Coregistered MR imaging myocardial viability maps and multi-detector row CT coronary angiography displays for surgical revascularization planning: initial experience.
OBJECTIVE
To evaluate assignment of left ventricular (LV) myocardial segments to coronary arterial territories by using coregistered magnetic resonance (MR) imaging and multi-detector row computed tomography (CT) displays; to assess the accuracy of coregistered displays in determining the distribution of clinically important coronary artery disease (CAD) and regional effect of CAD on LV myocardium in patients with chronic ischemic heart disease (CIHD); and to determine the utility of coregistered displays in optimizing surgical revascularization planning.


METHODS
This study was HIPAA compliant and was approved by the local Institutional Review Board, with waiver of informed consent. Twenty-six patients (19 men, seven women; age, 56 years +/- 12 [+/- standard deviation]) with CIHD underwent MR imaging assessment of myocardial viability and multi-detector row CT assessment of CAD on the same day. For coregistration, a population-based LV model was fit to each data set separately; models were then registered spatially. For data analysis, correspondence between coregistered displays and the 17-segment LV model for assessment of CIHD was evaluated, accuracy of using coregistered displays to evaluate the extent of CAD and myocardial disease was assessed, and utility of coregistered displays in optimizing surgical revascularization planning was determined.


RESULTS
Coronary assignment for coregistered displays and the 17-segment LV model differed in 17% of myocardial segments. For the majority of patients, three segments (midanterolateral [62%], apical lateral [73%], and apical inferior [58%]) were discordant. Segments were supplied by the left anterior descending artery, a diagonal branch, or a ramus intermedius with diagonal distribution in all but one case. Coregistered displays were deemed concordant with selective coronary angiography and alternate myocardial imaging in all cases. Overall, surgical planning was potentially enhanced in 83% of cases because, compared with alternate imaging modalities, coregistered displays were believed to demonstrate the relationship between coronary arteries and underlying myocardial tissue more definitively and efficiently (for patients in whom surgery was performed) or more correctly and comprehensively (for a presumably better-tailored surgery).


CONCLUSIONS
Assessment of CIHD can be improved by using coregistered displays that directly relate the condition of LV myocardium to the anatomy of the coronary arteries in individual patients.
Setser
Randolph M
RM
Department of Radiology, Section of Cardiovascular Imaging, the Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
O'Donnell
Thomas P
TP
Smedira
Nicholas G
NG
Sabik
Joseph F
JF
Halliburton
Sandra S
SS
Stillman
Arthur E
AE
White
Richard D
RD
D003287:Contrast Media; D017023:Coronary Angiography; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D009204:Myocardial Revascularization; D010347:Patient Care Planning; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D019786:Gadolinium DTPA