title: 3D fusion of LV venous anatomy on fluoroscopy venograms with epicardial surface on SPECT myocardial perfusion images for guiding CRT LV lead placement.
abstract: OBJECTIVE
  The aim of this study was to develop a 3-dimensional (3D) fusion tool kit to integrate left ventricular (LV) venous anatomy on fluoroscopy venograms with LV epicardial surface on single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for guiding cardiac resynchronization therapy (CRT) LV lead placement.
  
  
  BACKGROUND
  LV lead position is important for CRT response. For LV lead placement into viable regions with late activation, it is important to visualize both LV venous anatomy and myocardium.
  
  
  METHODS
  Major LV veins were manually identified on fluoroscopic venograms and automatically reconstructed into a 3D anatomy. 3D LV epicardial surface was extracted from SPECT MPI. SPECT-vein fusion that consisted of geometric alignment, landmark-based registration, and vessel-surface overlay was developed to fuse the 3D venous anatomy with the epicardial surface. The accuracy of this tool was evaluated using computed tomography (CT) venograms. LV epicardial surfaces and veins were manually identified on the CT images and registered with the SPECT image by an independent operator. The locations of the fluoroscopic and CT veins on the SPECT epicardial surfaces were compared using absolute distances on SPECT short-axis slice and the 17-segment model.
  
  
  RESULTS
  Ten CRT patients were enrolled. The distance between the corresponding fluoroscopic and CT veins on the short-axis epicardial surfaces was 4.6 ± 3.6 mm (range 0 to 16.9 mm). The presence of the corresponding fluoroscopic and CT veins in the 17-segment model agreed well with a kappa value of 0.87 (95% confidence interval: 0.82 to 0.93). The tool kit was used to guide LV lead placement in a catheter laboratory and showed clinical feasibility and benefit to the patient.
  
  
  CONCLUSIONS
  A tool kit has been developed to reconstruct 3D LV venous anatomy from dual-view fluoroscopic venograms and to fuse it with LV epicardial surface on SPECT MPI. It is technically accurate for guiding LV lead placement by the 17-segment model and is feasible for clinical use in the catheterization laboratory.
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia.
authors.forename: Weihua
authors.initials: W
authors.lastname: Zhou
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Hou
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia.
authors.forename: Marina
authors.initials: M
authors.lastname: Piccinelli
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia.
authors.forename: Xiangyang
authors.initials: X
authors.lastname: Tang
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Lijun
authors.initials: L
authors.lastname: Tang
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Kejiang
authors.initials: K
authors.lastname: Cao
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia.
authors.forename: Ernest V
authors.initials: EV
authors.lastname: Garcia
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China. Electronic address: jgzou@njmu.edu.cn.
authors.forename: Jiangang
authors.initials: J
authors.lastname: Zou
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia. Electronic address: jchen22@emory.edu.
authors.forename: Ji
authors.initials: J
authors.lastname: Chen
mesh_terms: D000368:Aged; D000465:Algorithms; D059925:Anatomic Landmarks; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D010690:Phlebography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D057188:Workflow
keywords: SPECT; cardiac resynchronization therapy (CRT); heart failure (HF); image-guided implantation