Definition of vascular territories on myocardial perfusion images by integration with true coronary anatomy: A hybrid PET/CT analysis

Mehrbod Som Som Javadi, Riikka Lautamäki, Jennifer Merrill, Corina Voicu, William Epley, Gerald McBride, Frank M. Bengel

Research output: Contribution to journalArticle

Abstract

For interpretation of myocardial perfusion studies, tissue segments are usually assigned to coronary vascular territories based on general assumptions about the most frequent vascular distribution pattern. These assumptions may be inaccurate because of interindividual variability of coronary anatomy. This limitation may be overcome by hybrid imaging through the individual integration of coronary anatomy with myocardial tissue regions. Methods: We studied 71 consecutive patients who underwent 82Rb perfusion PET/CT, including CT angiography, for work-up of coronary artery disease on a 64-slice PET/CT scanner. Coronary vessels as defined by CT were assigned to each of 17 myocardial segments for PET analysis using fusion images. Reassigned segmental maps were compared with standard assignment as proposed by the American Heart Association model, without knowledge of individual anatomy. The validity of segmental assignment was tested in 6 dogs by comparison of PET/CT with ex vivo dye staining of coronary territories. Results: Dog studies showed excellent agreement between PET/CTdefined segments and ex vivo-stained territories (κ, 0.80). In patients, 72% (51/71) demonstrated differences from the standard assignment in at least 1 myocardial segment; 112 of 1,207 segments were reassigned to nonstandard vascular territories. Most frequently, standard right coronary segments were reassigned to the left circumflex territory (39% of reassigned segments), standard circumflex segments were reassigned to the left anterior descending territory (30%), and standard left anterior descending segments were reassigned to either circumflex or right coronary (12% and 11%, respectively). In 27 studies with a myocardial perfusion defect, relative uptake in the vascular territory with the defect was significantly lower after CT-based reassignment and was higher in remote territories, resulting in better separation (ratio of defect to remote, 0.75 ± 0.13 vs. 0.81 ± 0.12 before reassignment; P = 0.0014). Conclusion: Standard assumptions about vascular territory distribution in myocardial perfusion analysis are frequently inaccurate because of morphologic variability of the coronary tree. If hybrid imaging has been used to study coronary anatomy and myocardial tissue perfusion, then localization of perfusion abnormalities should be based on CT-derived anatomy. This may bring about more accurate assignment to culprit vessels and thus improved guidance and monitoring of targeted therapy.

Original languageEnglish (US)
Pages (from-to)198-203
Number of pages6
JournalJournal of Nuclear Medicine
Volume51
Issue number2
DOIs
StatePublished - Feb 1 2010

Fingerprint

Blood Vessels
Anatomy
Perfusion
Multimodal Imaging
Dogs
Coronary Artery Disease
Coronary Vessels
Coloring Agents
Staining and Labeling

Keywords

  • CT coronary angiography
  • Hybrid imaging
  • PET/CT
  • Vascular territories

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Definition of vascular territories on myocardial perfusion images by integration with true coronary anatomy : A hybrid PET/CT analysis. / Javadi, Mehrbod Som Som; Lautamäki, Riikka; Merrill, Jennifer; Voicu, Corina; Epley, William; McBride, Gerald; Bengel, Frank M.

In: Journal of Nuclear Medicine, Vol. 51, No. 2, 01.02.2010, p. 198-203.

