Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology Diagnostic Performance of the Quantification of Myocardium at Risk from MPI SPECT/CTA 2G Fusion for Detecting Obstructive Coronary Disease: A Multicenter Trial. Marina Piccinelli1, Cesar Santana1, Gopi Kiran R Sirineni2, Russell D Folks1, C David Cooke1, CD Arepalli1, Santiago Aguade-Bruix3, Zohar Keidar4, Alex Frenkel4, Ora Israel4, Jaume Candell-Riera3, Ernest V Garcia1 1. Emory University School of Medicine, Atlanta, GA, USA 2. CHI Health-Creighton University Medical Center, Ohama, NE, USA 3. Vall d’Hebron University Hospital, Barcelona, Spain 4. Rambam Health Care Campus, Haifa, Israel Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology BACKGROUND The effective noninvasive identification of coronary artery disease (CAD) and its proper referral for invasive treatment are still unresolved issues. Research in the field of CAD management has highlighted the importance of evaluating both anatomy and physiology to provide appropriate treatment and prompted the development of 3D multimodality image fusion approaches. The aim of the current work is to present the multicenter validation of our 2nd generation 3D CTA-MPI image fusion framework for the automated quantitative assessment of CAD. Anatomical findings from invasive coronary angiography (ICA) used as gold standard. The myocardium at risk (MAR) index – introduced decades ago to relate the anatomic size of a coronary bed, i.e. the amount of myocardial mass supplied by an artery, to the size of an ischemic area – is also computed by means of our approach as a results of both anatomical and functional measurements, derived respectively from image quantification of CTA and MPI. Copyright American Society of Nuclear Cardiology

METHODS Study type: retrospective study Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology METHODS Study type: retrospective study Study subjects: 48 patients that underwent stress/rest SPECT MPI, CTA and were scheduled for a catheterization procedure, were enrolled from Emory University Hospital, Vall d’Hebron University Hospital and Rambam Hospital. All three procedures were performed within 90 days. Study endpoints: Prediction of anatomic Catheterization Laboratory results Study variables: MPI quantification of ischemia; CTA-derived anatomy (myocardium and coronaries); three measures of myocardium at risk: physiological (MPI-derived), anatomical (CTA-derived) and fused (after multimodality image fusion) Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology RESULTS CAD detection and localization results. ROC analysis in terms of area under the curve (AUC) for the MARa (CTA), MARp (MPI) and MARf (fusion) for both detection and localization of CAD with >70% DS. Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology CONCLUSIONS 1 - Using ICA as the reference standard, MAR as the quantitative parameter and AUC as the parameter to measure diagnostic performance, this study demonstrated that MPI-CTA fusion imaging can provide incremental diagnostic information compared to MPI or CTA alone for the diagnosis and localization of CAD. 2 - The present multicenter study shows that our totally automatic quantitative 2G fusion of MPI and CTA shows promise to provide incremental diagnostic value for detection and localization of CAD over either MPI or CTA alone, even when using only anatomical ICA findings as a reference standard. Copyright American Society of Nuclear Cardiology