Coronary artery disease (CAD) continues to be the leading cause of death in America. Coronary arteriography is the standard for diagnosing the anatomical basis of CAD: however, this invasive test has a non-negligible procedural risk and significant cost. Moreover, ~30% of coronary arteriograms show no demonstrable coronary artery stenosis, and only 1/3 are performed in conjunction with an interventional procedure. Non-invasive evaluation of coronary anatomy with multislice spiral CT coronary arteriography (CTCA) could potentially replace these diagnostic angiograms, but has limitations including image artifacts related to coronary arterial calcification and coronary stenting. Non-invasive ECG-gated myocardial perfusion imaging (MPI) provides physiologic information and is the standard for the assessment of hypoperfusion resulting from CAD;however, it also has limitations related to its measurement of flow being relative rather than absolute. We hypothesize that explicit integration of the anatomic information from CTCA and the physiologic information from MPI can ameliorate the limitations of each, improve assessment of CAD, and eliminate many diagnostic catheterizations, reserving invasive angiography primarily for interventional use. Our long term objective is to develop and validate computer-based methods to fuse, render and quantify complementary CTCA+MPI cardiac imagery. Our primary hypothesis is that 3D fusion and rendering of cardiac information from these complementary imaging modalities is more accurate and efficient in diagnosing CAD than conventional approaches of independently viewing each study.
Our specific aims are to develop new methods for fusing and rendering CTCAs and MPIs that take advantage of all relevant information available in both images. The new approach segments the ventricular surfaces from the CTCA using their expected shape and intensity, and then incorporates a mechanical model to nonlinearly fuse the MPI to these surfaces. The arteries segmented from the CTCA will thus be in alignment with the transformed MPI data. Quantitative information about arterial anatomy and myocardial perfusion will be combined and displayed using surface rendered 3D graphics. This approach will be entirely automatic and much more accurate than existing techniques. All work will be validated with animal and patient studies to show both accuracy of fusion and the efficacy of reading the fused display vs. separate CTCA and MPI slices, and vs. standard angiograms.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL085417-03
Application #
7844986
Study Section
Biomedical Imaging Technology Study Section (BMIT)
Program Officer
Larkin, Jennie E
Project Start
2008-06-01
Project End
2012-05-31
Budget Start
2010-06-01
Budget End
2011-05-31
Support Year
3
Fiscal Year
2010
Total Cost
$496,070
Indirect Cost
Name
Emory University
Department
Radiation-Diagnostic/Oncology
Type
Schools of Medicine
DUNS #
066469933
City
Atlanta
State
GA
Country
United States
Zip Code
30322
Liangjia Zhu; Yi Gao; Appia, Vikram et al. (2014) A complete system for automatic extraction of left ventricular myocardium from CT images using shape segmentation and contour evolution. IEEE Trans Image Process 23:1340-51
Garcia, Ernest V (2014) Are SPECT measurements of myocardial blood flow and flow reserve ready for clinical use? Eur J Nucl Med Mol Imaging 41:2291-3
Piccinelli, Marina; Faber, Tracy L; Arepalli, Chesnal D et al. (2014) Automatic detection of left and right ventricles from CTA enables efficient alignment of anatomy with myocardial perfusion data. J Nucl Cardiol 21:96-108
Zhu, Liangjia; Gao, Yi; Appia, Vikram et al. (2013) Automatic delineation of the myocardial wall from CT images via shape segmentation and variational region growing. IEEE Trans Biomed Eng 60:2887-95
Van Tosh, Andrew; Votaw, John R; Reichek, Nathaniel et al. (2013) The relationship between ischemia-induced left ventricular dysfunction, coronary flow reserve, and coronary steal on regadenoson stress-gated (82)Rb PET myocardial perfusion imaging. J Nucl Cardiol 20:1060-8
Appia, Vikram; Yezzi, Anthony (2013) Symmetric fast marching schemes for better numerical isotropy. IEEE Trans Pattern Anal Mach Intell 35:2298-304
Appia, Vikram; Yezzi, Anthony (2011) Active Geodesics: Region-based Active Contour Segmentation with a Global Edge-based Constraint. Proc IEEE Int Conf Comput Vis 2011:1975-1980
Zhu, Liangjia; Gao, Yi; Mohan, Vandana et al. (2011) Estimation of Myocardial Volume at Risk from CT Angiography. Proc SPIE Int Soc Opt Eng 7963:79632A-79632A6
Faber, Tracy L; Santana, Cesar A; Piccinelli, Marina et al. (2011) Automatic Alignment of Myocardial Perfusion Images With Contrast-Enhanced Cardiac Computed Tomography. IEEE Trans Nucl Sci 58:2296-2302
Appia, Vikram; Ganapathy, Balaji; Yezzi, Anthony et al. (2011) Localized Principal Component Analysis based Curve Evolution: A Divide and Conquer Approach. IEEE Int Conf Comput Adv Bio Med Sci 2011:1981-1986

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