von Spiczak Jochen, Manka Robert, Gotschy Alexander, Oebel Sabrina, Kozerke Sebastian, Hamada Sandra, Alkadhi Hatem
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
Int J Cardiovasc Imaging. 2018 Apr;34(4):649-660. doi: 10.1007/s10554-017-1260-6. Epub 2017 Oct 28.
The purpose of this work was to develop a framework for 3D fusion of CT coronary angiography (CTCA) and whole-heart dynamic 3D cardiac magnetic resonance perfusion (3D-CMR-Perf) image data-correlating coronary artery stenoses to stress-induced myocardial perfusion deficits for the assessment of coronary artery disease (CAD). Twenty-three patients who underwent CTCA and 3D-CMR-Perf for various indications were included retrospectively. For CTCA, image quality and coronary diameter stenoses > 50% were documented. For 3D-CMR-Perf, image quality and stress-induced perfusion deficits were noted. A software framework was developed to allow for 3D image fusion of both datasets. Computation steps included: (1) fully automated segmentation of coronary arteries and heart contours from CT; (2) manual segmentation of the left ventricle in 3D-CMR-Perf images; (3) semi-automatic co-registration of CT/CMR datasets; (4) projection of the 3D-CMR-Perf values on the CT left ventricle. 3D fusion analysis was compared to separate inspection of CTCA and 3D-CMR-Perf data. CT and CMR scans resulted in an image quality being rated as good to excellent (mean scores 3.5 ± 0.5 and 3.7 ± 0.4, respectively, scale 1-4). 3D-fusion was feasible in all 23 patients, and perfusion deficits could be correlated to culprit coronary lesions in all but one case (22/23 = 96%). Compared to separate analysis of CT and CMR data, coronary supply territories of 3D-CMR-Perf perfusion deficits were refined in two cases (2/23 = 9%), and the relevance of stenoses in CTCA was re-judged in four cases (4/23 = 17%). In conclusion, 3D fusion of CTCA/3D-CMR-Perf facilitates anatomic correlation of coronary lesions and stress-induced myocardial perfusion deficits thereby helping to refine diagnostic assessment of CAD.
这项工作的目的是开发一个框架，用于将CT冠状动脉造影（CTCA）和全心动态3D心脏磁共振灌注（3D-CMR-Perf）图像数据进行3D融合，将冠状动脉狭窄与应激诱导的心肌灌注缺损相关联，以评估冠状动脉疾病（CAD）。回顾性纳入了23例因各种适应证接受CTCA和3D-CMR-Perf检查的患者。对于CTCA，记录图像质量和冠状动脉直径狭窄>50%的情况。对于3D-CMR-Perf，记录图像质量和应激诱导的灌注缺损情况。开发了一个软件框架，以实现两个数据集的3D图像融合。计算步骤包括：（1）从CT中全自动分割冠状动脉和心脏轮廓；（2）在3D-CMR-Perf图像中手动分割左心室；（3）CT/CMR数据集的半自动配准；（4）将3D-CMR-Perf值投影到CT左心室上。将3D融合分析与单独检查CTCA和3D-CMR-Perf数据进行比较。CT和CMR扫描的图像质量被评为良好至优秀（平均评分分别为3.5±0.5和3.7±0.4，1-4分制）。3D融合在所有23例患者中均可行，除1例（22/23 = 96%）外，灌注缺损均与罪犯冠状动脉病变相关。与单独分析CT和CMR数据相比，3D-CMR-Perf灌注缺损的冠状动脉供血区域在2例（2/23 = 9%）中得到了细化，CTCA中狭窄的相关性在4例（4/23 = 17%）中被重新判断。总之，CTCA/3D-CMR-Perf的3D融合有助于冠状动脉病变与应激诱导的心肌灌注缺损的解剖学关联，从而有助于完善CAD的诊断评估。
