A comparison of quantitative coronary angiography systems using a unique set of in vivo coronary stenosis images

To compare the accuracy and precision of measurements of minimum lumen diameter (MLD) among two existing, and one new, quantitative coronary angiography systems.

The analysis was performed using in vivo cinearteriograms of precisely drilled, radiolucent plastic beads that were inserted percutaneously into the coronary arteries of canines. The existing algorithms compared were the ArTrek and the Coronary Measurement System (CMS). The latter was applied in two modes: a mode based on a minimal cost analysis algorithm and a mode based on a gradient field transform. The new algorithm (CorTrek) was also applied in two modes: a mode called the ArTrek compatible mode and a mode known as the 'regression' mode. The latter mode uses a look-up table, based on a phantom calibration step, to readjust the measured MLD to overcome system nonlinearities (overestimation of small diameters and underestimation of large diameters).

In the absence of editing, the optimal accuracy (no significant bias) was achieved with the ArTrek compatible algorithm (-0.03 mm for an MLD between 0.83 and 1.83 mm). All other algorithms showed significant under- or overestimation of the MLD within this range. The precision ranged from 0.18 to 0.40 mm without editing, and was best with the ArTrek algorithm.

The present study provides in vivo validation and comparative performance characteristics of a new, accurate coronary quantitative angiography system.