Innovative Software Creates 3D Views of Cardiac Arteries

Researchers at the University of Colorado Hospital (UCH; Aurora, USA), Philips Healthcare (Best, The Netherlands), and other institutions and businesses compared standard two-dimensional (2D) images to automatically generated, computer-reconstructed 3D images of 23 patients' coronary artery systems. To generate realistic 3D images, the researchers used a recently developed technique called rotational angiography, which uses X-ray projection images acquired during a 180° C-arm rotation and continuous contrast injection, followed by electrocardiogram (ECG)-gated iterative reconstruction. The researchers compared overall image quality, lesion visibility, and a comparison of 3D quantitative coronary analysis with 2D quantitative coronary analysis.

The results showed that two-thirds of the resulting 3D volume images were rated as having high image quality and provided the physician with additional clinical information, such as complete visualization of bifurcations and unobtainable views of the coronary tree. True-positive lesion detection rates were high (90-100%), whereas false-positive detection rates were low (0-8.1%). The researchers also found that 3D quantitative coronary analysis showed significant similarity with 2D quantitative coronary analysis in terms of lumen diameters, and provided vessel segment length free from the errors of foreshortening. The study was published in the February 2010 issue of Circulation: Cardiovascular Interventions.

"Coronary interventions may be improved by having a realistic, 3D image of the coronary artery tree,” said study coauthor Professor John Carroll, M.D., director of interventional cardiology at UCH. "The next step is to test it in multiple centers around the world. In addition, we'll formally test it to see the impact on clinical care. The bottom line is that this is very exciting technology that holds great promise.”

Currently, clinicians take multiple 2D X-ray images from different views to visualize what the arteries look like inside the body, using a contrast dye that temporarily fills the coronary arteries to visualize the inner diameter of the artery. This allows the detection of plaque build up, and consequently the insertion of a coronary stent to open a blocked artery and allow normal blood flow. The 2D images have been the standard method of presenting coronary angiographic structure for over 50 years.

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University of Colorado
Philips Healthcare