Quantitative coronary angiography: Technical issues
- Morton J Kern, MD, MSCAI, FAHA, FACC
Morton J Kern, MD, MSCAI, FAHA, FACC
- Professor of Medicine
- University of California, Irvine
A reduction in the coronary artery luminal cross-sectional diameter, estimated by the visual inspection of the radiocontrast column or lumenogram during conventional angiography, has been utilized to formulate predictions about clinical presentations and stress-induced reductions in coronary blood flow. Anatomic and physiologic approaches to coronary artery disease are complementary but because of numerous factors not evident from angiography (eg, length, entrance angle, coefficient of separation of laminar flow) comparison data yield contradictory results. As a result, quantitative approaches to the angiographic evaluation of coronary anatomy are infrequently employed on a routine daily basis in most laboratories. The greatest advantage of quantitative coronary angiography is its theoretical freedom from observer influences and bias, thereby minimizing significant potential intraobserver and interobserver variability.
The technical issues related to quantitative coronary angiography will be reviewed here. The clinical utility of this procedure is discussed separately. (See "Quantitative coronary angiography: Clinical applications".)
Many techniques are available for computer applications that permit quantification of coronary stenosis . A quantitative analysis of the angiogram requires some form of optical magnification of the cineangiographic image which, in turn, permits computer-assisted definition and quantitation of disease severity. With the off-line techniques, image acquisition proceeds in the conventional manner, with the generation of a digital cineangiogram displayed on the image processor. Digital quantitation of selected image frames can be made with or without electronic magnification, easily accomplished with modern digital quantitative software and analysis systems.
A two-times magnification factor is utilized in most laboratories, without regard to the optical system employed. The positioning of the camera and selection of the lens system is usually accomplished manually. After digitization, and prior to computer analysis, the images are stored in a specifically designed image processing system. These systems vary in complexity and cost, and are available with a large selection of hardware and software.
On-line digital systems and computer application packages have become widely available through commercial distribution. These systems are designed to facilitate accurate clinical analysis of thrombolysis, stent deployment, and other endovascular interventions. The major impediment to universal application of on-line quantitation has been image quality. Advances in image-enhancement continue to refine the utility of on-line quantitation.
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