Three-dimensional coronary reconstruction from routine single-plane coronary angiograms: In vivo quantitative validation

Background: Current X-ray technology displays the complex 3-dimensional (3-D) geometry of the coronary arterial tree as 2-dimensional (2-D) images. To overcome this limitation, an algorithm was developed for the reconstruction of the 3-D pathway of the coronary arterial tree using routine single-plane 2-D angiographic imaging. This method provides information in real-time and is suitable for routine use in the cardiovascular catheterization laboratory. Objectives: The purpose of this study was to evaluate the precision of this algorithm and to compare it with 2-D quantitative coronary angiography (QCA) system. Methods: Thirty-eight angiographic images were acquired from 11 randomly selected patients with coronary artery disease undergoing diagnostic cardiac catheterization. The 2-D images were analyzed using QCA software. For the 3-D reconstruction, an algorithm integrating information from at least two single-plane angiographic images taken from different angles was formulated. Results: 3-D acquisition was feasible in all patients and in all selected angiographic frames. Comparison between pairs of values yielded greater precision of the 3-D than the 2-D measurements of the minimal lesion diameter (P < 0.005), minimal lesion area (P < 0.05) and lesion length (P < 0.01). Conclusions: The study validates the 3-D reconstruction algorithm, which may provide new insights into vessel morphology in 3-D space. This method is a promising clinical tool, making it possible for cardiologists to appreciate the complex curvilinear structure of the coronary arterial tree and to quantify atherosclerotic lesions more precisely.