Session P95.6

New Analysis Tools for the Comprehensive Assessment of the Coronary Arteries and Myocardial Viability in CT Data Sets

C Kuehnel*, A Hennemuth, AH Mahnken, HO Peitgen

MeVis Research
Bremen, Germany

Coronary Artery Disease (CAD) is a main cause of death in western countries. Coronary arteries stenosis causes impaired perfusion of the myocardium with subsequent myocardial dysfunction. As dysfunctional, but viable myocardium has the potential for functional recovery after reperfusion, the tissue state is of great importance for the treatment decision. Therefore, the myocardial viability is a decisive factor for further treatment.
The purpose of this paper is to propose new analysis tools for the comprehensive assessment of the coronary arteries and myocardial viability in CT. First, coronary tree segmentation is performed by a progressive region growing after a one-click aorta initialization. Furthermore, the late enhancement tissue is determined by mixture-model based tissue classification. Thus, measurements of the vessel lumen and possible stenoses based on the centerlines of the segmentation mask are comparable to the late enhancement portion computed within the left ventricular (LV) mask.
Moreover, a combined visualization of the coronary arteries and the late enhancement in the left ventricular mask provides a visual correlation of the effect of the vessel distortion on the supplied myocardium. Finally, this comprehensive information is the decisive factor regarding the possible treatment, especially in case of a multi-vessel disease.
We incorporated our tools into a workflow-oriented software assistant that guides the user through the examination of the data. A first evaluation of the combined analysis of CT angiographic and late enhancement data with respect to a possible treatment strategy was successfully performed in 8 dual-source CT data sets of pigs with reperfused myocardial infarction. Our results demonstrate the great potential of a combined analysis from both modalities using our advanced methods. The analysis tools provide a reliable estimation of the size and location of infarction including an analysis of the causative coronary artery. Preliminary results with 2 patient data sets illustrate that accurate patient-specific information can be achieved in addition to the standardized AHA 17-segment model.

(Abstract Control Number: 280)