Integrated Single-Photon Emission Computed Tomography and Computed Tomography Coronary Angiography for the Assessment of Hemodynamically Significant Coronary Artery Lesions
Shmuel Rispler, MD, PhD*, ,*,
Zohar Keidar, MD, PhD,
Eduard Ghersin, MD ,
Ariel Roguin, MD, PhD ,
Adrian Soil||,2,
Robert Dragu, MD*,
Diana Litmanovich, MD,
Alex Frenkel, DSc,
Doron Aronson, MD*,
Ahuva Engel, MD,
Rafael Beyar, MD, DSc, FACC and
Ora Israel, MD,1
* Department of Cardiology, Technion-Israel Institute of Technology, Haifa, Israel
Department of Nuclear Medicine, Technion-Israel Institute of Technology, Haifa, Israel
Department of Medical Imaging, Technion-Israel Institute of Technology, Haifa, Israel
Division of Invasive Cardiology, Rambam Health Care Campus and the B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
|| Functional Imaging, General Electric Healthcare Technologies, Tirat Hacarmel, Israel.
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Figure 1 Cardiac SPECT/CTCA: CTCA of the LAD, CRX, and Ramus Intermedius Artery
(A) Computed tomography (CT) angiography curved multiplanar reformation of the left anterior descending coronary artery (LAD) demonstrates an irregular, mostly calcified plaque in the proximal LAD causing significant (>50%) diameter stenosis (solid white arrow). In addition, a hypodense filling defect causing tight luminal stenosis is demonstrated in the mid LAD (dotted arrow) and most probably represents an intraluminal thrombus. (B) The CT angiography curved multiplanar reformations of the left circumflex coronary artery (CRX) and (C) of the ramus intermedius show significant (>50%) diameter stenosis in the proximal part of both arteries (arrows). Figures 1 to 4 present the case of a 72-year-old woman with angina pectoris after recent anterior myocardial infarction. CTCA = computed tomography coronary angiography; LMCA = left main coronary artery; SPECT = single-photon emission computed tomography.
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Figure 2 Cardiac SPECT/CT Coronary Angiography: Myocardial Perfusion SPECT at Stress and Rest
Cardiac perfusion SPECT study at stress (top row) and rest (bottom row) shows a reversible perfusion defect in the apex and the antero-apical region (arrows) consistent with myocardial ischemia. The color convention used shows normal perfusion by brighter colors and decreased perfusion by darker colors. Abbreviations as in Figure 1.
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Figure 3 Cardiac SPECT/CTCA: Combined Fused Data of the Myocardial Perfusion and of the Coronary Vessels
Combined SPECT/CTCA data of myocardial perfusion (represented on the left ventricular epicardial surface extracted from the SPECT study) and of the coronary trees. Fused image at stress (left) shows decreased perfusion in the apex and the antero-apical wall (blue region, arrow) corresponding to the vascular territory of the LAD. Fused image at rest (right) shows normal perfusion to the same region. The fused information generated from the perfusion SPECT study and the coronary CTCA demonstrates the presence of myocardial ischemia related to LAD stenosis. The integration of anatomic (CTCA) and physiologic (myocardial perfusion imaging) information indicates that interventional therapy should be directed to the lesion in the LAD. Abbreviations as in Figure 1.
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Figure 4 Angiographic View of the Left Coronary Tree
Selective invasive angiography of the LAD shows severe stenosis (arrow), which was subsequently treated on the basis of the integrated SPECT/CTCA data. Abbreviations as in Figure 1.
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