title: Three-dimensional fusion of coronary arteries with myocardial perfusion distributions: clinical validation.
abstract: Clinical decisions regarding diagnosis and effective treatment of coronary artery disease frequently require integration of information from various imaging modalities, which are acquired, processed, and read at different physical locations and times. We have developed methods to integrate the information in 2 cardiac imaging studies, perfusion SPECT and coronary angiography. Three-dimensional (3D) models of the coronary artery tree created from biplane angiograms were automatically aligned with 3D models of the left ventricular epicardial surface created from perfusion SPECT. Myocardial mass at risk was used as a unique measure to validate the accuracy of the unification.
  
  
  METHODS
  Thirty patients were injected with the perfusion agent (99m)Tc-tetrosfosmin during balloon occlusion while undergoing percutaneous transluminal coronary angioplasty for single-vessel coronary artery disease. Thus, a single, severe perfusion defect was induced by a single coronary artery occlusion of known severity and placement. The accuracy of the unification was measured by computing the overlap between physiologic area at risk, determined using SPECT perfusion quantification techniques only, and anatomic area at risk, determined using coronary artery anatomy aligned with the epicardial surface of the left ventricle.
  
  
  RESULTS
  The unification resulted in an 80% overlap of areas at risk, and an overlap of 84% of normal areas, for all coronary artery distributions. The mass at risk measured based on the unified anatomic information correlated with the physiologically based mass at risk as y = 0.92x + 10.3 g; r = 0.76, SEE = 10.4 g.
  
  
  CONCLUSIONS
  A unification algorithm for automatically registering 3D models of the epicardial surface from perfusion SPECT and 3D coronary artery trees from coronary angiography has been presented and validated in 30 patient studies.
authors.affiliation: Department of Radiology, Emory University, Atlanta, Georgia 30322, USA. Tracy_Faber@emoryhealthcare.org
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Faber
authors.forename: Cesar A
authors.initials: CA
authors.lastname: Santana
authors.forename: Ernest V
authors.initials: EV
authors.lastname: Garcia
authors.forename: Jaume
authors.initials: J
authors.lastname: Candell-Riera
authors.forename: Russell D
authors.initials: RD
authors.lastname: Folks
authors.forename: John W
authors.initials: JW
authors.lastname: Peifer
authors.forename: Andrew
authors.initials: A
authors.lastname: Hopper
authors.forename: Santiago
authors.initials: S
authors.lastname: Aguade
authors.forename: Joan
authors.initials: J
authors.lastname: Angel
authors.forename: J Larry
authors.initials: JL
authors.lastname: Klein
mesh_terms: D000465:Algorithms; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis*; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin