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Comprehensive visualization of multimodal cardiac imaging data for assessment of coronary artery disease: first clinical results of the SMARTVis tool

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Abstract

Purpose

In clinical practice, both coronary anatomy and myocardial perfusion information are needed to assess coronary artery disease (CAD). The extent and severity of coronary stenoses can be determined using computed tomography coronary angiography (CTCA); the presence and amount of ischemia can be identified using myocardial perfusion imaging, such as perfusion magnetic resonance imaging (PMR). To determine which specific stenosis is associated with which ischemic region, experts use assumptions on coronary perfusion territories. Due to the high variability between patient’s coronary artery anatomies, as well as the uncertain relation between perfusion territories and supplying coronary arteries, patient-specific systems are needed.

Material and methods

We present a patient-specific visualization system, called Synchronized Multimodal heART Visualization (SMARTVis), for relating coronary stenoses and perfusion deficits derived from CTCA and PMR, respectively. The system consists of the following comprehensive components: (1) two or three-dimensional fusion of anatomical and functional information, (2) automatic detection and ranking of coronary stenoses, (3) estimation of patient-specific coronary perfusion territories.

Results

The potential benefits of the SMARTVis tool in assessing CAD were investigated through a case-study evaluation (conventional vs. SMARTVis tool): two experts analyzed four cases of patients with suspected multivessel coronary artery disease. When using the SMARTVis tool, a more reliable estimation of the relation between perfusion deficits and stenoses led to a more accurate diagnosis, as well as a better interobserver diagnosis agreement.

Conclusion

The SMARTVis comprehensive visualization system can be effectively used to assess disease status in multivessel CAD patients, offering valuable new options for the diagnosis and management of these patients.

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Abbreviations

BEP:

Bull’s eye plot

CAD:

Coronary artery disease

CTCA:

Computed tomography coronary angiography

CPR:

Curved-planar reformatted

FFR:

Fractional flow reserve

ICA:

Invasive coronary angiography

ICP:

Iterative closest point

LAD:

Left anterior descending artery

LCX:

Left circumflex artery

MPR:

Multi-planar reformatted

MPRI:

Myocardial perfusion reserve index

PMR:

Perfusion magnetic resonance imaging

RCA:

Right coronary artery

SMARTVis:

Synchronized multimodal heart visualization

TIC:

Time-intensity curve

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Authors and Affiliations

  1. Biomedical Imaging Group Rotterdam (BIGR), Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands

    Hortense A. Kirişli, C. T. Metz, M. Schaap, T. van Walsum & W. J. Niessen

  2. Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands

    Hortense A. Kirişli, V. Gupta, B. P. F. Lelieveldt & J. H. C. Reiber

  3. ICT Group, Department of Mediamatics, Delft University of Technology, Delft, The Netherlands

    V. Gupta & B. P. F. Lelieveldt

  4. Department of Radiology and Cardiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands

    S. W. Kirschbaum, A. Rossi, R. J. van Geuns & N. Mollet

Authors
  1. Hortense A. Kirişli
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  2. V. Gupta
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  3. S. W. Kirschbaum
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  4. A. Rossi
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  5. C. T. Metz
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  6. M. Schaap
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  7. R. J. van Geuns
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  8. N. Mollet
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  9. B. P. F. Lelieveldt
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  10. J. H. C. Reiber
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  11. T. van Walsum
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  12. W. J. Niessen
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Correspondence to Hortense A. Kirişli.

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Kirişli, H.A., Gupta, V., Kirschbaum, S.W. et al. Comprehensive visualization of multimodal cardiac imaging data for assessment of coronary artery disease: first clinical results of the SMARTVis tool. Int J CARS 7, 557–571 (2012). https://doi.org/10.1007/s11548-011-0657-2

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  • DOI: https://doi.org/10.1007/s11548-011-0657-2

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