Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland.
Invest Radiol. 2011 May;46(5):331-40. doi: 10.1097/RLI.0b013e3182056caf.
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).
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.
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).
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.
评估计算机断层冠状动脉造影术（CTCA）与功能心脏磁共振（CMR）的三维（3D）图像融合评估血流动力学相关冠状动脉疾病（CAD）的准确性和附加诊断价值。
共纳入 27 例经前瞻性心电图门控双源 CTCA 检查证实存在显著冠状动脉狭窄、并经导管血管造影和 1.5T 磁共振灌注缺损检查证实的患者。使用软件原型生成 3D 融合 CTCA/CMR 数据的表面表示和容积渲染图像。通过计算血池表面距离和 Dice 相似系数评估融合准确性。两位独立的、盲法的读者使用 CTCA 和 CMR 并排分析，并结合融合后的 CTCA/CMR 对心肌缺损进行归因于罪犯冠状动脉。与并排分析相比，融合 CTCA/CMR 的附加价值定义为归因于罪犯冠状动脉的心肌缺损的改变。
在所有患者中，CTCA/CMR 的 3D 融合是可行且准确的（血池表面距离：4.1 ± 1.3mm，范围：2.4-7.1mm；Dice 相似系数：0.78 ± 0.08，范围：0.51-0.86）。在 27 例患者中，有 6 例（22%）患者的 CTCA 和 CMR 并排分析无法将单个罪犯动脉分配给心肌缺损。在这 6 例患者中的 3 例中，融合 CTCA/CMR 可进一步限制罪犯冠状动脉。使用融合 CTCA/CMR 重新分配了 27 例患者中的 2 例（7%）的心肌缺损，而 22 例（81%）患者的结果保持不变。使用融合 CTCA/CMR 后，观察者对罪犯动脉与心肌缺损之间的归因的一致性增加（k=0.66-0.89）。
低剂量 CTCA 与功能 CMR 的 3D 融合是可行且准确的，与单独并排分析相比，可在低辐射剂量下增加血流动力学相关 CAD 的诊断价值。该技术对于以下情况可能具有临床意义：在 CAD 高发患者中计划手术或介入治疗程序，以及改善冠状动脉狭窄与相应心肌灌注缺损之间的拓扑分配。
