Integration of coronary anatomy, perfusion and metabolism: three-dimensional image fusion of coronary angiography and nuclear cardiac imaging

We studied three-dimensional (3D) fusion imaging that enabled the integration of coronary anatomy, perfusion and metabolic image on the patient-specific 3D left ventricle. In 36 patients with coronary artery disease, 420 coronary branches, including 46 branches supplied by collateral, were reconstructed (12 branches/patient). One hundred coronary branches had high-grade stenoses (>80%), 35% and 39% showed reversible and irreversible perfusion defects. Extent of perfusion defects showed good coincidence with the territories of corresponding coronary arteries. Forty-three myocardial regions were considered nonviable by perfusion imaging. Of these 43, 32 showed perfusion metabolism mismatch suggesting myocardial viability. Location and extent of viable myocardium were clearly defined. 3-D fusion imaging enabled assessment of perfusion and metabolic abnormalities of individual vessels on the patient-specific left ventricle.