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Diagnostic Accuracy of Image Postprocessing Methods for the Detection of Coronary Artery Stenoses by Using Multidetector CT¹

¹ From the Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (M.F., S.A., R.C.C., U.H., K.N., T.J.B., F.M., S.A.); and Department of Internal Medicine II, University of Erlangen, Ulmenweg 18, Erlangen 91054, Germany (D.R., W.G.D., S.A.). Received January 15, 2006; revision requested March 14; revision received May 24; accepted June 8; final version accepted October 4. Supported in part by Staedtler-Foundation, Nuremberg, Germany. M.F. supported in part by National Institutes of Health grant 1 T32 HL076136-02. K.N. supported by Interuniversity Cardiology Institute of the Netherlands (Utrecht, the Netherlands). F.M. supported by Daniela und Juergen Westphal-Stiftung, Flensburg, Germany. Address correspondence to S.A. (e-mail: stephan.achenbach{at}med2.med.uni-erlangen.de).

View larger version (16K): [in this window] [in a new window] [Download PPT slide]   Figure 1: Flow diagram describes number of subjects considered for the study and number of subjects excluded due to high heart rate or motion artifacts. bpm = Beats per minute.

View larger version (109K): [in this window] [in a new window] [Download PPT slide]   Figure 2a: Image postprocessing methods used in analysis of right coronary artery. (a) Transverse images. Operators could interactively move up and down stack of transverse images, which were reconstructed with 1.0-mm section thickness and 0.5-mm increment. Shown here is origin of the right coronary artery (arrow). (b) Oblique MPR. Operators could interactively and freely manipulate position and orientation of imaging plane. Right coronary artery image section was 1.0 mm thick (arrows). (c) Oblique MIP. Operators could interactively and freely manipulate position and orientation of image, consisting of a 5-mm section, displaying attenuation for each image pixel. This form of reconstruction allows depiction of longer segments of a given coronary artery. Section position and orientation of c are identical to those of b (arrow = right coronary artery). (d, e) Curved MPR. By using transverse and coronary images as reference, the artery course was interactively traced by an independent operator. A 1-mm MPR image was rendered, the plane of which followed the outlined trace. Images d and e show the resulting display of the right coronary artery (arrow). (f, g) Curved MIP. As with d and e, the course of the right coronary artery is traced. The image is then displayed as an MIP (3 mm thick). Images f and g show the resulting display of the right coronary artery (arrow). (h) Three-dimensional reconstruction. Image data set was segmented by an independent operator and subsequently displayed as 3D surface-weighted VRT image. The images could be viewed from any desired angle to assess the course of all arteries (arrows = right coronary artery). (i) Corresponding conventional coronary angiogram (arrow = right coronary artery) of the same patient.

View larger version (118K): [in this window] [in a new window] [Download PPT slide]   Figure 2b: Image postprocessing methods used in analysis of right coronary artery. (a) Transverse images. Operators could interactively move up and down stack of transverse images, which were reconstructed with 1.0-mm section thickness and 0.5-mm increment. Shown here is origin of the right coronary artery (arrow). (b) Oblique MPR. Operators could interactively and freely manipulate position and orientation of imaging plane. Right coronary artery image section was 1.0 mm thick (arrows). (c) Oblique MIP. Operators could interactively and freely manipulate position and orientation of image, consisting of a 5-mm section, displaying attenuation for each image pixel. This form of reconstruction allows depiction of longer segments of a given coronary artery. Section position and orientation of c are identical to those of b (arrow = right coronary artery). (d, e) Curved MPR. By using transverse and coronary images as reference, the artery course was interactively traced by an independent operator. A 1-mm MPR image was rendered, the plane of which followed the outlined trace. Images d and e show the resulting display of the right coronary artery (arrow). (f, g) Curved MIP. As with d and e, the course of the right coronary artery is traced. The image is then displayed as an MIP (3 mm thick). Images f and g show the resulting display of the right coronary artery (arrow). (h) Three-dimensional reconstruction. Image data set was segmented by an independent operator and subsequently displayed as 3D surface-weighted VRT image. The images could be viewed from any desired angle to assess the course of all arteries (arrows = right coronary artery). (i) Corresponding conventional coronary angiogram (arrow = right coronary artery) of the same patient.

