New X-ray imaging modalities and their integration with intravascular imaging and interventions

During recent years various techniques emerged providing more detailed images and insights in the cardiovascular system. C-Arm computed tomography is currently introduced in cardiac imaging offering the potential of three dimensional imaging of the coronary arteries, the cardiac chambers, venous system and a variety of anatomic anomalies inside the interventional environment. Furthermore it might enable perfusion imaging during percutaneous coronary intervention (PCI). Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are meanwhile established tools for detailed assessment of the coronary arteries. Their use might further increase with automated tissue characterization, three dimensional reconstruction, integration in angiography systems, and new emerging techniques. Parameters of fluid tissue interactions are important factors in the pathogenesis of atherosclerosis. These parameters can be calculated using computational fluid dynamics based on three dimensional models of the coronary vessels which can be derived from various sources including multislice computed tomography (MSCT), C-Arm CT or 3D reconstructed IVUS or OCT. Their use in the clinical setting has yet to be determined especially with regard to their ability in increasing treatment efficiency and clinical outcome.