Quantitative analysis of myocardial perfusion SPECT anatomically guided by coregistered 64-slice coronary CT angiography.
Sequential testing by coronary CT angiography (CTA) and myocardial perfusion SPECT (MPS) obtained on stand-alone scanners may be needed to diagnose coronary artery disease in equivocal cases. We have developed an automated technique for MPS-CTA registration and demonstrate its utility for improved MPS quantification by guiding the coregistered physiologic (MPS) with anatomic CTA information.


METHODS
Automated registration of MPS left ventricular (LV) surfaces with CTA coronary trees was accomplished by iterative minimization of voxel differences between presegmented CTA volumes and motion-frozen MPS data. Studies of 35 sequential patients (26 men; mean age, 67 +/- 12 y) with 64-slice coronary CTA, MPS, and available results of the invasive coronary angiography performed within 3 mo were retrospectively analyzed. Three-dimensional coronary vessels and CTA slices were extracted and fused with quantitative MPS results mapped on LV surfaces and MPS coronary regions. Automatically coregistered CTA images and extracted trees were used to correct the MPS contours and to adjust the standard vascular region definitions for MPS quantification.


RESULTS
Automated coregistration of MPS and coronary CTA had the success rate of 96% as assessed visually; the average errors were 4.3 +/- 3.3 mm in translation and 1.5 +/- 2.6 degrees in rotation on stress and 4.2 +/- 3.1 mm in translation and 1.7 +/- 3.2 degrees in rotation on rest. MPS vascular region definition was adjusted in 17 studies, and LV contours were adjusted in 11 studies using coregistered CTA images as a guide. CTA-guided myocardial perfusion analysis, compared with standard MPS analysis, resulted in improved area under the receiver-operating-characteristic (ROC) curves for the detection of right coronary artery (RCA) and left circumflex artery (LCX) lesions (0.84 +/- 0.08 vs. 0.70 +/- 0.11 for LCX, P = 0.03, and 0.92 +/- 0.05 vs. 0.75 +/- 0.09 for RCA, P = 0.02).


CONCLUSIONS
Software image coregistration of stand-alone coronary CTA and MPS obtained on separate scanners can be performed rapidly and automatically, allowing CTA-guided contour and vascular territory adjustment on MPS for improved quantitative MPS analysis.
Slomka
Piotr J
PJ
Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Cheng
Victor Y
VY
Dey
Damini
D
Woo
Jonghye
J
Ramesh
Amit
A
Van Kriekinge
Serge
S
Suzuki
Yasuzuki
Y
Elad
Yaron
Y
Karlsberg
Ronald
R
Berman
Daniel S
DS
Germano
Guido
G
D000368:Aged; D000465:Algorithms; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*