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Research ArticleClinical Investigations

Additional Diagnostic Value of Integrated Analysis of Cardiac CTA and SPECT MPI Using the SMARTVis System in Patients with Suspected Coronary Artery Disease

Hortense A. Kirişli, Vikas Gupta, Rahil Shahzad, Imad Al Younis, Anoeshka Dharampal, Robert-Jan van Geuns, Arthur J. Scholte, Michiel A. de Graaf, Raoul M.S. Joemai, Koen Nieman, Lucas van Vliet, Theo van Walsum, Boudewijn Lelieveldt and Wiro J. Niessen
Journal of Nuclear Medicine January 2014, 55 (1) 50-57; DOI: https://doi.org/10.2967/jnumed.113.119842
Hortense A. Kirişli
1Department of Medical Informatics, Biomedical Imaging Group Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands
2Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
3Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Vikas Gupta
2Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
4Department of Intelligent Systems, Faculty of EEMCS, Delft University of Technology, Delft, The Netherlands
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Rahil Shahzad
1Department of Medical Informatics, Biomedical Imaging Group Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands
3Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
5Quantitative Imaging Group, Imaging Science and Technology, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
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Imad Al Younis
6Department of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Anoeshka Dharampal
3Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
7Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Robert-Jan van Geuns
7Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Arthur J. Scholte
8Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Michiel A. de Graaf
8Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
9Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands; and
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Raoul M.S. Joemai
10Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Koen Nieman
3Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
7Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Lucas van Vliet
5Quantitative Imaging Group, Imaging Science and Technology, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
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Theo van Walsum
1Department of Medical Informatics, Biomedical Imaging Group Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands
3Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Boudewijn Lelieveldt
2Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
4Department of Intelligent Systems, Faculty of EEMCS, Delft University of Technology, Delft, The Netherlands
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Wiro J. Niessen
1Department of Medical Informatics, Biomedical Imaging Group Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands
3Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
5Quantitative Imaging Group, Imaging Science and Technology, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
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Abstract

CT angiography (CTA) and SPECT myocardial perfusion imaging (MPI) are complementary imaging techniques to assess coronary artery disease (CAD). Spatial integration and combined visualization of SPECT MPI and CTA data may facilitate correlation of myocardial perfusion defects and subtending coronary arteries and thus offer additional diagnostic value over either stand-alone or side-by-side interpretation of the respective datasets from the 2 modalities. In this study, we investigated the additional diagnostic value of a software-based CTA/SPECT MPI image fusion system over conventional side-by-side analysis in patients with suspected CAD. Methods: Seventeen symptomatic patients who underwent both CTA and SPECT MPI within a 90-d period were included in our study; 7 of them also underwent invasive coronary angiography (ICA). The potential benefits of the synchronized multimodal heart visualization (SMARTVis) system in assessing CAD were investigated through a case study involving 4 experts from 2 medical centers, in which we performed, first, a side-by-side analysis using structured CTA and SPECT reports and, second, an integrated analysis using the SMARTVis system in addition to the reports. Results: The fused interpretation led to a more accurate diagnosis, reflected in an increase in the individual observers’ sensitivity and specificity to correctly refer for invasive angiography eventually followed by revascularization. For the first, second, third, and fourth observers, the respective sensitivities improved from 50%, 60%, 80%, and 80% to 70%, 80%, 100%, and 90% and the respective specificities from 100%, 94%, 83%, and 83% to 100%, 100%, 94%, and 83%. Additionally, the interobserver diagnosis agreement increased from 74% to 84%. The improvement was primarily found in patients presenting with CAD in more vessels than the number of reported perfusion defects. Conclusion: Integrated analysis of cardiac CTA and SPECT MPI using the SMARTVis system results in an improved diagnostic performance.

  • coronary artery disease (CAD)
  • computed tomography angiography (CTA)
  • single-photon emission computed tomography myocardial perfusion imaging (SPECT/MPI)
  • SPECT/CTA fusion
  • diagnostic and prognostic application

Footnotes

  • ↵* Contributed equally to this work.

  • Published online Dec. 12, 2013.

  • © 2014 by the Society of Nuclear Medicine and Molecular Imaging, Inc.
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Journal of Nuclear Medicine: 55 (1)
Journal of Nuclear Medicine
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January 1, 2014
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Additional Diagnostic Value of Integrated Analysis of Cardiac CTA and SPECT MPI Using the SMARTVis System in Patients with Suspected Coronary Artery Disease
Hortense A. Kirişli, Vikas Gupta, Rahil Shahzad, Imad Al Younis, Anoeshka Dharampal, Robert-Jan van Geuns, Arthur J. Scholte, Michiel A. de Graaf, Raoul M.S. Joemai, Koen Nieman, Lucas van Vliet, Theo van Walsum, Boudewijn Lelieveldt, Wiro J. Niessen
Journal of Nuclear Medicine Jan 2014, 55 (1) 50-57; DOI: 10.2967/jnumed.113.119842

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Additional Diagnostic Value of Integrated Analysis of Cardiac CTA and SPECT MPI Using the SMARTVis System in Patients with Suspected Coronary Artery Disease
Hortense A. Kirişli, Vikas Gupta, Rahil Shahzad, Imad Al Younis, Anoeshka Dharampal, Robert-Jan van Geuns, Arthur J. Scholte, Michiel A. de Graaf, Raoul M.S. Joemai, Koen Nieman, Lucas van Vliet, Theo van Walsum, Boudewijn Lelieveldt, Wiro J. Niessen
Journal of Nuclear Medicine Jan 2014, 55 (1) 50-57; DOI: 10.2967/jnumed.113.119842
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Keywords

  • coronary artery disease (CAD)
  • computed tomography angiography (CTA)
  • single-photon emission computed tomography myocardial perfusion imaging (SPECT/MPI)
  • SPECT/CTA fusion
  • diagnostic and prognostic application
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