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Automatic Determination of Differential Coronary Artery Motion Minima for Cardiac Computed Tomography Optimal Phase Selection

Posted May 31, 2015 Updated Apr 10, 2023
By Jonathan Lessick MD DSc , Oliver Klass MD , Sabine Wuchenauer MTRA , Matthew J. Walker MS , Holger Schmitt PhD , Jochen Peters PhD , Juergen Weese PhD , Horst Brunner MD , Mani Vembar MS , Michael Grass PhD , Doron Aronson MD , Martin H.K. Hoffmann MD
7 min read

Rationale and Objectives

Selecting the optimal phase for coronary artery evaluation can be challenging, especially at higher heart rates, given that the optimal phase may differ for each of the coronary arteries. This study aimed to evaluate a novel vessel-specific algorithm which automatically outputs the minimum motion phase per coronary artery.

Materials and Methods

The study included 44 patients who underwent 256-slice cardiac computed tomography for evaluation of chest pain. End-systolic and mid-diastolic minimal motion phases were automatically calculated by a previously validated global motion algorithm and by a new vessel-specific algorithm which calculates the minimum motion for each of the three main coronary arteries, separately. Two readers blindly evaluated all coronary segments for image quality. Median scores per coronary artery were compared by the Wilcoxon signed rank test.

Results

The variation, per patient, between the optimal phases of the three coronary arteries was 5.0 ± 4.5% (1%–22%) for end systole and 4.8 ± 4.1% (0%–19%) for mid diastole. The mean image quality scores per coronary artery were 4.0 ± 0.61 for the vessel-specific approach and 3.80 ± 0.69 for the global phase selection ( P < .001). Overall, 46 of 122 arteries had a better score with the vessel-specific approach and five with the standard global approach. Interreader agreement was substantial ( k = 0.72).

Conclusions

This study has shown that multiple phases are required to ensure optimal image quality for all three coronary arteries and that a vessel-specific phase selection algorithm achieves superior results to the standard global approach.

Interpretation of computed tomography coronary angiography (CTCA) is usually performed on a single phase of the cardiac cycle. The optimal phase is usually selected empirically or with help of various automatic algorithms. However, it has been shown that the optimal quiet phase often differs for each coronary artery, especially at higher heart rates .

To avoid motion artifacts, CTCA image analysis is performed on the phase(s) with the least cardiac motion; however, there is currently no consensus concerning the selection of phases with the least cardiac motion. Several studies have attempted to determine the optimal cardiac quiescent phase , but definition of population-based quiescent phases is challenging because of high interpatient variability and significant heart rate dependency. Furthermore, the electrocardiographic (ECG) waveform by which CTCA acquisition is synchronized does not always adequately represent cardiac motion.

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Materials and methods

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Data Acquisition

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Automated Global Phase Selection

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Automated Vessel-Specific Phase selection

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Figure 1, Coronary arteries location on heart surface. An example of a surface rendering of a reconstructed and segmented heart showing the location of the individual coronary artery regions used for motion analysis. On the left, the heart is viewed from its posterior aspect and on the right from its anterior aspect. The RCA motion is based on the motion of the right atrial and ventricular epicardial regions on each side of the right atrioventricular groove and posterior interventricular groove. The LAD utilizes the parts of the left and right ventricles adjacent to the anterior interventricular groove and apex, and the LCx, the left ventricular and atrial surfaces on either side of the left atrioventricular groove and the obtuse margin of the left ventricle. LAD, left anterior descending artery; LCx, left circumflex artery; RCA, right coronary artery.

Figure 2, Coronary arteries velocity over heart cycle. An example of individual coronary artery velocity curves over the cardiac cycle, demonstrating the local minima or quiet phases ( arrows ) for each coronary artery at end systole and mid diastole. LAD, left anterior descending artery; LCx, left circumflex artery; RCA, right coronary artery.

