Vascular territories definition in myocardial perfusion imaging obtained with cadmium-zinc-telluride technology through integration of coronary computed tomography
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Abstract
Background and aim
The technology based on cadmium-zinc-telluride (CZT) allows to improve both spatial resolution and counting efficiency
The aim of the study is to evaluate whether the coronary arteries, anterior descended artery (LAD), circumflex artery (LCx) and right coronary artery (RCA), identified by CZT gamma-camera, maintain the anatomical correspondence with the standard 17-segment model developed by the American Heart Association (AHA).
Materials e methods
2418 myocardial perfusion scintigraphy (MPI) performed on CZT and 935 computerized coronary computed tomography (CCT), done in the same period, were retrospectively evaluated.
Segment assignment to the territories of the three major coronary arteries was performed by MPI-CCT hybrid imaging and evaluated by two expert in double-blind evaluation, creating an individualized 17-segment model. The interobserver agreement was calculated with Choen's K.
Results
680 segments were analysed in 40 patients. The two operators obtained a high agreement (>0.90). Significant anatomical variants of one of the three main coronaries were found in 12/40 (30%) patients.
Myocardial segments were reassigned in 76/680 (11.2%) cases to develop an individualized 17-segment model. In individualized model, the segments assigned were 4 segments from LCx to RCA, 21 segments from RCA to LCx, 40 segments from RCA to LAD and 11 segments from LCx to LAD. The most variable segments (39/76) were number 9, 10 and 15, belonging to the RCA, considering the assumptions of the AHA model.
Conclusions
The integration of MPI-CZT with CCT allows an accurate assignment of coronaries localization. The results obtained show a greater extension of the LAD territory and a greater variability for RCA and LCx, in comparison to AHA-model.
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