excellent or acceptable (11 of 11 cases for one reader, and 9 of 11 for the other). The results were evaluated quantitatively based on the distance between the registered epicardial surfaces. The quantitative measures indicated that the registered surfaces were within two pixels of one another (on average). The registration results were used to generate combined 3D renderings of information extracted from both data sets for visualization purposes.
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Affiliation(s)
- Bernhard Sturm
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH 44195, USA
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Schindler TH, Nitzsche E, Magosaki N, Brink I, Mix M, Olschewski M, Solzbach U, Just H. Regional myocardial perfusion defects during exercise, as assessed by three dimensional integration of morphology and function, in relation to abnormal endothelium dependent vasoreactivity of the coronary microcirculation. Heart 2003; 89:517-26. [PMID: 12695456 PMCID: PMC1767646 DOI: 10.1136/heart.89.5.517] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2002] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To test the hypothesis that scintigraphic regional myocardial perfusion defects during exercise in patients with normal coronary angiography may be related to abnormal endothelium dependent vasoreactivity of the corresponding myocardial territory in response to cold pressor testing. METHODS 38 patients were classified into two groups according to the presence or absence of exercise induced scintigraphic myocardial perfusion defects. A cold pressor test was done in all patients during routine coronary angiography, followed by dynamic positron emission tomography to establish coronary blood flow mediated vasoreactivity of the epicardial coronary artery and the myocardial territories supplied by the left anterior descending, left circumflex, and right coronary arteries. RESULTS 28 patients had regional myocardial perfusion defects while 10 had normal scintigraphic imaging. The three dimensional scintigraphic fusion image revealed 49 regional myocardial perfusion defects with a mean (SD) reversibility of the original stress defect of 20 (3)%. In patients with exercise induced regional myocardial perfusion defects, the responses of epicardial luminal area and regional myocardial blood flow (RMBF) to cold pressor testing were reduced compared with patients with normal perfusion imaging (epicardial luminal area: 5.2 (1.2) to 4.2 (0.86) mm2 v 4.7 (0.5) to 5.8 (0.5) mm2; RMBF: 0.75 (0.16) to 0.78 (0.20) ml/g/min v 0.75 (0.15) to 1.38 (0.26) ml/g/min; p < or = 0.03, respectively). In patients with regional abnormal scintigraphic perfusion, the corresponding RMBF response to cold pressor testing was more severely impaired than the mean myocardial blood flow in the remaining two vascular territories, but the difference was not significant (0.75 (0.16) to 0.78 (0.20) ml/g/min v 0.75 (0.10) to 0.87 (0.12) ml/g/min; NS). The endothelium independent increase in RMBF induced by glyceryl trinitrate did not differ between patients with exercise induced myocardial perfusion defects and those with normal perfusion images (0.75 (0.16) to 0.94 (0.09) ml/g/min v 0.75 (0.15) to 0.94 (0.09) ml/g/min; NS). There was a highly significant correlation between the endothelium dependent responses of RMBF to cold pressor testing and the severity of exercise induced scintigraphic regional myocardial perfusion defects (r = 0.95, p = 0.001). CONCLUSIONS Exercise induced scintigraphic regional myocardial perfusion defects in patients with angina but normal coronary angiography may be related to abnormal endothelium dependent vasoreactivity of the corresponding myocardial territory.
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Affiliation(s)
- T H Schindler
- Zentrum für Klinische Forschung II, Albert-Ludwig-Universität Freiburg, Germany
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Garcia EV, Faber TL, Galt JR, Cooke CD, Folks RD. Advances in nuclear emission PET and SPECT imaging. IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE : THE QUARTERLY MAGAZINE OF THE ENGINEERING IN MEDICINE & BIOLOGY SOCIETY 2000; 19:21-33. [PMID: 11016027 DOI: 10.1109/51.870228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
MESH Headings
- Artificial Intelligence
- Brain Neoplasms/diagnostic imaging
- Heart Diseases/diagnostic imaging
- Humans
- Image Processing, Computer-Assisted/methods
- Tomography, Emission-Computed/economics
- Tomography, Emission-Computed/instrumentation
- Tomography, Emission-Computed/trends
- Tomography, Emission-Computed, Single-Photon/economics
- Tomography, Emission-Computed, Single-Photon/instrumentation
- Tomography, Emission-Computed, Single-Photon/trends
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Affiliation(s)
- E V Garcia
- Emory University Hospital, Emory Center for PET, Atlanta, GA 30322, USA.
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