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Superimposed Display of Coronary Artery on Gated Myocardial Perfusion Scintigraphy

¹ Department of Radiology, National Cardiovascular Center, Suita, Osaka, Japan
² Division of Medical Technology and Science, Department of Medical Physics and Engineering, Course of Health Science, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan

View larger version (22K): [in a new window]   FIGURE 1. Basic flow chart of image fusion between coronary angiography and gated MPI.

View larger version (49K): [in a new window]   FIGURE 2. Principles of MPI reorientation. To obtain the same oblique angle as in biplane coronary angiography (A), we changed the conventional setting of the long axis of the left ventricle for reorientation (B) to a new setting for the long axis that was consistent with both LAO-60° and RAO-30° views (C).

View larger version (53K): [in a new window]   FIGURE 3. Results of phantom studies confirming the accuracy of reorienting the long axis of the left ventricle for image registration (top: RAO-30°; bottom: LAO-60°). (A and B) QGS 3D surface maps with inner and outer cardiac walls generated by the conventional method (A) and after reorientation (B). (C) Reoriented 3D surface maps were superimposed on radiographic images at RAO-30° and LAO-60° views. (D) Changing the surface display allowed the colored 3D map to reflect the relative count distribution with the fused radiographic image.

View larger version (120K): [in a new window]   FIGURE 4. Superimposed displays of a coronary angiogram and an exercise 3D surface map obtained from a 15-y-old girl with Kawasaki disease. An aneurysmal dilatation with distal stenosis (90% narrowing) was located in the proximal portion of the left anterior descending artery on coronary angiography. MPI showed anteroapical hypoperfusion during exercise. The perfusion abnormality was obviously distributed in the distal territory of the left descending coronary artery (A) and not in the diagonal branch territory (B). Meanwhile, the anterior LAO-60° view (C) and superimposition of the right coronary artery on the septal view of MPI (D) are also available with our technique.

View larger version (67K): [in a new window]   FIGURE 5. Superimposed displays of images from left coronary angiography and MPI at exercise (A) and rest (B) from a 57-y-old man with chest pain. The unified images show exercise-induced ischemia in the anteroapical myocardium in geometric correspondence with the diseased left anterior descending artery (arrow).

View larger version (114K): [in a new window]   FIGURE 6. Superimposed displays of a coronary angiogram and an exercise 3D surface map obtained from an 11-y-old girl with Kawasaki disease. (A) The unified image depicts apical and inferior hypoperfusion and a coronary aneurysm (arrow) with distal stenosis in the left anterior descending artery. The right coronary artery (arrowheads) was filled by collateral vessels through the septal branch because the proximal portion of the right coronary artery was occluded. (B) After bypass surgery, the nongated unified image shows homogeneous left ventricular perfusion with patency of the left internal mammary artery bypass graft at exercise. (C and D) ECG-gated unified images at end-diastole (C) and end-systole (D) show normal regional wall motion and count increase in the left ventricular wall.