Quantitative evaluation of myocardial function by a volume-normalized map generated from relative blood flow

Our study aimed to quantitatively evaluate blood flow in the left ventricle (LV) of apical hypertrophic cardiomyopathy (APH) by combining wall thickness obtained from cardiac magnetic resonance imaging (MRI) and myocardial perfusion from single-photon emission computed tomography (SPECT). In this study, we considered paired MRI and myocardial perfusion SPECT from ten patients with APH and ten normals. Myocardial walls were detected using a level set method, and blood flow per unit myocardial volume was calculated using 3D surface-based registration between the MRI and SPECT images. We defined relative blood flow based on the maximum in the whole myocardial region. Accuracies of wall detection and registration were around 2.50 mm and 2.95 mm, respectively. We finally created a bull's-eye map to evaluate wall thickness, blood flow (cardiac perfusion) and blood flow per unit myocardial volume. In patients with APH, their wall thicknesses were over 10 mm. Decreased blood flow per unit myocardial volume was detected in the cardiac apex by calculation using wall thickness from MRI and blood flow from SPECT. The relative unit blood flow of the APH group was 1/7 times that of the normals in the apex. This normalization by myocardial volume distinguishes cases of APH whose SPECT images resemble the distributions of normal cases