Department of Medical Informatics, Biomedical Imaging Group Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands.
J Nucl Med. 2014 Jan;55(1):50-7. doi: 10.2967/jnumed.113.119842. Epub 2013 Dec 12.
CT angiography (CTA) and SPECT myocardial perfusion imaging (MPI) are complementary imaging techniques to assess coronary artery disease (CAD). Spatial integration and combined visualization of SPECT MPI and CTA data may facilitate correlation of myocardial perfusion defects and subtending coronary arteries and thus offer additional diagnostic value over either stand-alone or side-by-side interpretation of the respective datasets from the 2 modalities. In this study, we investigated the additional diagnostic value of a software-based CTA/SPECT MPI image fusion system over conventional side-by-side analysis in patients with suspected CAD.
Seventeen symptomatic patients who underwent both CTA and SPECT MPI within a 90-d period were included in our study; 7 of them also underwent invasive coronary angiography (ICA). The potential benefits of the synchronized multimodal heart visualization (SMARTVis) system in assessing CAD were investigated through a case study involving 4 experts from 2 medical centers, in which we performed, first, a side-by-side analysis using structured CTA and SPECT reports and, second, an integrated analysis using the SMARTVis system in addition to the reports.
The fused interpretation led to a more accurate diagnosis, reflected in an increase in the individual observers' sensitivity and specificity to correctly refer for invasive angiography eventually followed by revascularization. For the first, second, third, and fourth observers, the respective sensitivities improved from 50%, 60%, 80%, and 80% to 70%, 80%, 100%, and 90% and the respective specificities from 100%, 94%, 83%, and 83% to 100%, 100%, 94%, and 83%. Additionally, the interobserver diagnosis agreement increased from 74% to 84%. The improvement was primarily found in patients presenting with CAD in more vessels than the number of reported perfusion defects.
Integrated analysis of cardiac CTA and SPECT MPI using the SMARTVis system results in an improved diagnostic performance.
CT 血管造影（CTA）和 SPECT 心肌灌注成像（MPI）是评估冠状动脉疾病（CAD）的互补成像技术。SPECT MPI 和 CTA 数据的空间整合和联合可视化可能有助于将心肌灌注缺损与支撑冠状动脉相关联，从而提供比两种模态的单独或并排解释各自数据集的额外诊断价值。在这项研究中，我们研究了基于软件的 CTA/SPECT MPI 图像融合系统在疑似 CAD 患者中的附加诊断价值，与传统的并排分析相比。
我们研究了在 90 天内同时接受 CTA 和 SPECT MPI 的 17 例有症状患者；其中 7 例还接受了冠状动脉造影（ICA）。通过涉及来自 2 个医疗中心的 4 位专家的病例研究，研究了同步多模式心脏可视化（SMARTVis）系统在评估 CAD 中的潜在益处，我们首先使用结构化的 CTA 和 SPECT 报告进行并排分析，其次使用 SMARTVis 系统进行综合分析除了报告。
融合解释导致更准确的诊断，反映在个体观察者的敏感性和特异性增加，正确推荐进行有创血管造影，最终进行血运重建。对于第一、第二、第三和第四观察者，各自的敏感性从 50%、60%、80%和 80%分别提高到 70%、80%、100%和 90%，各自的特异性从 100%、94%、83%和 83%提高到 100%、100%、94%和 83%。此外，观察者间诊断的一致性从 74%提高到 84%。这种改善主要发生在 CAD 患者中，CAD 患者的血管数量多于报告的灌注缺损数量。
使用 SMARTVis 系统对心脏 CTA 和 SPECT MPI 进行综合分析可提高诊断性能。