Research output: Contribution to journalArticle

Javadi, Mehrbod Som Som ; Lautamäki, Riikka ; Merrill, Jennifer ; Voicu, Corina ; Epley, William ; McBride, Gerald ; Bengel, Frank M. / Definition of vascular territories on myocardial perfusion images by integration with true coronary anatomy : A hybrid PET/CT analysis. In: Journal of Nuclear Medicine. 2010 ; Vol. 51, No. 2. pp. 198-203.
@article{c5f77d71e5fb4cc08e9e210b49ba33ca,
title = "Definition of vascular territories on myocardial perfusion images by integration with true coronary anatomy: A hybrid PET/CT analysis",
abstract = "For interpretation of myocardial perfusion studies, tissue segments are usually assigned to coronary vascular territories based on general assumptions about the most frequent vascular distribution pattern. These assumptions may be inaccurate because of interindividual variability of coronary anatomy. This limitation may be overcome by hybrid imaging through the individual integration of coronary anatomy with myocardial tissue regions. Methods: We studied 71 consecutive patients who underwent 82Rb perfusion PET/CT, including CT angiography, for work-up of coronary artery disease on a 64-slice PET/CT scanner. Coronary vessels as defined by CT were assigned to each of 17 myocardial segments for PET analysis using fusion images. Reassigned segmental maps were compared with standard assignment as proposed by the American Heart Association model, without knowledge of individual anatomy. The validity of segmental assignment was tested in 6 dogs by comparison of PET/CT with ex vivo dye staining of coronary territories. Results: Dog studies showed excellent agreement between PET/CTdefined segments and ex vivo-stained territories (κ, 0.80). In patients, 72{\%} (51/71) demonstrated differences from the standard assignment in at least 1 myocardial segment; 112 of 1,207 segments were reassigned to nonstandard vascular territories. Most frequently, standard right coronary segments were reassigned to the left circumflex territory (39{\%} of reassigned segments), standard circumflex segments were reassigned to the left anterior descending territory (30{\%}), and standard left anterior descending segments were reassigned to either circumflex or right coronary (12{\%} and 11{\%}, respectively). In 27 studies with a myocardial perfusion defect, relative uptake in the vascular territory with the defect was significantly lower after CT-based reassignment and was higher in remote territories, resulting in better separation (ratio of defect to remote, 0.75 ± 0.13 vs. 0.81 ± 0.12 before reassignment; P = 0.0014). Conclusion: Standard assumptions about vascular territory distribution in myocardial perfusion analysis are frequently inaccurate because of morphologic variability of the coronary tree. If hybrid imaging has been used to study coronary anatomy and myocardial tissue perfusion, then localization of perfusion abnormalities should be based on CT-derived anatomy. This may bring about more accurate assignment to culprit vessels and thus improved guidance and monitoring of targeted therapy.",
keywords = "CT coronary angiography, Hybrid imaging, PET/CT, Vascular territories",
author = "Javadi, {Mehrbod Som Som} and Riikka Lautam{\"a}ki and Jennifer Merrill and Corina Voicu and William Epley and Gerald McBride and Bengel, {Frank M.}",
year = "2010",
month = "2",
day = "1",
doi = "10.2967/jnumed.109.067488",
language = "English (US)",
volume = "51",
pages = "198--203",
journal = "Journal of Nuclear Medicine",
issn = "0161-5505",
publisher = "Society of Nuclear Medicine Inc.",
number = "2",

}

TY - JOUR

T1 - Definition of vascular territories on myocardial perfusion images by integration with true coronary anatomy

T2 - A hybrid PET/CT analysis

AU - Javadi, Mehrbod Som Som

AU - Lautamäki, Riikka

AU - Merrill, Jennifer

AU - Voicu, Corina

AU - Epley, William

AU - McBride, Gerald

AU - Bengel, Frank M.

