Aligning Coronary Anatomy and Myocardial Perfusion Territories: An Algorithm for the CORE320 Multicenter Study

Background —Appropriate clinical decisions concerning diagnosis and treatment of coronary artery disease rely on correct integration of coronary anatomy and myocardial perfusion data. The purpose of this manuscript is to introduce a new left ventricular segmentation model for improved alignment of coronary arterial segments and myocardial perfusion territories, designed for the CORE320 study. Methods and Results —CORE320 is a prospective, multicenter study with a primary objective to evaluate the diagnostic accuracy of 320-row detector computed tomography to detect coronary artery luminal stenosis and corresponding myocardial perfusion deficits in patients with suspected CAD compared with the gold standard of conventional coronary angiography and single photon emission computed tomography myocardial perfusion imaging. We describe a 19 coronary segment and 13 myocardial territory alignment model, its application in both standard and CT image datasets and the adjudication process of the initial cohort of patients recruited for the CORE320 study. Adjudication committees reviewed the images of the first 101 gold standard and 107 CT datasets. Based on the presented model and rules, all cases for adjudication were correctly identified. During image review, 6 (5.9%) gold standard and 9 (8.4%) CT datasets needed further realignment not triggered by the algorithm. Conclusions —We present a vascular territory distribution model developed for the CORE320 multicenter study which accounts for variability in coronary anatomy and potential myocardial perfusion territory overlap. Clinical Trial Registration —URL: http://www.clinicaltrials.gov. Unique identifier: [NCT00934037][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00934037&atom=%2Fcirccvim%2Fearly%2F2012%2F08%2F10%2FCIRCIMAGING.111.970608.atom