A deterministic approach to automated stenosis quantification

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Abstract
We developed a new approach to quantitative coronary angiography (QCA), which overcomes several limitations of available programs, such as dependence on operator input; limited tracking ability; fixed correction of the point spread function (PSF); and different calibration on empty vs. contrast-filled catheters. The program (Intelligent Images QCA, version 1.4) provides absolute reproducibility by deterministic, operator-independent identification of the skeleton and the edges of the coronary tree. The algorithm works as follows: application of a matched filter to emphasize selectively the coronary arteries; adaptive threshold binarization; binary thinning and skeletonization; perpendicular resampling with sub-pixel interpolation; derivative filtering; minimal cost edge detection; and automatic identification and quantification of the stenosis. Operator's interaction is restricted to definition of a region of interest; editing of either skeleton or edges is not allowed. PSF correction is fine-tuned to the actual frequency response of the imaging chain by calibration on a contrast-filled conical lucite phantom. Catheter calibration is carried out by a second derivative-based edge detection much less sensitive to the presence of contrast. In vitro phantom analysis (0.5 to 5.0 mm) showed accuracy of 0.028–0.031 mm and precision of 0.054–0.062 mm on nonmagnified images from the angio TV chain and the cine projector, respectively. In vivo evaluation on a series of consecutive diagnostic angiograms yielded correct contour detection of 70/73 stenoses (96%); interobserver intraframe MLD variability 0.00 mm; correct tracking of catheter edges 100%; interobserver variation coefficient of catheter calibration 3.3%; and mean difference of calibration factor on contrast-filled vs. empty catheters 2.7%. This new approach significantly improves reproducibility with respect to conventional QCA, maintaining high accuracy, precision, and applicability. Cathet. Cardiovasc. Intervent. 48:435–445, 1999.

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