PY - 2010/2/1

Y1 - 2010/2/1

N2 - For interpretation of myocardial perfusion studies, tissue segments are usually assigned to coronary vascular territories based on general assumptions about the most frequent vascular distribution pattern. These assumptions may be inaccurate because of interindividual variability of coronary anatomy. This limitation may be overcome by hybrid imaging through the individual integration of coronary anatomy with myocardial tissue regions. Methods: We studied 71 consecutive patients who underwent 82Rb perfusion PET/CT, including CT angiography, for work-up of coronary artery disease on a 64-slice PET/CT scanner. Coronary vessels as defined by CT were assigned to each of 17 myocardial segments for PET analysis using fusion images. Reassigned segmental maps were compared with standard assignment as proposed by the American Heart Association model, without knowledge of individual anatomy. The validity of segmental assignment was tested in 6 dogs by comparison of PET/CT with ex vivo dye staining of coronary territories. Results: Dog studies showed excellent agreement between PET/CTdefined segments and ex vivo-stained territories (κ, 0.80). In patients, 72% (51/71) demonstrated differences from the standard assignment in at least 1 myocardial segment; 112 of 1,207 segments were reassigned to nonstandard vascular territories. Most frequently, standard right coronary segments were reassigned to the left circumflex territory (39% of reassigned segments), standard circumflex segments were reassigned to the left anterior descending territory (30%), and standard left anterior descending segments were reassigned to either circumflex or right coronary (12% and 11%, respectively). In 27 studies with a myocardial perfusion defect, relative uptake in the vascular territory with the defect was significantly lower after CT-based reassignment and was higher in remote territories, resulting in better separation (ratio of defect to remote, 0.75 ± 0.13 vs. 0.81 ± 0.12 before reassignment; P = 0.0014). Conclusion: Standard assumptions about vascular territory distribution in myocardial perfusion analysis are frequently inaccurate because of morphologic variability of the coronary tree. If hybrid imaging has been used to study coronary anatomy and myocardial tissue perfusion, then localization of perfusion abnormalities should be based on CT-derived anatomy. This may bring about more accurate assignment to culprit vessels and thus improved guidance and monitoring of targeted therapy.

AB - For interpretation of myocardial perfusion studies, tissue segments are usually assigned to coronary vascular territories based on general assumptions about the most frequent vascular distribution pattern. These assumptions may be inaccurate because of interindividual variability of coronary anatomy. This limitation may be overcome by hybrid imaging through the individual integration of coronary anatomy with myocardial tissue regions. Methods: We studied 71 consecutive patients who underwent 82Rb perfusion PET/CT, including CT angiography, for work-up of coronary artery disease on a 64-slice PET/CT scanner. Coronary vessels as defined by CT were assigned to each of 17 myocardial segments for PET analysis using fusion images. Reassigned segmental maps were compared with standard assignment as proposed by the American Heart Association model, without knowledge of individual anatomy. The validity of segmental assignment was tested in 6 dogs by comparison of PET/CT with ex vivo dye staining of coronary territories. Results: Dog studies showed excellent agreement between PET/CTdefined segments and ex vivo-stained territories (κ, 0.80). In patients, 72% (51/71) demonstrated differences from the standard assignment in at least 1 myocardial segment; 112 of 1,207 segments were reassigned to nonstandard vascular territories. Most frequently, standard right coronary segments were reassigned to the left circumflex territory (39% of reassigned segments), standard circumflex segments were reassigned to the left anterior descending territory (30%), and standard left anterior descending segments were reassigned to either circumflex or right coronary (12% and 11%, respectively). In 27 studies with a myocardial perfusion defect, relative uptake in the vascular territory with the defect was significantly lower after CT-based reassignment and was higher in remote territories, resulting in better separation (ratio of defect to remote, 0.75 ± 0.13 vs. 0.81 ± 0.12 before reassignment; P = 0.0014). Conclusion: Standard assumptions about vascular territory distribution in myocardial perfusion analysis are frequently inaccurate because of morphologic variability of the coronary tree. If hybrid imaging has been used to study coronary anatomy and myocardial tissue perfusion, then localization of perfusion abnormalities should be based on CT-derived anatomy. This may bring about more accurate assignment to culprit vessels and thus improved guidance and monitoring of targeted therapy.

KW - CT coronary angiography

KW - Hybrid imaging

KW - PET/CT

KW - Vascular territories

UR - http://www.scopus.com/inward/record.url?scp=75749143512&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=75749143512&partnerID=8YFLogxK

U2 - 10.2967/jnumed.109.067488

DO - 10.2967/jnumed.109.067488

M3 - Article

C2 - 20080895

AN - SCOPUS:75749143512

VL - 51

SP - 198

EP - 203

JO - Journal of Nuclear Medicine

JF - Journal of Nuclear Medicine

SN - 0161-5505

IS - 2

ER -