Nichols A B, Berke A D, Han J, Reison D S, Watson R M, Powers E R
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY.
Am Heart J. 1988 Apr;115(4):722-32. doi: 10.1016/0002-8703(88)90871-x.
The accuracy and reproducibility of caliper and cinevideodensitometric measurements of coronary stenotic dimensions were compared in radiographic phantom models and in coronary arteriograms of 28 patients undergoing coronary angioplasty. Projected, single-plane coronary cine frames were analyzed by a computer-assisted videodensitometric method, which measures stenotic cross-sectional area without assumptions about lesion geometry. The accuracy (2.4%) and precision (+/- 1.9%) of cinevideodensitometry for measuring percent area stenosis in Plexiglas models of eccentric stenotic lesions was superior to the accuracy (24.7%) and precision (+/- 5.4%) of caliper measurements. Interobserver variability was significantly (p less than 0.05) better for cinevideodensitometric (r = 0.98; SEE = 6.4%) than for caliper measurements (r = 0.87; SEE = 13.1%). After angioplasty, percent diameter stenosis measured by calipers fell from 70 +/- 12% to 30 +/- 15%. Mean percent area reduction measured by cinevideodensitometry fell from 89.1 +/- 8% to 40.1 +/- 22% and stenotic area increased five-fold, from 0.59 +/- 0.5 to 3.47 +/- 1.6 mm2. Pre and post PTCA gradients did not correlate with lesion dimensions. Cinevideodensitometric measurements of absolute stenotic dimensions were more reproducible than relative measurements expressed as a percentage, due to the tapered caliber of normal arterial segments. Thus, cinevideodensitometric measurements were more accurate and reproducible than caliper measurements. The angiographic effects of coronary angioplasty are best measured by cinevideodensitometry, because residual lesions post PTCA are often eccentric, have indistinct margins, and are better characterized by changes in area than by changes in diameter.
在射线照相幻影模型以及28例接受冠状动脉成形术患者的冠状动脉造影中，对冠状动脉狭窄尺寸的游标卡尺测量和电影视频密度测量的准确性及可重复性进行了比较。通过计算机辅助视频密度测量法分析投射的单平面冠状动脉电影帧，该方法可测量狭窄横截面积，而无需对病变几何形状做假设。在偏心狭窄病变的有机玻璃模型中，电影视频密度测量法测量面积狭窄百分比的准确性（2.4%）和精密度（±1.9%）优于游标卡尺测量的准确性（24.7%）和精密度（±5.4%）。观察者间的变异性方面，电影视频密度测量法（r = 0.98；标准误 = 6.4%）显著（p < 0.05）优于游标卡尺测量（r = 0.87；标准误 = 13.1%）。冠状动脉成形术后，游标卡尺测量的直径狭窄百分比从70±12%降至30±15%。电影视频密度测量法测得的平均面积减少百分比从89.1±8%降至40.1±22%，狭窄面积增加了五倍，从0.59±0.5增至3.47±1.6 mm²。经皮腔内冠状动脉成形术（PTCA）前后的压力阶差与病变尺寸无相关性。由于正常动脉段管径呈锥形，电影视频密度测量法对绝对狭窄尺寸的测量比以百分比表示的相对测量更具可重复性。因此，电影视频密度测量法比游标卡尺测量更准确且可重复。冠状动脉成形术的血管造影效果最好通过电影视频密度测量法来测量，因为PTCA术后的残余病变通常是偏心的，边缘不清晰，通过面积变化比通过直径变化能更好地对其进行表征。