View larger version (121K): [in this window] [in a new window] [Download PPT slide]   Figure 2c: Image postprocessing methods used in analysis of right coronary artery. (a) Transverse images. Operators could interactively move up and down stack of transverse images, which were reconstructed with 1.0-mm section thickness and 0.5-mm increment. Shown here is origin of the right coronary artery (arrow). (b) Oblique MPR. Operators could interactively and freely manipulate position and orientation of imaging plane. Right coronary artery image section was 1.0 mm thick (arrows). (c) Oblique MIP. Operators could interactively and freely manipulate position and orientation of image, consisting of a 5-mm section, displaying attenuation for each image pixel. This form of reconstruction allows depiction of longer segments of a given coronary artery. Section position and orientation of c are identical to those of b (arrow = right coronary artery). (d, e) Curved MPR. By using transverse and coronary images as reference, the artery course was interactively traced by an independent operator. A 1-mm MPR image was rendered, the plane of which followed the outlined trace. Images d and e show the resulting display of the right coronary artery (arrow). (f, g) Curved MIP. As with d and e, the course of the right coronary artery is traced. The image is then displayed as an MIP (3 mm thick). Images f and g show the resulting display of the right coronary artery (arrow). (h) Three-dimensional reconstruction. Image data set was segmented by an independent operator and subsequently displayed as 3D surface-weighted VRT image. The images could be viewed from any desired angle to assess the course of all arteries (arrows = right coronary artery). (i) Corresponding conventional coronary angiogram (arrow = right coronary artery) of the same patient.

View larger version (114K): [in this window] [in a new window] [Download PPT slide]   Figure 2d: Image postprocessing methods used in analysis of right coronary artery. (a) Transverse images. Operators could interactively move up and down stack of transverse images, which were reconstructed with 1.0-mm section thickness and 0.5-mm increment. Shown here is origin of the right coronary artery (arrow). (b) Oblique MPR. Operators could interactively and freely manipulate position and orientation of imaging plane. Right coronary artery image section was 1.0 mm thick (arrows). (c) Oblique MIP. Operators could interactively and freely manipulate position and orientation of image, consisting of a 5-mm section, displaying attenuation for each image pixel. This form of reconstruction allows depiction of longer segments of a given coronary artery. Section position and orientation of c are identical to those of b (arrow = right coronary artery). (d, e) Curved MPR. By using transverse and coronary images as reference, the artery course was interactively traced by an independent operator. A 1-mm MPR image was rendered, the plane of which followed the outlined trace. Images d and e show the resulting display of the right coronary artery (arrow). (f, g) Curved MIP. As with d and e, the course of the right coronary artery is traced. The image is then displayed as an MIP (3 mm thick). Images f and g show the resulting display of the right coronary artery (arrow). (h) Three-dimensional reconstruction. Image data set was segmented by an independent operator and subsequently displayed as 3D surface-weighted VRT image. The images could be viewed from any desired angle to assess the course of all arteries (arrows = right coronary artery). (i) Corresponding conventional coronary angiogram (arrow = right coronary artery) of the same patient.

View larger version (116K): [in this window] [in a new window] [Download PPT slide]   Figure 2e: Image postprocessing methods used in analysis of right coronary artery. (a) Transverse images. Operators could interactively move up and down stack of transverse images, which were reconstructed with 1.0-mm section thickness and 0.5-mm increment. Shown here is origin of the right coronary artery (arrow). (b) Oblique MPR. Operators could interactively and freely manipulate position and orientation of imaging plane. Right coronary artery image section was 1.0 mm thick (arrows). (c) Oblique MIP. Operators could interactively and freely manipulate position and orientation of image, consisting of a 5-mm section, displaying attenuation for each image pixel. This form of reconstruction allows depiction of longer segments of a given coronary artery. Section position and orientation of c are identical to those of b (arrow = right coronary artery). (d, e) Curved MPR. By using transverse and coronary images as reference, the artery course was interactively traced by an independent operator. A 1-mm MPR image was rendered, the plane of which followed the outlined trace. Images d and e show the resulting display of the right coronary artery (arrow). (f, g) Curved MIP. As with d and e, the course of the right coronary artery is traced. The image is then displayed as an MIP (3 mm thick). Images f and g show the resulting display of the right coronary artery (arrow). (h) Three-dimensional reconstruction. Image data set was segmented by an independent operator and subsequently displayed as 3D surface-weighted VRT image. The images could be viewed from any desired angle to assess the course of all arteries (arrows = right coronary artery). (i) Corresponding conventional coronary angiogram (arrow = right coronary artery) of the same patient.