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Image Reconstructions

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Image Quality Assessment

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Statistical Analysis

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Results

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Optimal Phase Calculation

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Table 1

The Mean ± Standard Deviation, Range, and Deviation of the Quiet Phases (Percent of R-R Interval) Obtained by the Vessel-Specific and the Standard Global Algorithms for Each of the Coronary Arteries

Artery Vessel-Specific ES Global ES Vessel-Specific ED Global ED ES Phase Deviation ∗ MD Phase Deviation ∗ LAD 39.2 ± 4.3 38.7 ± 7.2 77.4 ± 5.1 74.0 ± 7.5 4.7 ± 4.7 7.0 ± 5.7 LCx 40.1 ± 4.9 38.7 ± 7.2 76.2 ± 4.6 74.0 ± 7.5 5.9 ± 6.6 5.9 ± 5.2 RCA 41.1 ± 5.5 38.7 ± 7.2 75.3 ± 4.5 74.0 ± 7.5 5.5 ± 5.5 5.5 ± 5.6 All 40.1 ± 4.9 38.7 ± 7.1 76.3 ± 4.8 74.0 ± 7.4 5.4 ± 5.6 6.1 ± 5.5

ED, end diastole; ES, end systole; LAD, left anterior descending artery; LCx, left circumflex artery; MD, mid diastole; RCA, right coronary artery.

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Image Quality Evaluation

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Table 2

Comparison of Image Quality Scores for the Two Approaches for Various Subgroups

Subgroup Standard Vessel-Specific Vessel-Specific Better Standard Better Equal_P_ Value All 3.80 ± 0.69 4.00 ± 0.61 46 5 71 .000 ES 3.35 ± 0.69 3.58 ± 0.68 54 5 63 .000 MD 3.53 ± 0.87 3.77 ± 0.70 50 12 60 .000 HR < 65 4.05 ± 0.56 4.22 ± 0.47 13 3 35 .005 HR > 65 3.61 ± 0.71 3.84 ± 0.66 33 2 36 .000 Age <60 years 3.68 ± 0.82 3.87 ± 0.72 22 1 13 .005 Age >60 years 3.85 ± 0.62 4.05 ± 0.55 49 4 33 .000 LAD 4.04 ± 0.62 4.17 ± 0.54 14 3 24 .011 LCx 3.52 ± 0.70 3.69 ± 0.64 14 2 24 .007 RCA 3.83 ± 0.65 4.12 ± 0.56 18 0 23 .000 No Ca 3.65 ± 0.80 3.86 ± 0.69 15 1 26 .002 Minimal Ca 3.89 ± 0.55 4.20 ± 0.54 15 0 13 .001 Prominent Ca 3.81 ± 0.65 3.98 ± 0.57 14 2 26 .003

Ca, calcium; ED, end diastole; ES, end systole; HR, heart rate; LAD, left anterior descending artery; LCx, left circumflex artery; MD, mid diastole; RCA, right coronary artery.

Figure 3, Examples of image quality comparisons for selected cases. (a) Standard ( left ) and vessel-specific ( right ) volume renderings at mid diastole show sharper image quality (IQ) with more segments visible for the LAD and diagonal branches by the vessel-specific algorithm IQ 3.8 ( left ) and 4.2 ( right ) at an heart rate (HR) of 72 beats/min. (b) Standard ( left ) and vessel-specific ( right ) multiplanar reformat of the RCA show sharper vessel border by the vessel-specific algorithm. Mean IQ 3.75 ( left ) and 4.5 ( right ) at a mean HR of 71 beats/min. (c) Standard ( left ) and vessel-specific ( right ) multiplanar reformat of the LCx shows significantly better IQ by the vessel-specific algorithm IQ 2.5 ( left ) and 4 ( right ) at a mean HR of 68 beats/min. LAD, left anterior descending artery; LCx, left circumflex artery; RCA, right coronary artery.

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Reader Agreement

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Discussion

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Academic Radiology, Volume 22, Issue 6
Journals General Radiology
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