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  • Review Article
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Multimodality imaging in interventional cardiology

Nature Reviews Cardiology volume 9, pages 333–346 (2012)Cite this article

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Abstract

'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

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Figure 1: Cardiac hybrid imaging of plaque vulnerability.
Figure 2: Evaluation of coronary artery disease with multidetector CT, MRI, and PET.
Figure 3: Cardiac hybrid imaging with 82Rb-PET–CT.
Figure 4: Black-blood MRI of the coronary artery wall.
Figure 5: Clinical algorithm for imaging in patients with suspected or known CAD.
Figure 6: ECG-gated 18F-FDG–PET–CT hybrid imaging in patients with CRT.
Figure 7: Echocardiographic guidance of the transcatheter edge-to-edge mitral-valve repair procedure.
Figure 8: Multimodality imaging and key steps before, during, and after TAVI.

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  1. Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands

    Bas L. van der Hoeven, Martin J. Schalij & Victoria Delgado

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All the authors contributed substantially to researching the data for this article, discussion of its contents, and to writing, reviewing, and editing the manuscript before submission.

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Correspondence to Victoria Delgado.

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V. Delgado declares that she is or has been a consultant for St. Jude Medical. B. L. van der Hoeven and M. J. Schalij declare no competing interests.

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van der Hoeven, B., Schalij, M. & Delgado, V. Multimodality imaging in interventional cardiology. Nat Rev Cardiol 9, 333–346 (2012). https://doi.org/10.1038/nrcardio.2012.14

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