Influence of operator- and patient-dependent variables on the suitability of automated quantitative coronary arteriography for routine clinical use.

This study was designed to elucidate the operator- and patient-dependent variables inherent in clinical application of quantitative coronary arteriography. Digital arteriograms from 25 consecutive patients undergoing diagnostic catheterization were analyzed by four experienced angiographers utilizing an automated coronary edge detection system to measure percent area stenosis. The identification of potentially significant lesions for quantitation constituted a major source of variability, with unanimous agreement on the presence of a greater than or equal to 50% stenosis occurring at 38 (29%) of the 130 reported sites. Selection of an optimal frame for quantitative analysis resulted in disagreement for every lesion reported. Frame selection by the operator, as opposed to measurement of preselected frames, increased the interobserver variability from 5% to 7% for automated geometric analysis (p less than 0.01), and from 8% to 10.5% for automated densitometric analysis (p less than 0.01). Fully automatic arterial border detection was possible for only 20 (52.5%) of the 38 unanimously identified stenoses. The 18 failures involved one or more of the following factors: 1) stenosis at a bifurcation (13 [72%]); 2) diffuse, severe disease (8 [44%]); 3) excessive vessel tortuosity or overlap or both (4 [22%]); and 4) poor image quality (5 [28%]). In contrast, the same automated border detection algorithm successfully traced all 15 preselected frames of discrete stenoses referred for coronary angioplasty. Automated quantitative coronary arteriography performs well when carefully selected, discrete stenoses are presented to the computer for analysis. However, quantitative analysis of routine clinical coronary arteriograms is limited by operator-dependent variability in stenosis identification and frame selection, as well as by complex coronary anatomy and suboptimal image quality. These limitations make automated quantitative coronary arteriography impractical for routine clinical use.

[1]  D Revel,et al.  [Automatic quantitative analysis of vascular stenosis. Experimental study of a digital angiography system applied to cardiology]. , 1989, Archives des maladies du coeur et des vaisseaux.

[2]  C. J. Kooijman,et al.  Variabilities in measurement of coronary arterial dimensions resulting from variations in cineframe selection. , 1988, Catheterization and cardiovascular diagnosis.

[3]  R. Vogel,et al.  Accuracy of individual and panel visual interpretations of coronary arteriograms: implications for clinical decisions. , 1990, Journal of the American College of Cardiology.

[4]  G W Hamilton,et al.  Physiologic basis for assessing critical coronary stenosis. Instantaneous flow response and regional distribution during coronary hyperemia as measures of coronary flow reserve. , 1974, The American journal of cardiology.

[5]  R. Dinsmore,et al.  Interobserver Variability in Coronary Angiography , 1976, Circulation.

[6]  K. Gould,et al.  Quantification of coronary artery stenosis in vivo. , 1985, Circulation research.

[7]  W. Roberts,et al.  Coronary artery narrowing in coronary heart disease: comparison of cineangiographic and necropsy findings. , 1979, Annals of internal medicine.

[8]  P D Esser,et al.  Quantification of relative coronary arterial stenosis by cinevideodensitometric analysis of coronary arteriograms. , 1984, Circulation.

[9]  M. LeFree,et al.  Automated quantitative coronary arteriography: morphologic and physiologic validation in vivo of a rapid digital angiographic method. , 1987, Circulation.

[10]  C. White,et al.  Comparison by quantitative angiographic assessment of coronary stenoses of one view showing the severest narrowing to two orthogonal views. , 1989, The American journal of cardiology.

[11]  O Nalcioglu,et al.  Videodensitometric determination of minimum coronary artery luminal diameter before and after angioplasty. , 1987, The American journal of cardiology.

[12]  S. Paulin,et al.  Computerized image analysis for quantitative measurement of vessel diameter from cineangiograms. , 1983, Circulation.

[13]  J. J. Gerbrands,et al.  Assessment of short-, medium-, and long-term variations in arterial dimensions from computer-assisted quantitation of coronary cineangiograms. , 1985, Circulation.

[14]  L. Klein,et al.  Quantification of absolute luminal diameter by computer-analyzed digital subtraction angiography: an assessment in human coronary arteries. , 1988, Circulation.

[15]  B Meier,et al.  Assessment of stenoses in coronary angioplasty. Inter- and intraobserver variability. , 1983, International journal of cardiology.

[16]  M. Stadius,et al.  Coronary artery revascularization. Critical need for, and consequences of, objective angiographic assessment of lesion severity. , 1990, Circulation.

