title: Diagnostic performance of the quantification of myocardium at risk from MPI SPECT/CTA 2G fusion for detecting obstructive coronary disease: A multicenter trial.
abstract: The effective non-invasive identification of coronary artery disease (CAD) and its proper referral for invasive treatment are still unresolved issues. We evaluated our quantification of myocardium at risk (MAR) from our second generation 3D MPI/CTA fusion framework for the detection and localization of obstructive coronary disease.
  
  
  
  Studies from 48 patients who had rest/stress MPI, CTA, and ICA were analyzed from 3 different institutions. From the CTA, a 3D biventricular surface of the myocardium with superimposed coronaries was extracted and fused to the perfusion distribution. Significant lesions were identified from CTA readings and positioned on the fused display. Three estimates of MAR were computed on the 3D LV surface on the basis of the MPI alone (MARp), the CTA alone (MARa), and the fused information (MARf). The extents of areas at risk were used to generate ROC curves using ICA anatomical findings as reference standard.
  
  
  
  Areas under the ROC curve (AUC) for CAD detection using MARfwas 0.88 (CI = 0.75-0.95) and for MARpand MARawere, respectively 0.82 (CI = 0.69-0.92) and 0.75 (CI = 0.60-0.86) using the ≥70% stenosis criterion. AUCs for CAD localization (all vessels) using MARfshowed significantly higher performance than either MARaor MARpor both.
  
  
  
  Using ICA as the reference standard, MAR as the quantitative parameter, and AUC to measure diagnostic performance, MPI-CTA fusion imaging provided incremental diagnostic information compared to MPI or CTA alone for the diagnosis and localization of CAD.
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA. mpiccin@emory.edu.
authors.forename: Marina
authors.initials: M
authors.lastname: Piccinelli
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA.
authors.forename: Cesar
authors.initials: C
authors.lastname: Santana
authors.affiliation: CHI Health-Creighton University Medical Center, Ohama, NE, USA.
authors.forename: Gopi Kiran R
authors.initials: GKR
authors.lastname: Sirineni
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA.
authors.forename: Russell D
authors.initials: RD
authors.lastname: Folks
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA.
authors.forename: C David
authors.initials: CD
authors.lastname: Cooke
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA.
authors.forename: Chesnal D
authors.initials: CD
authors.lastname: Arepalli
authors.affiliation: Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Aguade-Bruix
authors.affiliation: Rambam Health Care Campus, Haifa, Israel.
authors.forename: Zohar
authors.initials: Z
authors.lastname: Keidar
authors.affiliation: Rambam Health Care Campus, Haifa, Israel.
authors.forename: Alex
authors.initials: A
authors.lastname: Frenkel
authors.affiliation: Rambam Health Care Campus, Haifa, Israel.
authors.forename: Ora
authors.initials: O
authors.lastname: Israel
authors.affiliation: Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Candell-Riera
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA.
authors.forename: Ernest V
authors.initials: EV
authors.lastname: Garcia
mesh_terms: D000368:Aged; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
keywords: Multimodality image fusion; coronary artery disease; image quantification