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Optimisation of coronary vascular territorial 3D echocardiographic strain imaging using computed tomography: a feasibility study using image fusion

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Abstract

Current echocardiographic assessments of coronary vascular territories use the 17-segment model and are based on general assumptions of coronary vascular distribution. Fusion of 3D echocardiography (3DE) with multidetector computed tomography (MDCT) derived coronary anatomy may provide a more accurate assessment of left ventricular (LV) territorial function. We aimed to test the feasibility of MDCT and 3DE fusion and to compare territorial longitudinal strain (LS) using the 17-segment model and a MDCT-guided vascular model. 28 patients underwent 320-slice MDCT and transthoracic 3DE on the same day followed by invasive coronary angiography. MDCT (Aquilion ONE, ViSION Edition, Toshiba Medical Systems) and 3DE apical full-volume images (Artida, Toshiba Medical Systems) were fused offline using a dedicated workstation (prototype fusion software, Toshiba Medical Systems). 3DE/MDCT image alignment was assessed by 3 readers using a 4-point scale. Territorial LS was assessed using the 17-segment model and the MDCT-guided vascular model in territories supplied by significantly stenotic and non-significantly stenotic vessels. Successful 3DE/MDCT image alignment was obtained in 86 and 93 % of cases for reader one, and reader two and three, respectively. Fair agreement on the quality of automatic image alignment (intra-class correlation = 0.40) and the success of manual image alignment (Fleiss’ Kappa = 0.40) among the readers was found. In territories supplied by non-significantly stenotic left circumflex arteries, LS was significantly higher in the MDCT-guided vascular model compared to the 17-segment model: −15.00 ± 7.17 (mean ± standard deviation) versus −11.87 ± 4.09 (p < 0.05). Fusion of MDCT and 3DE is feasible and provides physiologically meaningful displays of myocardial function.

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Acknowledgments

Kota Aoyagi, Application Research Group, Clinical Application Research and Development Dept., Center for Medical Research and Development, Toshiba Medical Systems Corporation for his in-depth knowledge and help regarding the workings of the prototype 3-dimensional echocardiography and multidetector computed tomography fusion software.

Funding

Department of Cardiology, Hvidovre Hospital, Copenhagen, Denmark and Danish Agency for Science, Technology and Innovation by The Danish Council for Strategic Research (EDITORS: Eastern Denmark Initative to improve Revascularization Strategies, Grant 09-066994). This study did not receive any financial support from industry.

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Authors and Affiliations

  1. Department of Cardiology 2014, Faculty of Health Sciences, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Martina Chantal de Knegt, A. Fuchs, P. Weeke, R. Møgelvang, C. Hassager & K. F. Kofoed

  2. Department of Cardiology, Faculty of Health Sciences, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark

    Martina Chantal de Knegt

  3. Department of Radiology, Faculty of Health Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    K. F. Kofoed

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  1. Martina Chantal de Knegt
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  2. A. Fuchs
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  3. P. Weeke
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  4. R. Møgelvang
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Correspondence to Martina Chantal de Knegt.

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Conflict of interest

Klaus Kofoed has received research grants from AP Møller og hustru Chastine McKinney Møllers Fond, The John and Birthe Meyer Foundation, Research Council of Rigshopitalet, The University of Copenhagen, The Danish Heart Foundation, The Lundbeck Foundation, The Danish Agency for Science, Technology and Innovation by The Danish Council for Strategic Research; is principle investigator of the investigator initiated CATCH-2 trial, CSub320 trial and at the steering committee of the CORE320 trial—supported in part by Toshiba Medical Corporation; and is on the Speakers Bureau of Toshiba Medical Systems, Advisory board work for VITAL Images Inc. All other authors report no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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de Knegt, M.C., Fuchs, A., Weeke, P. et al. Optimisation of coronary vascular territorial 3D echocardiographic strain imaging using computed tomography: a feasibility study using image fusion. Int J Cardiovasc Imaging 32, 1715–1723 (2016). https://doi.org/10.1007/s10554-016-0964-3

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  • DOI: https://doi.org/10.1007/s10554-016-0964-3

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