Hybrid image visualization tool for 3D integration of CT coronary anatomy and quantitative myocardial perfusion PET

  • Martina Marinelli
  • Vincenzo Positano
  • Stephan G. Nekolla
  • Paolo Marcheschi
  • Giancarlo Todiere
  • Natalia Esposito
  • Stefano Puzzuoli
  • Giuseppe A. L’Abbate
  • Paolo Marraccini
  • Danilo Neglia
Original Article



Multimodal cardiac imaging by CTA and quantitative PET enables acquisition of patient-specific coronary anatomy and absolute myocardial perfusion at rest and during stress. In the clinical setting, integration of this information is performed visually or using coronary arteries distribution models. We developed a new tool for CTA and quantitative PET integrated 3D visualization, exploiting XML and DICOM clinical standards.


The hybrid image tool (HIT) developed in the present study included four main modules: (1) volumetric registration for spatial matching of CTA and PET data sets, (2) an interface to PET quantitative analysis software, (3) a derived DICOM generator able to build DICOM data set from quantitative polar maps, and (4) a 3D visualization tool of integrated anatomical and quantitative flow information. The four modules incorporated in the HIT tool communicate by defined standard XML files: XML-transformation and XML MIST standards.


The HIT tool implements a 3D representation of CTA showing real coronary anatomy fused to PET-derived quantitative myocardial blood flow distribution. The technique was validated on 16 data sets from EVINCI study population. The validation of the method confirmed the high matching between “original” and derived data sets as well as the accuracy of the registration procedure.


Three-dimensional integration of patient- specific coronary artery anatomy provided by CTA and quantitative myocardial blood flow obtained from PET imaging can improve cardiac disease assessment. The HIT tool introduced in this paper may represent a significant advancement in the clinical use of this multimodal approach.


CAD Hybrid imaging Myocardial flow reserve XML 3D visualization 


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Copyright information

© CARS 2012

Authors and Affiliations

  • Martina Marinelli
    • 1
  • Vincenzo Positano
    • 2
  • Stephan G. Nekolla
    • 3
  • Paolo Marcheschi
    • 2
  • Giancarlo Todiere
    • 2
  • Natalia Esposito
    • 1
  • Stefano Puzzuoli
    • 1
  • Giuseppe A. L’Abbate
    • 2
  • Paolo Marraccini
    • 1
  • Danilo Neglia
    • 1
    • 2
  1. 1.Institute of Clinical Physiology, CNRPisaItaly
  2. 2.Fondazione Gabriele MonasterioCNR-Regione ToscanaPisaItaly
  3. 3.Nuklearmedinische Klinik der TU MünchenMunichGermany

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