Multimodality imaging in interventional cardiology

• Published in: Nature reviews cardiology Vol. 9; no. 6; pp. 333 - 346
• Main Authors: van der Hoeven, Bas L., Schalij, Martin J., Delgado, Victoria
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.06.2012; Nature Publishing Group
• Subjects: 692/699/75/230; 692/699/75/593/15; 692/700/1421; 692/700/565/2776; Animals; Cardiac Catheterization; Cardiac Imaging; Cardiac Resynchronization Therapy - methods; Cardiac Surgery; Cardiology; Cardiovascular diseases; Care and treatment; Coronary Angiography; Coronary Artery Disease - diagnosis; Demographic aspects; Diagnosis; Diagnostic imaging; Diagnostic Imaging - methods; Heart Diseases - diagnosis; Heart Diseases - therapy; Heart Failure - diagnosis; Heart Failure - therapy; Heart Valve Prosthesis Implantation - methods; Humans; Image Interpretation, Computer-Assisted; Magnetic Resonance Imaging; Magnetic Resonance Imaging, Interventional; Medicine; Medicine & Public Health; Methods; Molecular Imaging; Multimodal Imaging; Positron-Emission Tomography; Predictive Value of Tests; Prognosis; Radiography, Interventional; review-article; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Ultrasonography, Interventional; Netherlands
• ISSN: 1759-5002; 1759-5010
• DOI: 10.1038/nrcardio.2012.14

Multimodality and hybrid imaging combine various imaging modalities to enhance diagnostic accuracy and improve clinical outcomes. Dr. Delgado and colleagues review the use of multiple novel imaging techniques to evaluate plaque burden and stability in patients with coronary artery disease, target cardiac resynchronization therapy in patients with heart failure, and guide transcatheter procedures in patients with valvular heart disease. 'Multimodality' imaging—the side-by-side interpretation of data obtained from various noninvasive imaging techniques, such as echocardiography, radionuclide techniques, multidetector CT (MDCT), and MRI—allows anatomical, morphological, and functional data to be combined, increases diagnostic accuracy, and improves the efficacy of cardiovascular interventions and clinical outcomes. During the past decade, advances in software and hardware have allowed co-registration of various imaging modalities, resulting in cardiac 'hybrid' or 'fusion' imaging. In this Review, we discuss the roles of both multimodality and hybrid imaging in three broad areas of cardiology—coronary artery disease (CAD), heart failure, and valvular heart disease. In the evaluation of CAD, integration of either single-photon emission computed tomography (SPECT) or PET with CT coronary angiography provides both morphological and functional data in a single procedure. Accordingly, the functional consequences (myocardial hypoperfusion on SPECT or PET) of anatomical pathology (coronary anatomy on MDCT or MRI) can be assessed. Co-registration of PET and MRI data sets to provide cellular and molecular information on plaque composition and stability is now possible. Furthermore, novel imaging modalities have been implemented to guide electrophysiological and transcatheter-based procedures, such as cardiac resynchronization therapy (an established treatment for patients with heart failure), and transcatheter valve repair or replacement procedures. Key Points Multimodality imaging has a central role in the clinical management of patients with cardiovascular diseases Cardiac hybrid imaging has become feasible and available in various clinical scenarios and has important implications for clinical decision-making For patients with an intermediate likelihood of having coronary artery disease, single-photon emission computed tomography–CT and PET–CT might become first-line imaging tools to detect flow-limiting coronary artery stenosis In electrophysiology, cardiac multimodality imaging has a central role to guide and improve the efficacy of several procedures, such as device implantation for cardiac resynchronization therapy Emerging transcatheter valve implantation or repair procedures demand high-resolution imaging techniques to plan and guide the interventions accurately