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Background. Percutaneous coronary intervention(PCI) in stable coronary arterydisease(CAD) is commonly triggered by abnormal myocardial perfusionimaging(MPI). However, due to the possibilities of multivessel disease andvariability of coronary artery perfusion distribution, opportunity exists tobetter align anatomic stenosis with perfusion abnormalities to improverevascularization decisions. This study aims to develop a 3D multi-modalityfusion approach to assist decision-making for PCI. Methods. Coronary arteriesfrom fluoroscopic angiography(FA) were reconstructed into 3D artery anatomy.Left ventricular(LV) epicardial surface was extracted from SPECT. The 3D arteryanatomy was non-rigidly fused with the LV epicardial surface. The accuracy ofthe 3D fusion was evaluated via both computer simulation and real patient data.For technical validation, simulated FA and MPI were integrated and thencompared with the ground truth from a digital phantom. For clinical validation,FA and SPECT images were integrated and then compared with the ground truthfrom CT angiograms. Results. In the technical evaluation, the distance-basedmismatch error between simulated fluoroscopy and phantom arteries is1.86(SD:1.43)mm for left coronary arteries(LCA) and 2.21(SD:2.50)mm for rightcoronary arteries(RCA). In the clinical validation, the distance-based mismatcherrors between the fluoroscopy and CT arteries were 3.84(SD:3.15)mm for LCA and5.55(SD:3.64)mm for RCA. The presence of the corresponding fluoroscopy and CTarteries in the AHA 17-segment model agreed well with a Kappa value of 0.91(95%CI: 0.89-0.93) for LCA and 0.80(CI: 0.67-0.92) for RCA. Conclusions. Our fusionapproach is technically accurate to assist PCI decision-making and isclinically feasible to be used in the catheterization laboratory. There is anopportunity to improve the decision-making and outcomes of PCI in stable CAD.

3D Fusion between Fluoroscopy Angiograms and SPECT Myocardial Perfusion Images to Guide Percutaneous Coronary Intervention