Abstract
Although intravenous digital subtraction angiography was originally intended as a means of performing lessinvasive peripheral angiography, this less invasive approach has not proven feasible for coronary artery studies. Digital imaging has, however, proven helpful for the immediate replay, enhancement and quantification of coronary arteriography and enables the performance of regional blood flow (coronary flow reserve) analysis. Flow analysis is clinically helpful in determining the hemodynamic significance of individual coronary stenoses, which cannot always be assessed even using quantitative stenosis measurements. One method of assessing flow reserve by digital means uses parametric images to display the timing (color coded) and density (intensity coded) of the contrast bolus as it transverses the regional myocardial circulation. Analysis of baseline and hyperemic condition parametric images provides quantitative regional flow reserve information.
Similar content being viewed by others
References
Myerowitz PD, Turnipseed WD, Shaw C-G, Mistretta CA, Swanson DK, Chopra PS, Berkhoff HA, Kroncke GM, Dhanani SP, Rowe GG, Van Lysel M, Crummy AB: Computerized fluoroscopy: New technique for the non-invasive evaluation of the aorta, coronary artery bypass grafts, and left ventricular function. J Thorac Cardiovasc Surg 83: 65–73, 1982
Myerowitz PD, Turnipseed WD, Swanson DK, Van Lysel M, Peppier W, Mistretta C, Chopra PS, Berkhoff H, Kroncke G, Hasegawa B, Steighorst M, Turski P, Crummy AB: Digital subtraction angiography as a method for screening for coronary artery disease during peripheral vascular angiography. Surgery 92: 1042–1048, 1982
Brundage BH, Lipton MJ, Herfkens RJ, Berninger WH, Redington RW, Chatterjee K, Carlsson E: Detection of patent coronary bypass grafts by computerized axial tomography: A preliminary report. Circulation 61: 826–831, 1980
Drury JK, Gray R, Diamond GA, Whiting J, Pfaff M, Vas R, Wheeler W, Nathan M, Forrester JS: Computer enhanced digital angiography visualizes coronary bypass grafts without need for selective injection. Circulation 66 (Suppl II): II-229, 1982 (abstr)
Goldberg HL, Moses JW, Borer JS, Fisher J, Cohen B, Skelly NT, Carter J: The role of digital subtraction angiography in coronary and bypass graft arteriography. Circulation 66 (Suppl II): II-229, 1982 (abstr)
Fisher LD, Judkins MP, Lesperance J, Cameron A, Swaye P, Ryan T, Maynard C, Bourassa M, Kennedy JW, Gosselin A, Kemp H, Faxon D, Wexler L, Davis KB et al.: Reproducibility of coronary arteriographic reading in the coronary artery surgery study (CASS). Cathet Cardiovasc Diag 8: 565–575, 1982
Grondin CM, Dydra I, Pasternac A, Campeau L, Bourassa MG, Lesperance J: Discrepancies between cineangiographic and post-mortem findings in patients with coronary artery disease and recent myocardial revascularization. Circulation 49: 703–708, 1974
Detre KM, Wright PH, Murphy ML, Takaro T: Observer agreement in evaluating coronary angiograms. Circulation 52: 979–986, 1975
Zir LM, Miller SW, Dinsmore RE, Gilbert JP, Harthorne JW: Interobserver variability in coronary angiography. Circulation 52: 627–632, 1976
White CW, Wright CB, Doty DB, Hiratza LF, Eastham CI., Harrison DG, Marcus ML: Does visual interpretation of the coronary arteriogram predict the physiologic importance of a coronary stenosis? N Engl J Med 310: 819–824, 1984
Hodgson JMcB, LeGrand V, Bates ER, Mancini GBJ, Aueron FM, O'Neill WW, Simon SB, Beauman GJ, LeFree MT, Vogel RA: Validation in dogs of a rapid digital angiographic technique to measure relative coronary blood flow during routine cardiac catheterization. Am J Cardiol 55: 188–193, 1985
