Digital quantification eliminates intraobserver and interobserver variability in the evaluation of coronary artery stenosis

Vas, Ran; Eigler, Neal; Miyazono, Calvin; Pfaff, J. Martin; Resser, Kenneth J.; Weiss, Morris M.; Nivatpumin, Thasana; Whiting, James S.; Forrester, James S.

doi:10.1016/0002-9149(85)91122-1

Cited by 57 publications

(16 citation statements)

References 14 publications

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“…Digital quantification of coronary artery stenosis has been shown to yield a better reproducibility than visual interpretation, which leads to a systematic overestimation of stenoses in the intermediate (50-75%) range. 23 Using either a visual or a quantitative automated evaluation of coronary angiograms, Serruys et al 22 emphasized the better reproducibility of automatic assessment of coronary diameter, enabling an absolute definition of restenosis. Although automated computer assessment of stenoses from digital subtraction angiographic images has been carefully validated in the coronary circulation, 24 no validated method exists of automated quantification for renal artery stenoses.…”

Section: Discussionmentioning

confidence: 99%

Restenosis after a first percutaneous transluminal renal angioplasty.

et al. 1993

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The incidence of restenosis after a first successful percutaneous transluminal angioplasty of a native renal artery and the clinical and angiographic variables that may influence its occurrence were studied in 104 hypertensive patients. Angiograms obtained immediately before and after angioplasty and, in 92 patients, 8.8 ±6.0 months after angioplasty were interpreted separately by two observers. Stenosis severity was classified into five grades, and restenosis was defined by a stenosis one grade or more higher at follow-up than immediately after angioplasty. Interobserver concordance for etiology, stenosis grade, and other angiographic items yielded K coefficients in the range of 0328-0.942. Sessions were organized to reach a consensus in each case. Ostial stenoses were more frequent in patients with atheromatous stenoses, and branch stenoses were more frequent in those with fibromuscular dysplasia. There was no significant difference between the 15 patients (16%) with restenosis and those without concerning sex distribution, mean age, mean blood pressure, plasma creatinine level, and etiology distribution. Truncal stenoses were less prone to restenosis than ostial or branch stenoses (12% versus 35%, respectively; 95% confidence interval of difference, -0.6% to 47%). In patients with atheromatous stenoses, aortitis or aortic ectasia were associated with a high restenosis incidence (35% when present versus 8% when absent; 95% confidence interval of difference, 5% to 48%). In conclusion, restenosis was observed in one sixth of patients after a first successful renal angioplasty; its incidence was low in patients with truncal stenoses and high in those with severe aortic atheroma. Automated renal artery stenosis quantification methods are needed to standardize stenosis description.

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Section: Discussionmentioning

confidence: 99%

Restenosis after a first percutaneous transluminal renal angioplasty.

et al. 1993

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“…There is large inter-and intra-observer variability with visual evaluation of coronary cineangiograms [%13] which can be minimized by computerized methods [1,5,14,[15][16][17][18]. Clinical studies evaluating various treatment regimens have mandated a more reproducible method for evaluating coronary disease and, thus, quantitative coronary analysis has gained widespread implementation.…”

Section: Discussionmentioning

confidence: 99%

Effects of video frame averaging, smoothing and edge enhancement on the accuracy and precision of quantitative coronary arteriography

et al. 1990

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Digital analysis of cine film provides numerous options for altering images by frame averaging or filtering algorithms that either smooth or enhance edges. While these may subjectively enhance image quality, there is no uniformity in their use among laboratories and effects on quantitative coronary analysis may not be ideal. To determine which processing algorithms might help or hinder quantitative coronary arteriography, cine film images of precision drilled stenotic cylinders (0.83 to 1.83 nm diameter) implanted in dog coronary arteries were analyzed with and without such algorithms. Video frame averaging of 1 to 49 frames had no effect on measures of accuracy (mean differences) but precision (standard deviation of mean differences) was improved from 0.23 to 0.17 mm (p less than 0.05) with video averaging of greater than or equal to 25 frames. Edge enhancement filtering algorithms resulted in slight deterioration of accuracy and precision and smoothing filtering algorithms caused modest improvements in these parameters; however, these changes were not significantly different from unprocessed images. Using edge enhancement filtering algorithms, accuracy was significantly worse (-0.27 mm) compared to a smoothing filter enhancement algorithm (-0.08 mm, p less than 0.001). The combination of video averaging and smoothing algorithms had no additional beneficial effects. Thus, precision of quantitative coronary analysis of cine film can be optimized by appropriate video averaging. Edge enhancement filtering algorithms should be avoided whereas smoothing filter enhancement algorithms may improve accuracy.

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“…cent diameter stenosis or the interobserver variability of measurements between digital and cine. Vas and Bray came to similar conclusions regarding the comparability of digital and cine methods, but with processed images and study designs not reflective of current clinical practice [21][22][23][24][25][26][27][28][29][30][31][32][33][34].…”

Section: Comparability Of Digital and Film-based Coronary Angiographymentioning

confidence: 94%

Comparison of digital and cine coronary arteriography

Gurley

Nissen

1990

Int J Cardiac Imag

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Digital coronary arteriography has advanced from a curiosity to a powerful clinical tool. This development has been motivated by the new imaging demands of interventional cardiology, by the need for quantifying atherosclerotic disease, and by advances in computer and video technology. Digital imaging has now essentially replaced cinefilm for clinical decision making in some catheterization laboratories, although uncertainty remains regarding the diagnostic comparability of the two modalities. Therefore, we compared simultaneously acquired digital and cine arteriograms from 18 patients with multivessel coronary artery disease. Digital utilized pulse-progressive technique, a 512 x 512 pixel x 8 bit image matrix, and no post processing. Four angiographers interpreted the arteriograms, identifying 131 stenotic lesions for measurement with manual calipers. Measurements of percent diameter stenosis by digital and cine correlated closely (r = 0.88), but digital estimated stenoses to be significantly more severe than cine (p less than 0.0001). This difference was most significant in small (less than 2 mm diameter) arteries, in branch arteries, and with mild stenoses. The differences between digital and cine were not statistically significant for stenoses greater than 50% diameter narrowing. Interobserver variability was similar for digital and cine imaging. Thus, unprocessed digital and film-based coronary arteriography yield similar assessments of atherosclerotic stenoses, but the techniques may not be diagnostically interchangeable. This paper discusses the technical advances which have occurred in digital coronary arteriography, the comparability of digital and cine imaging, and the factors which may be responsible for observed differences between the two modalities.

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Digital quantification eliminates intraobserver and interobserver variability in the evaluation of coronary artery stenosis

Cited by 57 publications

References 14 publications

Restenosis after a first percutaneous transluminal renal angioplasty.

Restenosis after a first percutaneous transluminal renal angioplasty.

Effects of video frame averaging, smoothing and edge enhancement on the accuracy and precision of quantitative coronary arteriography

Comparison of digital and cine coronary arteriography

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