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

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

Correspondence: For correspondence or reprints contact: Philipp A. Kaufmann, MD, Nuclear Cardiology, Cardiovascular Center, University Hospital Zurich, NUK C 32, Raemistrasse 100, CH-8091 Zurich, Switzerland. E-mail: pak{at}usz.ch

Myocardial perfusion imaging with SPECT (SPECT-MPI) and 64-slice CT angiography (CTA) are both established techniques for the noninvasive evaluation of coronary artery disease (CAD). Three-dimensional (3D) SPECT/CT image fusion may offer an incremental diagnostic value by integrating both sets of information. We report our first clinical experiences with fused 3D SPECT/CT in CAD patients. Methods: Thirty-eight consecutive patients with at least 1 perfusion defect on SPECT-MPI (1-d adenosine stress/rest SPECT with ^99mTc-tetrofosmin) and 64-slice CTA were included. 3D volume-rendered fused SPECT/CT images were generated and compared with the findings from the side-by-side analysis with regard to coronary lesion interpretation by assigning the perfusion defects to their corresponding coronary lesion. Results: The fused SPECT/CT images added information on pathophysiologic lesion severity in 27 coronary stenoses (22%) of 12 patients (29%) (P < 0.001). Among 40 equivocal lesions on side-by-side analysis, the fused interpretation confirmed hemodynamic significance in 14 lesions and excluded functional relevance in 10 lesions. In 3 lesions, assignment of perfusion defect and coronary lesion appeared to be reliable on side-by-side analysis but proved to be inaccurate on fused interpretation. Added diagnostic information by SPECT/CT was more commonly found in patients with stenoses of small vessels (P = 0.004) and involvement of diagonal branches (P = 0.01). Conclusion: In addition to being intuitively convincing, 3D SPECT/CT fusion images in CAD may provide added diagnostic information on the functional relevance of coronary artery lesions.

Key Words: myocardial perfusion imaging • SPECT • coronary CT angiography • SPECT/CT fusion • coronary artery disease

COPYRIGHT © 2007 by the Society of Nuclear Medicine, Inc.

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