Determination of left ventricular ejection fraction by computer densitometric analysis of digital subtraction angiography: Experimental validation and correlation with area-length methods

Nissen, Steven E.; Élion, Jacques; Grayburn, Paul A.; Booth, David C.; Wisenbaugh, Thomas; DeMaria, Anthony N.

doi:10.1016/0002-9149(87)91191-x

Cited by 19 publications

(7 citation statements)

References 13 publications

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“…This comparison demonstrated that the dual-energy images were of sufficient quality to support quantitative analysis techniques. Two important quantitative techniques are densitometric analysis [7][8][9] and parametric imaging [17]. Both of these methodologies require some means of subtracting image structures unrelated to the signal of interest.…”

Section: Misregistration Artifactsmentioning

confidence: 99%

“…Contrast enhancement allows ventriculography to be performed with direct left ventricular injection of small amounts of contrast material [1][2][3] or with a venous injection [3][4][5][6]. Subtraction allows the determination of ejection fractions from high resolution images using an intravenous injection and videodensitometric techniques [7][8][9]. The potential for measuring absolute left ventricular volume exists [10].…”

Section: Introductionmentioning

confidence: 99%

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Left ventricular dual-energy digital subtraction angiography: a motion immune digital subtraction technique

et al. 1991

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Digital subtraction angiography (DSA) allows quantitative analysis of ventricular function via densitometric and parametric imaging techniques. However, DSA is limited by the artifacts in temporal subtraction images that result from patient and cardiac motion. Dual-energy subtraction imaging is insensitive to motion. This study evaluated the initial application of dual-energy subtraction in cardiac patients. The image quality of dual-energy subtraction left ventriculograms obtained from a pulmonary artery injection of contrast was assessed in 13 patients, ranging in weight from 54 to 100 kg. The dual-energy images were compared with left ventricular images obtained using standard left ventricular injection cine angiography. End-systolic and end-diastolic ventricular volumes calculated from the cine (C) and dual-energy (DE) images using the Area-Length method were compared. The resulting regression line was DE = 0.98 C+ 7.0 ml, and the r value was 0.987. Dual-energy subtraction provided good left ventricular visualization, free from misregistration artifacts, even during patient motion.

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Section: Misregistration Artifactsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Left ventricular dual-energy digital subtraction angiography: a motion immune digital subtraction technique

et al. 1991

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“…Therefore, formerly videodensitometry was tested experimentally by electromagnetic flowmeters [1,2,11] and clinically by comparing the results derived from videometry and thermodilution [8,12,13]. In this study for the first time the method was validated by generating and evaluating well defined 'in vitro angiocardiograms' (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…For analog videodensitometry, to remove these pre-contrast fluctuations, So and Do are measured in the time-density curve before contrast injection [1,7,8]. For digital densitometry they can be removed by ECG gated mask image subtraction [14].…”

Section: Methodsmentioning

confidence: 99%

“…i upper panel). Proposed solutions to this problem are to approximate that rise functionally [3,12,13] or to record it with the aid of a region next to the ventricle [4,5,8]. We found that the application of the method of differences introduced for the determination of FEF for analog densitometry by Falliner and coworkers [11] was both simple and reliable.…”

Section: Methodsmentioning

confidence: 99%

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Determination of cardiac ejection and valvular regurgitant fraction by on-line digital densitometry — methodology, validation, and application

1991

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Videodensitometry allows to obtain both left and right ventricular ejection fraction (EF) and aortic or pulmonary regurgitant fraction (RGF) from the wash-out curve of contrast medium. We developed this technique to digital densitometry and integrated it in the standard digital image acquisition system 'Digitron' using Siemens user's library. Sources of error like scatter radiation, veiling glare, accumulation of iodine in tissue, and inhomogeneous contrast mixing were considered by using ECG gated image subtraction, background reference regions, data fit to ideal wash-out curves and calculation of EF and RGF exclusively from density differences. The method was validated by phantom studies in which simulated angiocardiograms were generated with given values of EF (50 to 70%) and RGF (0 to 45%). The results tended to overestimate RGF by up to 10 percent points, when image contrast was high and the ventricle was masked poorly by the lead shutters. In the clinical setting, the reliability of the results can be judged from the fit of the wash-out curve presented automatically on the screen on a semi-logarithmic scale. The technique is available to the physician in the catheterization laboratory on-line during or immediately after the examination, which facilitates routine use.

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On‐line evaluation of systolic performance by densitometry in digital left ventriculography

Lehmkuhl

Altstidl

Machnig

et al. 1996

Clinical Cardiology

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Summary:The angiocardiographic evaluation of left ventricular end-diastolic (LVEDV) and end-systolic (LVESV) volumes and ejection fraction (EF) is routinely performed by the area-length method (ALM) but may lead to erroneous results. Digital imaging in real time allows densitometric procedures of determining left ventricular (LV) performance to be applied alternatively. In this study, we present densitometric algorithms for the analysis of LVEDV, LVESV, and EF from digital image data, establish accuracy and reproducibility, *and determine value and limitations in comparison with ALM in single-plane 30" right anterior oblique (RAO) projection. A linear relationship between iodine depth and measured densities is mainly burdened with scatter radiation and beam hardening which reduce primary radiation and suppress iodine depth. However, facilities such as deconvolution and correction algorithms are capable of reducing these sources of error.In the present study, computer-analyzed contrast images of iodine-tilled wedges and spheres showed a near-linear relationship between iodine depth between 50-100 mg/cm' and measured densities. Contrast images of heart casts and LV angio-grams of 54 patients were obtained with a digital image acquisition and processing system, and evaluated by two in- The angiographic study of patients demonstrated significant correlations between both methods (LVEDV r = 0.78, LVESV r = 0.83, total volumes: r = 0.89; EF r = 0.88). The standard errors of estimate can be ascribed to systematic, method-related errors of both DENS and ALM (LVEDV k 28.9 ml, LVESV f 23.4 ml, total volumes (EDV and ESV) f 27.1 ml; EF & 8.1 %). The intra-and interobserver variability, respectively, exhibited significantly smaller (p 5 0.0 1 and p I 0.05, respectively) standard errors of estimate for densitometric EF [4.6% (DENS) vs. 8.5% (ALM) and 7.1% (DENS) vs. 10.3% (ALM), respectively]. Inclined but not significant differences were found for LVEDV and LVESV. In conclusion, the data presented indicate that the calculation of LV volumes and EF in digital left ventriculography may be performed accurately by densitometric calculation in single-plane 30" RAO projection. Minor underestimations in densitometric volume determination may be anticipated in the evaluation of LV geometry.

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Determination of left ventricular ejection fraction by computer densitometric analysis of digital subtraction angiography: Experimental validation and correlation with area-length methods

Cited by 19 publications

References 13 publications

Left ventricular dual-energy digital subtraction angiography: a motion immune digital subtraction technique

Left ventricular dual-energy digital subtraction angiography: a motion immune digital subtraction technique

Determination of cardiac ejection and valvular regurgitant fraction by on-line digital densitometry — methodology, validation, and application

On‐line evaluation of systolic performance by densitometry in digital left ventriculography

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