vander Werf T, Heethaar RM, Meijer FL: Coronary digital subtraction using the concept of apparent cardiac arrest. J Am Coll Cardiol 1: 690, 1983 (abstr)
Tobis J, Nalcioglu O, Iseri L, Johnston WD, Roeck W, Castleman E, Bauer B, Montelli S, Henry WL: Detection and quantitation of coronary artery stenoses from digital subtraction angiograms compared with 35-millimeter film cineangiograms. Am J Cardiol 54: 489–494, 1984
Feldman RL, Pepine CJ, Curry RC, Conti RC: Quantitative coronary arteriography using 105 mm photospot angiography and an optical magnifying device. Cathet Cardiovasc Diag 5: 195–201, 1979
Gensini GG, Kelly AE, Da Costa BCB, Huntington PP: Quantitative angiography: The measurement of coronary vasomobility in the intact animal and man. Chest 60: 522–530, 1971
Rafflenbeul W, Smith LR, Rogers WJ, Mantle JA, Rackley CE, Russell RO: Quantitative coronary arteriography: Coronary anatomy of patients with unstable angina pectoris reexamined 1 year after optimal medical therapy. Am J Cardiol 43: 699–707, 1979
Brown BG, Bolson E, Frimer M, Dodge HT: Quantitative coronary arteriography: Estimation of dimension, hemodynamic resistance, and atheroma mass of coronary artery lesions using the arteriogram and digital computation. Circulation 55: 329–337, 1977
Booman F, Reiber JHC, Gerbrands JJ, Slager CJ, Schwurbiers JCH, Meester GT: Quantitative analysis of coronary occlusions from coronary cineangiograms. IEEE Comput Cardiol 177–180, 1979
Reiber HJC, Booman F, Tan HS, Slager CJ, Schwubiers JCH, Gerbrands JJ, Meester GT: A cardiac image analysis system: Objective quantitative processing of angiograms. IEEE Comput Cardiol 239–242, 1978
Spears JR, Sandor T, Als AV, Malagold M, Markis JE, Grossman W, Serur JR, Paulin S: Computerized image analysis for quantitative measurement of vessel diameter from cineangiograms. Circulation 68: 453–461, 1983
Smith DN, Colfer H, Brymer JF, Pitt B, Kliman SH: A semiautomated computer technique for processing coronary angiograms. IEEE Comput Cardiol 325–328, 1981
Spears JR, Sandor T, Bairn DS, Paulin S: The minimum error in estimating coronary luminal cross-sectional area from cineangiographic diameter measurements. Cathet Cardiovasc Diag 9: 119–128, 1983
Kirkieede RL, Fung P, Smalling RW, Gould KL: Automated evaluation of vessel diameter from arteriograms. IEEE Comput Cardiol 215–218, 1982
LeFree MT, Simon SB, Lewis RJ, Bates ER, Vogel RA: Digital radiographic coronary artery quantification. IEEE Comput Cardiol 1985 (in press)
Crawford DW, Brooks SH, Barndt R, Blankenhorn DH: Measurement of atherosclerotic luminal irregularity and obstruction by radiographic densitometry. Invest Radiol 12: 307–313, 1977
Hoornstra K, Hanselman JMH, Holland WPJ, De Wey Peters GW, Zwamborn AW: Videodensitometry for measuring blood vessel diameter. Acta Radiol (Diag) 21: 115–164, 1980
Kishon Y, Yerushalmi S, Deutsch V, Neufeld HN: Measurement of coronary arterial lumen by densitometric analysis of angiograms. Angiology 30: 304–312, 1979
Kruger RA: Estimation of the diameter of an iodine concentration within blood vessels using digital radiography devices. Med Phys 8: 652–658, 1981
Nichols AB, Gabrich CFO, Fenoglio JJ, Esser PD: Quantification of relative coronary arterial stenosis by cinevideodensitometric analysis of coronary arteriograms. Circulation 69: 512–522, 1984
Sandor T, Als AV, Paulsin S: Cinedensitometric measurement of coronary arterial stenosis. Cathet Cardiovasc Diag 5: 229–245, 1979
Gould KL, Lipscomb K, Hamilton GW: Physiologic basis or assessing critical coronary stenosis: Instantaneous flow response and regional distribution as measures of coronary flow reserve. Am J Cardiol 33: 87–94, 1974
