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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Quantitative assessment of diffuse coronary artery disease using a three-dimensional reconstruction method compared
T Tsuchiya1, M Shimizu, H Yoshio
1Second Department of Internal Medicine, School of Medicine, Kanazawa University, Japan.
Insights
Estimating coronary artery stenosis in diffuse disease is challenging. This study validates a new method using coronary arteriograms to calculate normal lumen size, enabling accurate stenosis quantification.
Area of Science:
- Cardiovascular imaging
- Interventional cardiology
- Medical diagnostics
Background:
- Estimating stenosis in diffuse coronary artery disease (CAD) is difficult due to the absence of normal reference segments.
- A potential solution involves relating normal coronary lumen size to the distal myocardial bed to estimate 'normal' lumen area.
- This could allow for stenosis degree estimation in diffuse CAD by comparing to calculated normal areas.
Purpose of the Study:
- To validate the hypothesis that normal coronary lumen size correlates with distal myocardial bed size.
- To establish a method for estimating normal coronary lumen area in patients with diffuse coronary artery disease (CAD).
Main Methods:
- Simultaneous bidirectional coronary arteriography was performed on 14 healthy subjects (Group A) and 16 patients with CAD (Group B).
- A computerized edge-detection system measured coronary lumen cross-sectional area.
- A 3D reconstruction method calculated summed distal branch length.
Main Results:
- A strong correlation (r=0.948) was found between lumen area and branch length in Group A.
- In Group B, some segments showed lumen areas smaller than expected based on the Group A relationship.
- Calculated stenosis ratios for 22 segments strongly correlated with intravascular ultrasound measurements (r=0.980).
Conclusions:
- The study successfully validated a novel approach for quantifying diffuse coronary artery disease (CAD).
- This method utilizes clinical arteriograms to estimate stenosis severity, addressing a significant clinical challenge.
Background:
It can be difficult to estimate the degree of stenosis in patients with diffuse coronary artery disease (CAD), because of the lack of a normal reference segment. If the size of normal coronary lumen has a direct relation to size of distal myocardial bed, it could be used to estimate the 'normal' cross-sectional area of coronary lumen. Accordingly, we could estimate the degree of stenosis of coronary arteries with diffuse disease by comparing them with calculated 'normal' areas of lumen.
Objective:
To assess the validity of the above hypothesis.
Method:
Fourteen subjects without coronary atherosclerosis (group A) and 16 patients with CAD (group B) underwent simultaneous bidirectional coronary arteriography. Using these coronary arteriograms, we determined the relationship between cross-sectional area of coronary lumen measured by using a computerized edge-detection system and summed distal branch length calculated by using our computerized three-dimensional reconstruction method.
Results:
For group A, we found a close correlation between area of lumen and branch length (r= 0.948). However, for group B, there were some segments for which the measured area of lumen was clearly smaller than that expected from the relationship for group A. From this relationship for group A, we calculated the stenosis ratios of 22 segments and, to confirm their accuracy, we compared the stenotic ratios with those measured on intravascular ultrasound images. The stenotic ratio of each segment of stenotic coronary artery calculated by our method agreed significantly well with the results obtained from the ultrasound measurements (r= 0.980).
Conclusions:
These observations validate a novel approach to quantifying diffuse CAD using clinical arteriograms.
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