von Birgelen C, Mintz G S, Nicosia A, Foley D P, van der Giessen W J, Bruining N, Airiian S G, Roelandt J R, de Feyter P J, Serruys P W
Thoraxcenter, University Hospital Rotterdam-Dijkzigt, The Netherlands.
J Am Coll Cardiol. 1997 Aug;30(2):436-43. doi: 10.1016/s0735-1097(97)00154-x.
This study evaluates the feasibility, reliability and reproducibility of electrocardiogram (ECG)-gated intravascular ultrasound (IVUS) image acquisition during automated transducer withdrawal and automated three-dimensional (3D) boundary detection for assessing on-line the result of coronary stenting.
Systolic-diastolic image artifacts frequently limit the clinical applicability of such automated analysis systems.
In 30 patients, after successful angiography-guided implantation of 34 stents in 30 target lesions, we carried out IVUS examinations on-line with the use of ECG-gated automated 3D analyses and conventional manual analyses of two-dimensional images from continuous pullbacks. These on-line measurements were compared with off-line 3D reanalyses. The adequacy of stent deployment was determined by using ultrasound criteria for stent apposition, symmetry and expansion.
Gated image acquisition was successfully performed in all patients to allow on-line 3D analysis within 8.7 +/- 0.6 min (mean +/- SD). Measurements by on-line and off-line 3D analyses correlated closely (r > or = 0.95), and the minimal stent lumen differed only minimally (8.6 +/- 2.8 mm2 vs. 8.5 +/- 2.8 mm2, p = NS). The conventional analysis significantly overestimated the minimal stent lumen (9.0 +/- 2.7 mm2, p < 0.005) in comparison with results of both 3D analyses. Fourteen stents (41%) failed to meet the criteria by both 3D analyses, all of these not reaching optimal expansion, but only 7 (21%) were detected by conventional analysis (p < 0.02). Intraobserver and interobserver comparison of stent lumen measurements by the automated approach revealed minimal differences (0.0 +/- 0.2 mm2 and 0.0 +/- 0.3 mm2) and excellent correlations (r = 0.99 and 0.98, respectively).
ECG-gated image acquisition after coronary stent deployment is feasible, permits on-line automated 3D reconstruction and analysis and provides reliable and reproducible measurements; these factors facilitate detection of the minimal lumen site.
本研究评估在自动回撤换能器及自动三维（3D）边界检测过程中，心电图（ECG）门控血管内超声（IVUS）图像采集用于在线评估冠状动脉支架置入结果的可行性、可靠性及可重复性。
收缩期 - 舒张期图像伪影常常限制此类自动分析系统的临床应用。
对30例患者，在血管造影引导下成功将34枚支架植入30个靶病变后，我们使用ECG门控自动3D分析及对连续回撤的二维图像进行传统手动分析的方法进行IVUS在线检查。将这些在线测量结果与离线3D重新分析结果进行比较。通过超声标准评估支架贴壁、对称性及扩张情况来确定支架置入是否充分。
所有患者均成功进行了门控图像采集，以便在8.7±0.6分钟（平均±标准差）内进行在线3D分析。在线和离线3D分析测量结果密切相关（r≥0.95），最小支架管腔仅略有差异（8.6±2.8mm²对8.5±2.8mm²，p =无显著性差异）。与两种3D分析结果相比，传统分析显著高估了最小支架管腔（9.0±2.7mm²，p<0.005）。两种3D分析均显示14枚支架（41%）未达到标准，所有这些支架均未达到最佳扩张，但传统分析仅检测到7枚（21%）（p<0.02）。自动方法测量支架管腔的观察者内及观察者间比较显示差异极小（0.0±0.2mm²和0.0±0.3mm²）且相关性极佳（r分别为0.99和0.98）。
冠状动脉支架置入后进行ECG门控图像采集是可行的，可进行在线自动3D重建及分析，并提供可靠且可重复的测量结果；这些因素有助于检测最小管腔部位。
