A precise, three-dimensional atlas of myocardial perfusion correlated withcoronary arteriographic anatomy

To map precise myocardial perfusion anatomy, we correlated detailed coronar y arteriographic anatomy for every coronary artery and all secondary branch es in the heart that had How-limiting stenosis with corresponding specific, circumscribed, myocardial perfusion defects by positron emission tomograph y. Eight hundred ninety-five patients with abnormal coronary arteriograms s howing any visible coronary artery narrowing of greater than 10% diameter s tenosis underwent positron emission tomography perfusion imaging at rest an d after dipyridamole stress; the data obtained were processed automatically into 3-dimensional topographic displays of relative radionuclide uptake in anterior, septal, left lateral, and inferior quadrant views, without atten uation artifacts, depth-dependent resolution, or spatial distortion of pola r displays. The selection criterion for detailed anatomic analysis was the presence of a discrete, localized, moderate to severe, dipyridamole-induced perfusion defect, defined by automated algorithms as 1 quadrant view outsi de 2 SDs of healthy control subjects with which a specific stenotic coronar y artery and/or its secondary branches could be correlated unequivocally on the coronary arteriogram for mapping precise perfusion anatomy, not for de termining sensitivity or specificity. Because the anatomy of myocardial perfusion is inherently not statistical d ata, the results are presented as a summary atlas and series of individual cases that illustrate myocardial perfusion anatomy. Because the patterns of myocardial perfusion anatomy were derived from a large number of subjects, the atlas provides generalized information, not previously published, that correlates detailed arteriographic anatomy with perfusion anatomy includin g secondary diagonal, marginal, and posterior descending branches of the co ronary arteries.