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Validation of a new cardiac image fusion software for three-dimensional integration of myocardial perfusion SPECT and stand-alone 64-slice CT angiography

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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 (≥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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References

  1. Leschka S, Alkadhi H, Plass A, Desbiolles L, Grunenfelder J, Marincek B, et al. Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur Heart J 2005;26:1482–7.

    Article  PubMed  Google Scholar 

  2. Topol EJ, Nissen SE. Our preoccupation with coronary luminology. The dissociation between clinical and angiographic findings in ischemic heart disease. Circulation 1995;92:2333–42.

    PubMed  CAS  Google Scholar 

  3. Namdar M, Hany TF, Koepfli P, Siegrist PT, Burger C, Wyss CA, et al. Integrated PET/CT for the assessment of coronary artery disease: a feasibility study. J Nucl Med 2005;46:930–5.

    PubMed  Google Scholar 

  4. Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). Circulation 2003;108:1404–18.

    Article  PubMed  Google Scholar 

  5. Silber S, Albertsson P, Aviles FF, Camici PG, Colombo A, Hamm C, et al. Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur Heart J 2005;26:804–47.

    Article  PubMed  Google Scholar 

  6. Smith SC Jr, Feldman TE, Hirshfeld JW Jr, Jacobs AK, Kern MJ, King SB 3rd, et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update 2001 Guidelines for Percutaneous Coronary Intervention). Circulation 2006;113:e166–e286.

    Article  PubMed  Google Scholar 

  7. Bax JJ, Beanlands RS, Klocke FJ, Knuuti J, Lammertsma AA, Schaefers MA, et al. Diagnostic and clinical perspectives of fusion imaging in cardiology: is the total greater than the sum of its parts? Heart 2007;93:16–22.

    Article  PubMed  CAS  Google Scholar 

  8. Schindler TH, Magosaki N, Jeserich M, Oser U, Krause T, Fischer R, et al. Fusion imaging: combined visualization of 3D reconstructed coronary artery tree and 3D myocardial scintigraphic image in coronary artery disease. Int J Card Imaging 1999;15:357–68; discussion 69–70.

    Article  PubMed  CAS  Google Scholar 

  9. Schindler TH, Magosaki N, Jeserich M, Nitzsche E, Oser U, Abdollahnia T, et al. 3D assessment of myocardial perfusion parameter combined with 3D reconstructed coronary artery tree from digital coronary angiograms. Int J Card Imaging 2000;16:1–12.

    Article  PubMed  CAS  Google Scholar 

  10. Faber TL, Santana CA, Garcia EV, Candell-Riera J, Folks RD, Peifer JW, et al. Three-dimensional fusion of coronary arteries with myocardial perfusion distributions: clinical validation. J Nucl Med 2004;45:745–53.

    PubMed  Google Scholar 

  11. Nakaura T, Utsunomiya D, Shiraishi S, Tomiguchi S, Honda T, Ogawa H, et al. Three-dimensional cardiac image fusion using new CT angiography and SPECT methods. AJR Am J Roentgenol 2005;185:1554–7.

    Article  PubMed  Google Scholar 

  12. Gaemperli O, Schepis T, Kaufmann PA. SPECT-CT fusion imaging integrating anatomy and perfusion. Eur Heart J 2006;Jun 7:[Epub ahead of print].

  13. Cerqueira MD, Verani MS, Schwaiger M, Heo J, Iskandrian AS. Safety profile of adenosine stress perfusion imaging: results from the Adenoscan Multicenter Trial Registry. J Am Coll Cardiol 1994;23:384–9.

    Article  PubMed  CAS  Google Scholar 

  14. Koepfli P, Hany TF, Wyss CA, Namdar M, Burger C, Konstantinidis AV, et al. CT attenuation correction for myocardial perfusion quantification using a PET/CT hybrid scanner. J Nucl Med 2004;45:537–42.

    PubMed  Google Scholar 

  15. Fricke H, Fricke E, Weise R, Kammeier A, Lindner O, Burchert W. A method to remove artifacts in attenuation-corrected myocardial perfusion SPECT introduced by misalignment between emission scan and CT-derived attenuation maps. J Nucl Med 2004;45:1619–25.

    PubMed  Google Scholar 

  16. Germano G, Kavanagh PB, Waechter P, Areeda J, Van Kriekinge S, Sharir T, et al. A new algorithm for the quantitation of myocardial perfusion SPECT. I: Technical principles and reproducibility. J Nucl Med 2000;41:712–9.

    PubMed  CAS  Google Scholar 

  17. Klein JL, Garcia EV, DePuey EG, Campbell J, Taylor AT, Pettigrew RI, et al. Reversibility bull’s-eye: a new polar bull’s-eye map to quantify reversibility of stress-induced SPECT thallium-201 myocardial perfusion defects. J Nucl Med 1990;31:1240–6.

    PubMed  CAS  Google Scholar 

  18. Hoffmann MH, Shi H, Manzke R, Schmid FT, De Vries L, Grass M, et al. Noninvasive coronary angiography with 16-detector row CT: effect of heart rate. Radiology 2005;234:86–97.

    Article  PubMed  Google Scholar 

  19. Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 1975;51:5–40.

    PubMed  CAS  Google Scholar 

  20. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539–42.

    Article  PubMed  Google Scholar 

  21. Fishman EK, Ney DR, Heath DG, Corl FM, Horton KM, Johnson PT. Volume rendering versus maximum intensity projection in CT angiography: what works best, when, and why. Radiographics 2006;26:905–22.

    Article  PubMed  Google Scholar 

  22. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1:307–10.

    PubMed  CAS  Google Scholar 

  23. White CW, Wright CB, Doty DB, Hiratza LF, Eastham CL, Harrison DG, et al. Does visual interpretation of the coronary arteriogram predict the physiologic importance of a coronary stenosis? N Engl J Med 1984;310:819–24.

    Article  PubMed  CAS  Google Scholar 

  24. Garcia MJ, Lessick J, Hoffmann MH. Accuracy of 16-row multidetector computed tomography for the assessment of coronary artery stenosis. Jama 2006;296:403–11.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

This study was supported by a grant from the Swiss National Science Foundation (SNSF-professorship grant No. PP00A-68835) and by a grant of the National Center of Competence in Research, Computer Aided and Image Guided Medical Interventions (NCCR CO-ME) of the Swiss National Science Foundation. Victor Kalff’s sabbatical leave was financially supported by the Alfred Hospital and its Whole Time Medical Specialists Fund, Melbourne, Australia.

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Correspondence to Philipp A. Kaufmann.

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Gaemperli, O., Schepis, T., Kalff, V. et al. 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 34, 1097–1106 (2007). https://doi.org/10.1007/s00259-006-0342-9

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  • DOI: https://doi.org/10.1007/s00259-006-0342-9

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