title: 3D fusion of functional cardiac magnetic resonance imaging and computed tomography coronary angiography: accuracy and added clinical value.
abstract: OBJECTIVE
  To evaluate the accuracy and added diagnostic value of 3-dimensional (3D) image fusion of computed tomography coronary angiography (CTCA) and functional cardiac magnetic resonance (CMR) for assessing hemodynamically relevant coronary artery disease (CAD).
  
  
  METHODS
  Twenty-seven patients with significant coronary stenoses on prospectively electrocardiography-gated dual-source CTCA, confirmed by catheter angiography and perfusion defects on CMR at 1.5 T were included. Surface representations and volume-rendered images from 3D-fused CTCA/CMR data were generated using a software prototype. Fusion accuracy was evaluated by calculating surface distances of blood pools and Dice similarity coefficients. Two independent, blinded readers assigned myocardial defects to culprit coronary arteries with side-by side analysis of CTCA and CMR and using fused CTCA/CMR. Added value of fused CTCA/CMR was defined as change in assignment of culprit coronary artery to myocardial defect compared with side-by-side analysis.
  
  
  RESULTS
  3D fusion of CTCA/CMR was feasible and accurate (surface distance of blood pools: 4.1 ± 1.3 mm, range: 2.4-7.1 mm; Dice similarity coefficients: 0.78 ± 0.08, range: 0.51-0.86) in all patients. Side-by-side analysis of CTCA and CMR allowed no assignment of a single culprit artery to a myocardial defect in 6 of 27 (22%) patients. Fused CTCA/CMR allowed further confinement of culprit coronary arteries in 3 of these 6 patients (11%). Myocardial defects were reassigned in 2 of 27 (7%) patients using fused CTCA/CMR, whereas the results remained unchanged in 22 of 27 (81%) patients. Interobserver agreement for assignment of culprit arteries to myocardial defects increased with fused CTCA/CMR (k = 0.66-0.89).
  
  
  CONCLUSIONS
  3D fusion of low-dose CTCA and functional CMR is feasible and accurate, and adds, at a low radiation dose, diagnostic value for the assessment of hemodynamically relevant CAD as compared with side-by-side analysis alone. This technique can be clinically useful for the following: planning of surgical or interventional procedures in patients having a high prevalence of CAD and for improved topographic assignment of coronary stenoses to corresponding myocardial perfusion defects.
authors.affiliation: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland.
authors.forename: Olivio F
authors.initials: OF
authors.lastname: Donati
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
authors.forename: Hans
authors.initials: H
authors.lastname: Scheffel
authors.forename: Caroline
authors.initials: C
authors.lastname: Kuehnel
authors.forename: Anja
authors.initials: A
authors.lastname: Hennemuth
authors.forename: Christophe
authors.initials: C
authors.lastname: Wyss
authors.forename: Naim
authors.initials: N
authors.lastname: Azemaj
authors.forename: André
authors.initials: A
authors.lastname: Plass
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kozerke
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.forename: Sebastian
authors.initials: S
authors.lastname: Leschka
authors.forename: Paul
authors.initials: P
authors.lastname: Stolzmann
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D017023:Coronary Angiography / Q000295:instrumentation / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D023921:Coronary Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*; D014463:Ultrasonography