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Updated: Nov 9, 2025
Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
3D fusion between fluoroscopy angiograms and SPECT myocardial perfusion images to guide percutaneous coronary
Haipeng Tang1, Robert R Bober2, Chen Zhao3
1School of Computing Sciences and Computer Engineering, University of Southern Mississippi, Hattiesburg, MS, 39406, USA.
Insights
This study developed a fusion imaging technique to better align coronary artery anatomy with perfusion defects, improving decisions for percutaneous coronary intervention (PCI) in coronary artery disease (CAD). The method showed technical accuracy and clinical feasibility for guiding PCI.
Area of Science:
- Cardiovascular Imaging
- Medical Image Analysis
- Interventional Cardiology
Background:
- Percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) often follows abnormal myocardial perfusion imaging (MPI).
- Challenges in aligning coronary artery anatomy with perfusion defects can impact revascularization decisions.
- A need exists to improve the correlation between anatomical stenosis and perfusion abnormalities for better PCI guidance.
Purpose of the Study:
- To develop and evaluate a multi-modality image fusion approach.
- To enhance decision-making for PCI in patients with CAD.
- To integrate 3D coronary artery anatomy with left ventricular epicardial surface data.
Main Methods:
- Reconstructed 3D coronary artery anatomy from fluoroscopic angiography (FA).
- Extracted left ventricular (LV) epicardial surface from SPECT.
- Performed non-rigid fusion of artery anatomy and epicardial surface, validated with simulations and patient data.
Main Results:
- Fusion approach demonstrated technical accuracy in simulations (1.86-2.21 mm mismatch) and patient data (3.84-5.55 mm mismatch).
- High agreement (Kappa 0.91 for LCA, 0.80 for RCA) was found between fused and CT angiogram-derived coronary arteries using the AHA-17-segment model.
- The fusion method proved clinically feasible for use in catheterization laboratories.
Conclusions:
- The developed multi-modality fusion approach is technically accurate and clinically feasible for assisting PCI decisions.
- Further research is required to ascertain if this fusion technique improves PCI-related patient outcomes.
- This method offers a potential advancement in guiding revascularization strategies for CAD.
Background:
Percutaneous coronary intervention (PCI) in stable coronary artery disease (CAD) is commonly triggered by abnormal myocardial perfusion imaging (MPI). However, due to the possibilities of multivessel disease, serial stenoses and variability of coronary artery perfusion distribution, an opportunity exists to better align anatomic stenosis with perfusion abnormalities to improve revascularization decisions. This study aims to develop a multi-modality fusion approach to assist decision-making for PCI.
Methods And Results:
Coronary arteries from fluoroscopic angiography (FA) were reconstructed into 3D artery anatomy. Left ventricular (LV) epicardial surface was extracted from SPECT. The artery anatomy and epicardial surface were non-rigidly fused. The accuracy of the 3D fusion was evaluated via both computer simulation and real patient data. Simulated FA and MPI were integrated and then compared with the ground truth from a digital phantom. The distance-based mismatch errors between simulated fluoroscopy and phantom arteries were 1.86 ± 1.43 mm for left coronary arteries (LCA) and 2.21 ± 2.50 mm for right coronary arteries (RCA). FA and SPECT images in 30 patients were integrated and then compared with the ground truth from CT angiograms. The distance-based mismatch errors between the fluoroscopy and CT arteries were 3.84 ± 3.15 mm for LCA and 5.55 ± 3.64 mm for RCA. The presence of the corresponding fluoroscopy and CT arteries in the AHA-17-segment model agreed well with a Kappa value of 0.91 (CI 0.89-0.93) for LCA and a Kappa value of 0.80 (CI 0.67-0.92) for RCA.
Conclusions:
Our fusion approach is technically accurate to assist PCI decision-making and is clinically feasible to be used in the catheterization laboratory. Future studies are necessary to determine if fusion improves PCI-related outcomes.
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