View larger version (124K): [in this window] [in a new window] [Download PPT slide]   Figure 2f: Image postprocessing methods used in analysis of right coronary artery. (a) Transverse images. Operators could interactively move up and down stack of transverse images, which were reconstructed with 1.0-mm section thickness and 0.5-mm increment. Shown here is origin of the right coronary artery (arrow). (b) Oblique MPR. Operators could interactively and freely manipulate position and orientation of imaging plane. Right coronary artery image section was 1.0 mm thick (arrows). (c) Oblique MIP. Operators could interactively and freely manipulate position and orientation of image, consisting of a 5-mm section, displaying attenuation for each image pixel. This form of reconstruction allows depiction of longer segments of a given coronary artery. Section position and orientation of c are identical to those of b (arrow = right coronary artery). (d, e) Curved MPR. By using transverse and coronary images as reference, the artery course was interactively traced by an independent operator. A 1-mm MPR image was rendered, the plane of which followed the outlined trace. Images d and e show the resulting display of the right coronary artery (arrow). (f, g) Curved MIP. As with d and e, the course of the right coronary artery is traced. The image is then displayed as an MIP (3 mm thick). Images f and g show the resulting display of the right coronary artery (arrow). (h) Three-dimensional reconstruction. Image data set was segmented by an independent operator and subsequently displayed as 3D surface-weighted VRT image. The images could be viewed from any desired angle to assess the course of all arteries (arrows = right coronary artery). (i) Corresponding conventional coronary angiogram (arrow = right coronary artery) of the same patient.

View larger version (120K): [in this window] [in a new window] [Download PPT slide]   Figure 2g: Image postprocessing methods used in analysis of right coronary artery. (a) Transverse images. Operators could interactively move up and down stack of transverse images, which were reconstructed with 1.0-mm section thickness and 0.5-mm increment. Shown here is origin of the right coronary artery (arrow). (b) Oblique MPR. Operators could interactively and freely manipulate position and orientation of imaging plane. Right coronary artery image section was 1.0 mm thick (arrows). (c) Oblique MIP. Operators could interactively and freely manipulate position and orientation of image, consisting of a 5-mm section, displaying attenuation for each image pixel. This form of reconstruction allows depiction of longer segments of a given coronary artery. Section position and orientation of c are identical to those of b (arrow = right coronary artery). (d, e) Curved MPR. By using transverse and coronary images as reference, the artery course was interactively traced by an independent operator. A 1-mm MPR image was rendered, the plane of which followed the outlined trace. Images d and e show the resulting display of the right coronary artery (arrow). (f, g) Curved MIP. As with d and e, the course of the right coronary artery is traced. The image is then displayed as an MIP (3 mm thick). Images f and g show the resulting display of the right coronary artery (arrow). (h) Three-dimensional reconstruction. Image data set was segmented by an independent operator and subsequently displayed as 3D surface-weighted VRT image. The images could be viewed from any desired angle to assess the course of all arteries (arrows = right coronary artery). (i) Corresponding conventional coronary angiogram (arrow = right coronary artery) of the same patient.

