ASNC presentation
Corridor4DM: The Michigan method for quantitative nuclear cardiology

https://doi.org/10.1016/j.nuclcard.2007.06.006Get rights and content

Quantitative software for the analysis and review of myocardial perfusion emission computed tomography images is an indispensable tool in the nuclear physician’s evaluation of patients with known or suspected heart disease. The Corridor4DM (4DM) application (formerly known as 4DM-SPECT), developed at the University of Michigan Medical Center, is a quantitative software application providing automated processing, analysis, and reporting of myocardial perfusion and function from cardiac emission computed tomography studies in a tightly integrated, user-centered environment. With health care placing increased emphasis on higher quality and efficiency in diagnostic imaging, quantitative analysis and review software applications need to provide a comprehensive environment supporting correlative review of multimodality images, integrated report generation, and remote review capabilities. The current and future design capabilities of the 4DM software application are discussed with respect to the changing landscape of imaging, where cardiac computed tomography, positron emission tomography, structured reporting, and remote review are expanding the base requirement specifications for quantitative software.

Introduction

Quantitative software for the analysis and review of myocardial perfusion emission computed tomography (ECT) images is an indispensable tool in the nuclear physician’s evaluation of patient studies for the diagnosis and assessment of coronary artery disease (CAD) and heart failure. Accurate and comprehensive software applications that can provide correlative information on cardiac function, perfusion, metabolism, and anatomy in a single, integrated environment improve diagnostic accuracy and efficiency of the imaging professional. Nuclear cardiology is fortunate to have several automated quantitative software packages that have extensive clinical validation available for routine clinical use. 4DM-SPECT, one of these packages, is the focus of this discussion.

4DM-SPECT was initially developed in the Nuclear Medicine Research Laboratory at the University of Michigan (Ann Arbor, Mich) between 1994 and 1996. The focus of this early development was to clinically validate new attenuation correction methods for cardiac perfusion single photon emission computed tomography (SPECT) by providing new methods for perfusion database creation and patient study comparisons. To handle the demands of these clinical validations, 4DM-SPECT was designed with a flexible framework to include many advanced statistical and correlative features for data analysis. This framework developed into a user-centered review environment. The user was afforded many configurable options for inclusion in the analysis and review environment. The combination of a user-centered environment with automated processing algorithms for accurate quantitative estimates of SPECT myocardial perfusion and function made for early success of the program when it was commercialized in 2001.

Today, the developers (INVIA, Ann Arbor, Mich) of 4DM-SPECT recognize the changing landscape of diagnostic cardiac imaging. Cardiac positron emission tomography (PET) and computed tomography (CT) imaging will have more prominent roles in cardiac imaging. To embrace the new landscape, 4DM-SPECT has adopted the name Corridor4DM (4DM) with expanded processing and review modules for cardiac SPECT, PET, and CT. The Corridor4DM name symbolizes the focused path from image acquisition to the final clinical diagnosis and report. 4DM uses the same proven methods of development and validation for 4DM-SPECT, with strong clinical input from the University of Michigan and other clinical partners. The aim of the 4DM development team is to provide state-of-the-art software for the current and future generations of cardiac diagnostic imaging protocols.

Section snippets

Comprehensive quantitative analysis

4DM’s framework was engineered to provide an integrated environment with automated processing, analysis, and reporting of reconstructed ECT. Specifically, 4DM provides the following capabilities:

  • Automated processing of gated and ungated ECT (PET or SPECT) volumetric images for left ventricular (LV) function (if gated) and perfusion

  • Automated processing of gated blood pool SPECT images

  • Review of raw SPECT projection data

  • Review of CT volumetric images, stand-alone or fused with ECT data

  • Review of

Connectivity for improved utilization

Quantification and review software will have an increasingly important role as clinics need to achieve more timely reporting with increased efficiency. To this end, it is becoming increasingly common for physicians and clinicians to demand access to imaging study data outside of the traditional confines of the laboratory and fixed review stations. Standardization of radiology information system/picture archive communication system (PACS) systems allows for efficient communication and

Support for CT and hybrid ECT-CT imaging

With advancements in cardiovascular imaging, new quantitative display and review methods are necessary to fulfill the needs of the cardiovascular imaging professional. Dedicated CT and hybrid PET-CT and SPECT-CT imaging systems offer the exciting potential for correlating CT anatomy with ECT perfusion and function. For hybrid ECT-CT imaging systems combined with breathhold CT imaging protocols, the physician is presented with substantially larger volumes of image data from which more diagnostic

Conclusion

With increasing directives to maximize accuracy and efficiency in diagnostic imaging, automated, reproducibly accurate, quantitative methods are necessary to provide high-quality diagnoses. The future of quantitative software will require a single, comprehensive environment with tightly integrated processing and review of myocardial perfusion, function, metabolism, and anatomy. A single environment improves accuracy by providing tightly correlated information to the interpreting physician and

Acknowledgment

We thank Dr John J. Mahmarian for the CT and SPECT image data shown in Figure 8B. We also acknowledge Laura Berarducci for her assistance in preparing this manuscript.

E.P.F. and J.R.C. acknowledge that they are founding members of INVIA (Ann Arbor, Mich), which has the exclusive development and licensing rights for the Corridor 4DM software.

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