[17]  D. Hackel,et al.  Comparison of angiographic and postmortem findings in patients with coronary artery disease. , 1975, The American journal of cardiology.

[18]  T. Takaro,et al.  Observer Agreement in Evaluating Coronary Angiograms , 1975, Circulation.

[19]  S H Brooks,et al.  Reproducibility of a consensus panel in the interpretation of coronary angiograms. , 1978, American heart journal.

[20]  E. Bolson,et al.  Quantitative Coronary Arteriography: Estimation of Dimensions, Hemodynamic Resistance, and Atheroma Mass of Coronary Artery Lesions Using the Arteriogram and Digital Computation , 1977, Circulation.

[21]  K. Lipscomb,et al.  Effects of coronary stenoses on coronary flow reserve and resistance. , 1974, The American journal of cardiology.

[22]  J A Seibert,et al.  Videodensitometric quantitation of stenosis: in vitro and in vivo validation. , 1985, Radiology.

[23]  I C Cooper,et al.  Assessment of coronary angioplasty by an automated digital angiographic method. , 1988, American heart journal.

[24]  M. Sanmarco,et al.  Computerized edge tracking and lesion measurement in coronary angiograms. A pilot study comparing smokers with non-smokers. , 1984, Atherosclerosis.

[25]  W. C. Elliott,et al.  Diagnostic Accuracy of Selective Coronary Cinearteriography , 1967, Circulation.

[26]  C M Grondin,et al.  Discrepancies Between Cineangiographic and Postmortem Findings in Patients with Coronary Artery Disease and Recent Myocardial Revascularization , 1974, Circulation.

[27]  J. Murray,et al.  Variability in the Analysis of Coronary Arteriograms , 1977, Circulation.

[28]  J E Edwards,et al.  Correlation of the Antemortem Coronary Arteriogram and the Postmortem Specimen , 1973, Circulation.

[29]  L. Klein,et al.  Assessment of coronary artery stenoses by digital subtraction angiography: a pathoanatomic validation. , 1987, American heart journal.

[30]  L D Fisher,et al.  Reproducibility of coronary arteriographic reading in the coronary artery surgery study (CASS). , 1982, Catheterization and cardiovascular diagnosis.

[31]  H J ten Katen,et al.  Assessment of percutaneous transluminal coronary angioplasty by quantitative coronary angiography: diameter versus densitometric area measurements. , 1984, The American journal of cardiology.

[32]  K. Gould,et al.  Pressure‐Flow Characteristics of Coronary Stenoses in Unsedated Dogs at Rest and during Coronary Vasodilation , 1978, Circulation research.

[33]  J. J. Gerbrands,et al.  Coronary Artery Dimensions from Cineangiograms-Methodology and Validation of a Computer-Assisted Analysis Procedure , 1984, IEEE Transactions on Medical Imaging.

[34]  E J Topol,et al.  Variability of quantitative digital subtraction coronary angiography before and after percutaneous transluminal coronary angioplasty. , 1987, The American journal of cardiology.

[35]  E R Bates,et al.  A comparison of 35 mm cine film and digital radiographic image recording: implications for quantitative coronary arteriography. Film vs. digital coronary quantification. , 1988, Investigative radiology.

[36]  T. Bashore,et al.  Accuracy of digital angiography for quantitation of normal coronary luminal segments in excised, perfused hearts. , 1987, The American journal of cardiology.

[37]  S. M. Collins,et al.  Visual estimates of percent diameter coronary stenosis: "a battered gold standard". , 1988, Journal of the American College of Cardiology.

[38]  E L Bolson,et al.  A new digital electronic caliper for measurement of coronary arterial stenosis: comparison with visual estimates and computer-assisted measurements. , 1984, The American journal of cardiology.

[39]  G.B.John Mancini,et al.  Comparison of 35 mm Cine Film and Digital Radiographic Image Imaging for Quantitative Coronary Arteriography , 1988 .

[40]  T. Bashore,et al.  Comparison of coronary stenosis quantitation results from on-line digital and digitized cine film images. , 1988, The American journal of cardiology.

[41]  A. Ross,et al.  Interpretation of coronary angiograms. , 1990, Journal of the American College of Cardiology.

[42]  K. Gould,et al.  Physiological Significance of Coronary Flow Velocity and Changing Stenosis Geometry during Coronary Vasodilation in Awake Dogs , 1982, Circulation research.