View larger version (104K): [in this window] [in a new window] [Download PPT slide]   Figure 2h: Image postprocessing methods used in analysis of right coronary artery. (a) Transverse images. Operators could interactively move up and down stack of transverse images, which were reconstructed with 1.0-mm section thickness and 0.5-mm increment. Shown here is origin of the right coronary artery (arrow). (b) Oblique MPR. Operators could interactively and freely manipulate position and orientation of imaging plane. Right coronary artery image section was 1.0 mm thick (arrows). (c) Oblique MIP. Operators could interactively and freely manipulate position and orientation of image, consisting of a 5-mm section, displaying attenuation for each image pixel. This form of reconstruction allows depiction of longer segments of a given coronary artery. Section position and orientation of c are identical to those of b (arrow = right coronary artery). (d, e) Curved MPR. By using transverse and coronary images as reference, the artery course was interactively traced by an independent operator. A 1-mm MPR image was rendered, the plane of which followed the outlined trace. Images d and e show the resulting display of the right coronary artery (arrow). (f, g) Curved MIP. As with d and e, the course of the right coronary artery is traced. The image is then displayed as an MIP (3 mm thick). Images f and g show the resulting display of the right coronary artery (arrow). (h) Three-dimensional reconstruction. Image data set was segmented by an independent operator and subsequently displayed as 3D surface-weighted VRT image. The images could be viewed from any desired angle to assess the course of all arteries (arrows = right coronary artery). (i) Corresponding conventional coronary angiogram (arrow = right coronary artery) of the same patient.

View larger version (177K): [in this window] [in a new window] [Download PPT slide]   Figure 2i: Image postprocessing methods used in analysis of right coronary artery. (a) Transverse images. Operators could interactively move up and down stack of transverse images, which were reconstructed with 1.0-mm section thickness and 0.5-mm increment. Shown here is origin of the right coronary artery (arrow). (b) Oblique MPR. Operators could interactively and freely manipulate position and orientation of imaging plane. Right coronary artery image section was 1.0 mm thick (arrows). (c) Oblique MIP. Operators could interactively and freely manipulate position and orientation of image, consisting of a 5-mm section, displaying attenuation for each image pixel. This form of reconstruction allows depiction of longer segments of a given coronary artery. Section position and orientation of c are identical to those of b (arrow = right coronary artery). (d, e) Curved MPR. By using transverse and coronary images as reference, the artery course was interactively traced by an independent operator. A 1-mm MPR image was rendered, the plane of which followed the outlined trace. Images d and e show the resulting display of the right coronary artery (arrow). (f, g) Curved MIP. As with d and e, the course of the right coronary artery is traced. The image is then displayed as an MIP (3 mm thick). Images f and g show the resulting display of the right coronary artery (arrow). (h) Three-dimensional reconstruction. Image data set was segmented by an independent operator and subsequently displayed as 3D surface-weighted VRT image. The images could be viewed from any desired angle to assess the course of all arteries (arrows = right coronary artery). (i) Corresponding conventional coronary angiogram (arrow = right coronary artery) of the same patient.

View larger version (111K): [in this window] [in a new window] [Download PPT slide]   Figure 3a: Comparison of image postprocessing methods in patient with stenosis of the left circumflex coronary artery confirmed on conventional coronary angiogram. (a) Series of three transverse images (from left to right) above, at the level of, and distal to the lesion (arrow = left circumflex artery). While the contrast-enhanced lumen is clearly visible proximally and distally to the lesion, the middle image shows absence of contrast-enhanced lumen; only one calcification appears. (b) Visualization of stenosis (arrow) in an oblique MPR. (c) Visualization of stenosis (arrow) in an oblique MIP. (d) Curved MPR of left main and left circumflex coronary artery (arrow = stenosis). (e) Curved MIP (3 mm thick) of left main and left circumflex coronary artery (arrow = stenosis). (f) Three-dimensional reconstruction. Stenosis with a calcification (arrow) can clearly be seen.