Harrison DG, White CW, Hiratzka LF, Doty DB, Barnes DH, Eastham CL, Marcus ML: The value of lesion crosssectional area determined by quantitative coronary angiography in assessing the physiologic significance of proximal left anterior descending coronary artery stenoses. Circulation 69: 1111–1119, 1984
Klocke FJ: Measurements of coronary blood flow and dcgree of stenosis: Current clinical implications and continuing uncertainties. J Am Coll Cardiol 1: 31–41, 1983
Vogel R: Quantitative aspects of myocardial perfusion imaging. Sem Nucl Med 10: 146–156, 1980
Hodgson JMcB, Mancini GBJ, Legrand V, Vogel RA: Characterization of changes in coronary blood flow during the first six seconds after intracoronary contrast injection. Invest Radiol 20: 246–252, 1985
Rutishauser W. Bussman W-D, Noseda G, Meier W, Wellauer J: Blood flow measurements through single coronary arteries by roentgen densitometry: I. A comparison of flow measured by a radiographic technique applicable in the intact organism and by electromagnetic flowmeter. AJR 109: 12–20, 1970
Smith HC, Frye RI, Donald DE, Davis GD, Pluth JR, Sturn RE, Wood EH: Roentgen videodensitometric measurement of coronary blood flow: Determination from simultaneous indicator-dilution curves at selected sites in the coronary circulation and in coronary artery-saphenous vein grafts. Mayo Clin Proc 46: 800–806, 1971
Spiller P, Schmiel FK, Politz B, Block M, Fermor U, Hackbarth W, Jehle J, Korfer R, Pannek H: Measurement of systolic and diastolic flow rates in the coronary artery system by x-ray densitometry. Circulation 68: 337–347, 1983
Foerster J, Link DP, Lantz BMT: Measurement of coronary reactive hyperemia during clinical angiography by video dilution technique. Acta Radiol 22: 209–216, 1981
Nissen SE, Elion JL, Booth DC, Evans J, DeMaria AN: Value and limitations of computer analysis of digital subtraction angiography in the assessment of coronary flow reserve. Circulation 73: 562–571, 1986
Robb RA, Wood EH, Ritman EL, Johnson SA, Sturm RE, Greenleaf JF, Gilbert BK Chevalier PA: Three-dimensional reconstruction and display of the working canine heart and lungs by multiplanar x-ray scanning video densitometry. IEEE Comput Cardiol 151–163, 1974
Vogel R, LeFree M, Bates E, O'Neill WW, Foster R, Kirlin P, Smith D, Pitt B: Use of digital techniques to selective coronary arteriography: Use of myocardial contrast appearance time to measure coronary flow reserve. Am Heart J 107: 153–164, 1984
O'Neill WW, Walton JA, Bates ER, Colfer HT, Aueron FM, LeFree MT, Pitt B, Vogel RA: Criterion for successful coronary angioplasty, as assessed by alterations in coronary flow reserve. J Am Coll Cardiol 3: 1382–1390, 1984
Vogel RA: Radiographic assessment of coronary blood flow parameters. Circulation 72: 833–839, 1985
LeGrand V, Hodgson JMcB, Bates ER, Aueron FM, Mancini GBJ, Smith JS, Gross MD, Vogel RA: Abnormal coronary flow reserve and abnormal radionuclide exercise tests in patients with normal coronary arteries. J Am Coll Cardiol 6: 1245–1253, 1985
LeGrand V, Aueron FM, Bates ER, O'Neill WW, Hodgson JMcB, Mancini GBJ, Vogel RA: Reversibility of coronary collaterals and alterations in regional coronary flow reserve following successful angioplasty. Am J Cardiol 54: 453–454, 1984
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Vogel, R.A., Mancini, G.B.J. & Bates, E.R. Digital subtraction angiographic assessment of the coronary arteries and coronary flow reserve. Int J Cardiac Imag 1, 225–232 (1985). https://doi.org/10.1007/BF01568670
Issue Date:
DOI: https://doi.org/10.1007/BF01568670