3D fusion of functional cardiac magnetic resonance imaging and computed tomography coronary angiography: accuracy and added clinical value.

Abstract

PURPOSE:

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).

CONCLUSION:

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: Olivio F Donati, Hatem Alkadhi, Hans Scheffel, Caroline Kuehnel, Anja Hennemuth, Christophe Wyss, Naim Azemaj, André Plass, Sebastian Kozerke, Volkmar Falk, Sebastian Leschka, Paul Stolzmann
• Journal: Investigative radiology (Invest Radiol) Vol. 46 Issue 5 Pg. 331-40 (May 2011) ISSN: 1536-0210 [Electronic] United States
• PMID: 21285891 (Publication Type: Journal Article, Randomized Controlled Trial)

Topics

• Adult
• Aged
• Algorithms
• Coronary Angiography (instrumentation, methods)
• Coronary Artery Disease (diagnosis, pathology, surgery)
• Coronary Stenosis (diagnosis, diagnostic imaging, pathology)
• Coronary Vessels (pathology)
• Female
• Humans
• Magnetic Resonance Imaging (instrumentation, methods)
• Male
• Middle Aged
• Predictive Value of Tests
• Prospective Studies
• Sensitivity and Specificity
• Single-Blind Method
• Tomography, X-Ray Computed (instrumentation, methods)
• Ultrasonography