Quantitative analysis of coronary arteriograms by microprocessor cinevideodensitometry

Abstract

A rapid microprocessor technique for measuring the cross-sectional area, diameter, and relative percentage stenosis of coronary atherosclerotic lesions by cinevideodensitometric analysis was developed and validated. Video images of projected 35-mm coronary arteriographic cine frames were analyzed from cinevideodensitometric profile curves recorded for the catheter shaft, normal artery, and stenotic segment. In radiographic phantom studies of calibrated, contrast-filled, plexiglass cylinders, cinevideodensitometric measurements correlated linearly with percentage relative stenosis (r = 0.98; SEE = 4.1%), diameter (r = 0.99; SEE = 0.12 mm), and cross-sectional area (r = 0.99; SEE = 0.32 mm2). In postmortem studies of two patients dying after coronary arteriography, cross-sectional areas of arterial segments measured by cinevideodensitometry correlated well (r = 0.99; SEE = 0.71 mm) with areas of acrylic resin casts of the coronary arteries. Intraobserver variability (r = 0.99; SEE = 2.6%) and interobserver variability (r = 0.96; SEE = 5.3%) of cinevideodensitometric measurements of coronary arteriograms were low. Additionally, percentage relative stenosis measured in the right anterior oblique projection correlated well with measurements in the left anterior oblique projection (r = 0.98; SEE = 0.11 mm2) of patients with eccentric stenotic lesions. Lastly, cinevideodensitometric measurements were significantly (p less than 0.05) more reproducible than caliper measurements. This inexpensive dedicated microprocessor system provides rapid cinevideodensitometric measurements of coronary arterial dimensions, without requiring manual tracing of arterial segments or the major expense of a main-frame computer system.

Reproducibility of measurements of coronary narrowings by videodensitometry: Unreliability of single view measurements

“…The system has been described in detail in recent publications [9][10][11], and the techniques used were those reported by these authors. Briefly, as described, a diastolic frame from the coronary cineangiogram was chosen for analysis which satisfied the following criteria: the frame was selected from the mid-phase of the injection with the vessel well filled; the radiographic projection chosen was approximately at fight angles to the X-ray beam, in order to display the long axis of the vessel without foreshortening; there was no overlapping of sidebranches at the stenotic or normal segment; finally the catheter and arterial segments were not on the extreme margins of the field.…”

“…We evaluated this system in our laboratory to determine whether such a system could provide the same reproducibility for similar measurements in routine clinical practice, and whether it is indeed sufficient to analyse coronary artery stenoses in only one projection as suggested by the authors [10].…”

“…These include manual tracing of projected cine-angiograms with subsequent computer-assisted analysis of the dimensions [6], digital electronic calipers [7], the computer-based Cardiovascular Angiography Analysis System (CAAS) [8], and cine-videodensitometric analysis [9]. This last system [9], was subsequently manufactured for commercial application by Vanguard Instruments Corporation in conjunction with the developers at Columbia University [10]. These investigators were able to achieve a high degree of intraobserver and interobserver correlation of in vitro and in vivo measurements of percent diameter stenosis, cross-sectional area, percent area stenosis, stenotic diameter and normal diameter.…”

Effects of a Single Oral Dose of Cilostazol on Epicardial Coronary Arteries and Hemodynamics in Humans.

“…The luminal CSA (mm 2 ) in the selected segments (48 segments in total at each sampling point) was measured using a Vanguard XR-70 Coronary Analyzer (Vanguard Instruments Corp, Melville, NY, USA), which is a quantitative coronary analyzing system with computerassisted videodensitometry. 12,13 In brief, the method is based on the finding that the videodensity of cinefilm is linearly proportional to the concentration of intraluminal contrast medium and to the CSA of contrast-filled cylinders. The video image of the selected cine frame is analyzed by positioning the regions of interest (ROIs) on either side of the reference catheter shaft and the artery segment to be measured.…”

An objective computer system for the quantification of artery stenoses

“…Such a system has been developed by the group at the Thoraxcenter in Rotterdam [3][4][5]. A similar system has also been developed by Silver et al [6].…”