View larger version (136K): [in this window] [in a new window] [Download PPT slide]   Figure 3b: Comparison of image postprocessing methods in patient with stenosis of the left circumflex coronary artery confirmed on conventional coronary angiogram. (a) Series of three transverse images (from left to right) above, at the level of, and distal to the lesion (arrow = left circumflex artery). While the contrast-enhanced lumen is clearly visible proximally and distally to the lesion, the middle image shows absence of contrast-enhanced lumen; only one calcification appears. (b) Visualization of stenosis (arrow) in an oblique MPR. (c) Visualization of stenosis (arrow) in an oblique MIP. (d) Curved MPR of left main and left circumflex coronary artery (arrow = stenosis). (e) Curved MIP (3 mm thick) of left main and left circumflex coronary artery (arrow = stenosis). (f) Three-dimensional reconstruction. Stenosis with a calcification (arrow) can clearly be seen.

View larger version (149K): [in this window] [in a new window] [Download PPT slide]   Figure 3c: Comparison of image postprocessing methods in patient with stenosis of the left circumflex coronary artery confirmed on conventional coronary angiogram. (a) Series of three transverse images (from left to right) above, at the level of, and distal to the lesion (arrow = left circumflex artery). While the contrast-enhanced lumen is clearly visible proximally and distally to the lesion, the middle image shows absence of contrast-enhanced lumen; only one calcification appears. (b) Visualization of stenosis (arrow) in an oblique MPR. (c) Visualization of stenosis (arrow) in an oblique MIP. (d) Curved MPR of left main and left circumflex coronary artery (arrow = stenosis). (e) Curved MIP (3 mm thick) of left main and left circumflex coronary artery (arrow = stenosis). (f) Three-dimensional reconstruction. Stenosis with a calcification (arrow) can clearly be seen.

View larger version (131K): [in this window] [in a new window] [Download PPT slide]   Figure 3d: Comparison of image postprocessing methods in patient with stenosis of the left circumflex coronary artery confirmed on conventional coronary angiogram. (a) Series of three transverse images (from left to right) above, at the level of, and distal to the lesion (arrow = left circumflex artery). While the contrast-enhanced lumen is clearly visible proximally and distally to the lesion, the middle image shows absence of contrast-enhanced lumen; only one calcification appears. (b) Visualization of stenosis (arrow) in an oblique MPR. (c) Visualization of stenosis (arrow) in an oblique MIP. (d) Curved MPR of left main and left circumflex coronary artery (arrow = stenosis). (e) Curved MIP (3 mm thick) of left main and left circumflex coronary artery (arrow = stenosis). (f) Three-dimensional reconstruction. Stenosis with a calcification (arrow) can clearly be seen.

View larger version (140K): [in this window] [in a new window] [Download PPT slide]   Figure 3e: Comparison of image postprocessing methods in patient with stenosis of the left circumflex coronary artery confirmed on conventional coronary angiogram. (a) Series of three transverse images (from left to right) above, at the level of, and distal to the lesion (arrow = left circumflex artery). While the contrast-enhanced lumen is clearly visible proximally and distally to the lesion, the middle image shows absence of contrast-enhanced lumen; only one calcification appears. (b) Visualization of stenosis (arrow) in an oblique MPR. (c) Visualization of stenosis (arrow) in an oblique MIP. (d) Curved MPR of left main and left circumflex coronary artery (arrow = stenosis). (e) Curved MIP (3 mm thick) of left main and left circumflex coronary artery (arrow = stenosis). (f) Three-dimensional reconstruction. Stenosis with a calcification (arrow) can clearly be seen.

View larger version (130K): [in this window] [in a new window] [Download PPT slide]   Figure 3f: Comparison of image postprocessing methods in patient with stenosis of the left circumflex coronary artery confirmed on conventional coronary angiogram. (a) Series of three transverse images (from left to right) above, at the level of, and distal to the lesion (arrow = left circumflex artery). While the contrast-enhanced lumen is clearly visible proximally and distally to the lesion, the middle image shows absence of contrast-enhanced lumen; only one calcification appears. (b) Visualization of stenosis (arrow) in an oblique MPR. (c) Visualization of stenosis (arrow) in an oblique MIP. (d) Curved MPR of left main and left circumflex coronary artery (arrow = stenosis). (e) Curved MIP (3 mm thick) of left main and left circumflex coronary artery (arrow = stenosis). (f) Three-dimensional reconstruction. Stenosis with a calcification (arrow) can clearly be seen.