A novel three-dimensional quantitative coronary angiography system: In-vivo comparison with intravascular ultrasound for assessing arterial segment length†

Background: Accurate on-line assessments of vessel dimensions are of utmost importance for selecting the appropriate stent size in coronary interventions. Recently a new three-dimensional quantitative coronary angiography (3D QCA) analytical software package was developed to accurately assess the vessel dimensions for the planning and guidance of such coronary interventions. This study aimed to validate the 3D QCA software package for assessing arterial segment length by comparing with intravascular ultrasound (IVUS). In addition, the difference in the two measurements from 3D QCA and IVUS for curved segments was studied. Methods: A retrospective study including 20 patients undergoing both coronary angiography and IVUS examinations of the left coronary artery was set up for the validation. The same vessel segments of interest between proximal and distal markers were identified and measured on both angiographic and IVUS images, by the 3D QCA software and by a quantitative IVUS software package, respectively. In addition, the curvature of each of the segments of interest was assessed and the correlation between the accumulated curvature of the segment and the difference in segment lengths measured from the two imaging modalities was analyzed. Results: 37 vessel segments of interest were identified from both angiographic and IVUS images. The 3D QCA segment length was slightly longer than the IVUS segment length (15.42 ± 6.02 mm vs. 15.12 ± 5.81 mm, P = 0.040). The linear correlation of the two measurements was: 3D QCA Length = −0.09 + 1.03 × IVUS Length (r2 = 0.98, P < 0.001). Bland-Altman plot showed that the difference in the two measurements was not correlated with the average of the two measurements (P = 0.141), but with the accumulated curvature of the segment (P = 0.015). After refining the difference by the correlation, the average difference of the two measurements decreased from 0.30 ± 0.86 mm (P = 0.040) to 0.00 ± 0.78 mm (P = 0.977). Conclusions: The 3D QCA software package can accurately assess the actual arterial segment length. The difference in segment lengths measured from 3D QCA and IVUS was correlated with the accumulated curvature of the segment. © 2010 Wiley-Liss, Inc.