The Study Of Quantitative Analysis In Coronary Angiography 3-dimensional Reconstruction

Background:Despite advances in cardiovascular imaging, coronary angiography remains the "gold standard" for the assessment of coronary artery disease. Using current X-ray techniques, the complex three-dimensional (3D) spatial relationships of the coronary artery are displayed as two-dimensional images. Vessel overlap and foreshortening of vessel segments in single plane provide inadequate visual information to operators, especially for eccentric stenosis lesions and bifurcation lesions which are not identical in different projected images. With the improvements in computational power, it is now possible to perform 3D reconstruction based on the two image sequences which the difference of projected angles exceed 60°, display of coronary images and quantify complex characteristics of coronary arteries.Objective:Our study is to compare the accuracy of coronary angiography 3-dimensional reconstruction quantitative coronary analysis (3D-QCA) and 2-dimensional quantitative coronary analysis (2D-QCA) in diagnostic accuracy.Materials and methods:①Fifty nine patients (81 vessel segments) undergoing coronary angiography and IVUS check were enrolled for coronary angiography 3D reconstruction. IVUS as a reference standard, to compare the diagnostic accuracy of 3D-QCA and 2D-QCA [ 2D-QCA(M) (the mean of two planes) and 2D-QCA(E)(the plane of extreme stenosis)], included of measuring the parameters of vessel segments—minimal lumen area(MLA), referent vessel area(RVA), area stenosis rate(AS%), contrasting the sensitivity and the specificity of these two methods, and investigating the correlation of Symmetry Index (SI) (the parameter in 3D-QCA) and Eccentric Index(EI) (the parameter in IVUS).②194 patients (225 bifurcation lesions) undergoing stenting were enrolled for coronary angiography 3D reconstruction(the diameter of side branch≥2.0mm), and divided into 3 groups(two-stents, sigle-stent +dilation, sigle-stent no dilation). To analysis parameters and restenosis rates of main vessel (MV) and side branch (SB) detected by 2D-QCA and 3D-QCA, and the comparison of SI between pro-operation and post-operationResults:①In 81 vessel segments, there were non-significant difference in the parameters detected by 2D-QCA, 3D-QCA and IVUS. The subsection found that there were 33 eccentric stenosis lesions(EI>2.0) and a significant difference was noted between 2D-QCA and 3D-QCA, 2D-QCA and IVUS when measured MLA and AS% of them. MLA detected by 2D-QCA was lower and AS% was higher(P<0.05) .There were 48 concentric stenosis vessels and non-significant difference in the measurement of them. In 22 bifurcation lesions, little difference was detected in MV and a apparent difference was founded between 2D-QCA(E) and 3D-QCA, IVUS when measured MLA and AS% in SB (P<0.05) , but the measurement of 3D-QCA and IVUS were non-significantly different.②There were 39 vessels (in total 81 vessels) which AS%≥50% measured by IVUS. The sensitivity of 2D-QCA and 3D-QCA identically were 94.8%, and the specificity. 3D-QCA>2D-QCA(M)>2D-QCA(E) (97.3%, 93.5%, 86.0%) .③In 225 bifurcation lesions, there were non-significant difference in measurement of MV, but when detected MLA and AS% of SB, an obvious difference was founded between 2D-QCA and 3D-QCA (P<0.05) .④The restenosis rates both of MV and SB in 3 groups were 2D-QCA≥3D-QCA (P>0.05).⑤There were linear correlation between SI (the parameter of 3D-QCA) and EI(the parameter of IVUS)( P<0.05)). The comparison of SI between pro-operation and post-operation displayed the shape changing of SB ostium. Conclusion:1. IVUS as a reference standard, 3D-QCA can measure the parameters of coronary stenosis lesions accurately, especially in eccentric stenosis lesions and bifurcation lesions which better than 2D-QCA.2. The specificity of 3D-QCA in diagnosis positive stenosis(AS%≥50%) is higher than 2D-QCA.3. The restenosis rate both of MV and SB evaluated by 2D-QCA are slightly higher than 3D-QCA.4. There are linear correlation between SI (the parameter of 3D-QCA) and EI (the parameter of IVUS). The comparison of SI in pro-operation and in post-operation can display the shape changing of SB ostium.