A comparison of the accuracy and reproducibility of digital three-dimensional coronary artery reconstructions using edge detection or videodensitometry

Modeling the 3D coronary tree for labeling purposes

Coronary artery diseases are usually revealed using X-ray angiographies. Such images are complex to analyze because they provide a 2D projection of a 3D object. Medical diagnosis suffers from inter- and intra-clinician variability. Therefore, reliable software for the 3D reconstruction and labeling of the coronary tree is strongly desired. It requires the matching of the vessels in the different available angiograms, and an approach which identifies the arteries by their anatomical names is a way to solve this difficult problem. This paper focuses on the automatic labeling of the left coronary tree in X-ray angiography. Our approach is based on a 3D topological model, built from the 3D anthropomorphic phantom, Coronix. The phantom is projected under different angles of view to provide a data base of 2D topological models. On the other hand, the vessel skeleton is extracted from the patient's angiogram. The algorithm compares the skeleton with the 2D topological model which has the most similar vascular net shape. The method performs in a hierarchical manner, first labeling the main artery, then the sub-branches. It handles inter-individual anatomical variations, segmentation errors and image ambiguities. We tested the method on standard angiograms of Coronix and on clinical examinations of nine patients. We demonstrated successful scores of 90% correct labeling for the main arteries and 60% for the sub-branches. The method appears to be particularly efficient for the arteries in focus. It is therefore a very promising tool for the automatic 3D reconstruction of the coronary tree from monoplane temporal angiographic clinical sequences.

3D coronary reconstruction from routine single-plane coronary angiograms: clinical validation and quantitative analysis of the right coronary artery in 100 patients

BACKGROUND

Current coronary angiographic techniques display complex three-dimensional (3D) coronary structures in two dimensions (2D). We have developed a 3D reconstruction (3DR) algorithm using standard single-plane angiographic images that allows for 3D display of coronary structures. The purpose of this study was to validate our 3DR algorithm and quantify anatomic characteristics of the right coronary artery (RCA) in vivo.

METHODS

Accuracy and reproducibility studies were performed using 3DRs of a coronary phantom and in vivo following 3DRs in 40 patients. The anatomic features of the RCA were then quantified in 100 patients.

RESULTS

Comparison of length and bifurcation angles (BA) from the phantom to the 3DRs revealed good accuracy and correlation for both (r = 0.95 and 0.93 respectively), with diameter error of < 7%. In vivo, the average root mean square (RMS) error in the spatial coordinates of the vessel centerlines was 3.12 +/- 0.77 and 3.16 +/- 0.75 mm in 20 left coronary arteries (LCA) and 20 RCAs respectively. Interobserver average RMS error was 3.47 +/- 1.96 mm and intraobserver average RMS error was 3.02 +/- 1.07 and 3.44 +/- 1.57 mm for two different operators (p = NS). The average RCA length was 10.2 +/- 1.7 cm, average radius of curvature (ROC) was 52 +/- 9 degrees, and the average 3D bifurcation angle of the posterior descending artery (PDA) from the RCA was 55 +/- 22 degrees. Foreshortening (FS) of the segments of the RCA in three 'standard' projections ranged from 0-60, 0-75, and 0-82% respectively.

CONCLUSIONS

Using our 3DR algorithm patient-specific anatomic characteristics can be accurately displayed and quantified, expanding the information that can be derived from routine coronary angiography.

Validation of an accurate method for three-dimensional reconstruction and quantitative assessment of volumes, lengths and diameters of coronary vascular branches and segments from biplane angiographic projections

The goal of the study was the validation of an accurate method for three-dimensional reconstruction and quantitative assessment of volumes, lengths and diameters of coronary vascular branches and segments from biplane angiographic projections.

METHODS

The accuracy was tested in a complex phantom. In vivo, inter- and intraobserver agreement were assessed by analysis of routine angiograms. The sensitivity was evaluated using angiograms of patients having diagnostic vasoactive pharmacological intervention. Two-dimensional quantitative coronary angiography (2-D QCA) and 3-D QCA were compared concerning the accuracy of diameter evaluation.

RESULTS

3-D QCA yields accurate results (< 3% error) even based on nonorthogonal views, provided that projections parallel to the object are avoided. The inter- and intraobserver variability is < or = 5%. Significant (p < 0.01) changes of the volume (36-39%) and the diameter (19-21%) are detected following pharmacological intervention. 2-D QCA and 3-D QCA agree in short matched segments without foreshortening. 2-D QCA is rather sensitive to foreshortening and not suitable for evaluation of diameters of longer branches or total coronaries.

CONCLUSION

3-D QCA permits an accurate, reproducible and sensitive comprehensive three-dimensional geometric analysis of the coronaries and is superior to 2-D QCA with respect to extended diameter evaluation.

Validation of an accurate method for three-dimensional reconstruction and quantitative assessment of volumes, lengths and diameters of coronary vascular branches and segments from biplane angiographic projections

The goal of the study was the validation of an accurate method for three-dimensional reconstruction and quantitative assessment of volumes, lengths and diameters of coronary vascular branches and segments from biplane angiographic projections.

METHODS

The accuracy was tested in a complex phantom. In vivo, inter- and intraobserver agreement were assessed by analysis of routine angiograms. The sensitivity was evaluated using angiograms of patients having diagnostic vasoactive pharmacological intervention. Two-dimensional quantitative coronary angiography (2-D QCA) and 3-D QCA were compared concerning the accuracy of diameter evaluation.

RESULTS

3-D QCA yields accurate results (< 3% error) even based on nonorthogonal views, provided that projections parallel to the object are avoided. The inter- and intraobserver variability is < or = 5%. Significant (p < 0.01) changes of the volume (36-39%) and the diameter (19-21%) are detected following pharmacological intervention. 2-D QCA and 3-D QCA agree in short matched segments without foreshortening. 2-D QCA is rather sensitive to foreshortening and not suitable for evaluation of diameters of longer branches or total coronaries.

CONCLUSION

3-D QCA permits an accurate, reproducible and sensitive comprehensive three-dimensional geometric analysis of the coronaries and is superior to 2-D QCA with respect to extended diameter evaluation.