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Cardiac Image Fusion from Stand-Alone SPECT and CT: Clinical Experience

Oliver Gaemperli1, Tiziano Schepis1, Ines Valenta1, Lars Husmann2, Hans Scheffel2, Victor Duerst1, Franz R. Eberli1, Thomas F. Luscher1, Hatem Alkadhi2 and Philipp A. Kaufmann1,3

1 Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland; 2 Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland; and 3 Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland


Figure 1
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  		FIGURE 1.  Interpretation of stenosed coronary segments with regard to hemodynamic significance on side-by-side (white columns) or fused (black columns) analysis. *P < 0.001 for comparison of fused vs. side-by-side analysis ({chi}2 test).

 

Figure 2
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  		FIGURE 2.  (A) Stress and rest perfusion polar maps of SPECT-MPI study show mixed basal anterolateral defect and reversible inferoapical perfusion defect (arrowheads). (B and D) Fused SPECT/CT images reveal total occlusion of LAD and subtotal occlusion of first diagonal branch (DA1), which are confirmed by conventional CA (C). Anterolateral perfusion defect is caused by lesion of partially calcified small intermediary branch (IM); however, this vessel is not well visualized by CA.

 

Figure 3
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  		FIGURE 3.  (A) Perfusion polar maps at stress (dobutamine stress) and rest show reversible anteroseptal perfusion defect. (B and C) 64-slice CTA revealed myocardial bridging (MB) of mid LAD of >2-cm length and calcified plaque at origin of first diagonal branch (DA). (D) Fused 3D SPECT/CT images could allocate reversible perfusion defect to DA, whereas MB seemed to be hemodynamically insignificant.

 

Figure 4
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  		FIGURE 4.  (A) Perfusion polar maps of SPECT-MPI at stress and rest show largely reversible anteroapical perfusion defect (arrowhead). (B) 3D volume-rendered CTA images show coronary vessel tree with stenosis of mid LAD and proximal stenosis of first diagonal branch (DA1). (C) Fused 3D SPECT/CT images are able to identify DA1 stenosis as functionally relevant lesions. (D) Findings were confirmed by invasive CA.

 




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