Skip to main content

Comparison of QCA systems

The International Journal of Cardiac Imaging volume 13, pages 271–280 (1997)Cite this article

Abstract

Aims: Excellent agreement between different ‘second generation’ systems for quantitative coronary arteriography (QCA) has been found in in vitro measurements. To verify the quality and stability of QCA when used in clinical practice, three QCA systems (AWOS, Cardio, and CMS) were used in a representative set of coronary artery lesions. Methods and results: This set consisted of angiographic stenosis images of 57 patients which varied in stenosis severity and morphology. The process of image acquisition, calibration, and measurement was strictly standardized to eliminate procedural sources of error. Three observers performed QCA five times in each lesion with each QCA system. Interobserver variability was low (Dnorm 0.01–0.05 mm, Dmin 0.01–0.02 mm, %stenosis 0.3–0.7%). Values of system precision were excellent (Dnorm 0.11–0.13 mm, Dmin 0.04–0.06 mm, %stenosis 2.1–2.6%). Comparison of measurements between the three QCA systems revealed good agreement (range of mean differences for Dnorm 0.03–0.12 mm, Dmin 0.04–0.11 mm, and%stenosis 0.5–3.6%) and high correlation (corr 0.902–0.977). There was a tendency to measure smaller values for Dmin and consequently to identify more severe stenoses with the AWOS system than with the Cardio and CMS systems. All QCA results were compared to measurements done with the Brown Dodge method to reveal systematic failure of the QCA measurements. These results showed excellent agreement without any systematic deviation (mean differences for Dnorm 0.01–0.08 mm, Dmin 0.02–0.06 mm, and%stenosis 1.3–1.8%). None of the differences were statistically significant. Conclusion: We therefore conclude that using the defined version of the AWOS, Cardio, and CMS systems, there is no difference in precision or accuracy when used for QCA of coronary artery lesions.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Beauman GJ, Reiber JHC, Koning G, van Houdt RCM, Vogel RA. Angiographic core laboratory analyses of arterial phantom images: comparative evaluations of accuracy and precision. In: Reiber JHC, Serruys PW (eds). Progress in quantitative coronary arteriography. Kluwer Academic Publishers, Netherlands, 1994, pp. 87-104.

    Google Scholar 

  2. Desmet W, De Scheerder I, Beatt K, Huehns T, Piessens J. In vivo comparison of different quantitative edge detection systems used for measuring coronary arterial diameters. Cath Cardiovasc Diagn 1995; 34: 72-80.

    Google Scholar 

  3. Keane D, Haase J, Slager CJ, Montauban von Swijndregt E, Lehmann KG, Ozaki Y, di Mario C, Kirkeeide R, Serruys PW. Comparative validation of quantitative coronary angiography systems. Results and implications from a multicenter study using a standardized approach. Circulation 1995; 91: 2174-2183.

    Google Scholar 

  4. Hermiller JB, Cusma JT, Spero LA, Fortin DF, Harding MB, Bashore TM. Quantitative and qualitative coronary angiographic analysis: review of methods, utility, and limitations. Cath Cardiovasc Diagn 1992; 25: 110-131.

    Google Scholar 

  5. Reiber JHC, van der Zwet PMJ, Koning G, von Land CD, van Meurs B, Gerbrands JJ, Buis B, van Voorthuisen AE. Accuracy and precision of quantitative digital coronary arteriography: observer, short-, and medium-term variabilities. Cath Cardiovasc Diagn 1993; 28: 187-198.

    Google Scholar 

  6. Reiber JHC, van der Zwet PMJ, von Land CD, Koning G, van Meurs B, Buis B, van Voorthuisen AE. Quantitative coronary angiography: equipment and technical requirements. In: Reiber JHC, Serruys PW (eds). Advances in quantitative coronary arteriography. Kluwer Academic Publishers, Netherlands, 1993, pp. 75-111.

    Google Scholar 

  7. Linderer T, Wunderlich W, Backs B, Noering J, Schroeder R. Edge detection in quantitative coronary arteriography (QCA): the impact of image zoom on edge positioning, accuracy, precision and discrimination. Proceedings of Computers in Cardiology, IEEE, 1992, pp. 99-102.

  8. Wunderlich W, Linderer T, Backs B, Fischer F, Schröder R. Optimum edge detection in quantitative coronary arteriography. In: Lemke HU (ed). Computer assisted Radiology. Springer, Heidelberg, 1993, pp. 303-308.

    Google Scholar 

  9. Stiel GM, Barth K, Eicker B, Vogel C, Towara U, Nienaber CA. AWOS: angiographic work station for digital quantitative coronary angiography. Proceedings of Computers in Cardiology, IEEE, 1993, pp. 599-602.

  10. Stiel GM, Nienaber CA, Lattermann A, Barth K, Eicker B, Vogel C, Meinertz T. Comparison of coronary vessels edge detection and cross line methods to quantify the degree of stenosis as accessed by digital systems. Proceedings of Computers in Cardiology, IEEE, 1994, pp. 473-475.

  11. Reiber JHC, van Eldik-Helleman P, Visser-Akkerman N, Kooijman CJ, Serruys PW. Variabilities in measurement of coronary arterial dimensions resulting from variations in cineframe selection. Cath Cardiovasc Diagn 1988; 14: 221-228.

    Google Scholar 

  12. Herrington DM, Walford GD. Optimal frame selection for QCA. In: Reiber JHC, Serruys PW (eds). Advances in quantitative coronary arteriography. Kluwer Academic Publishers, Netherlands, 1993, pp. 125-135.

    Google Scholar 

  13. Brown BG, Bolson E, Frimer M, Dodge HT. Quantitative coronary arteriography. Estimation of dimensions, hemodynamic resistance, and atheroma mass of coronary artery lesions using the arteriogram and digital computation. Circulation 1977; 55: 329-337.

    Google Scholar 

  14. Reiber JHC, Koning G, von Land CD, van der Zwet PMJ. Why and how should QCA systems be validated? In: Reiber JHC, Serruys PW (eds). Progress in quantitative coronary arteriography. Kluwer Academic Publishers, Netherlands, 1994, pp. 33-48.

    Google Scholar 

  15. Herrington DM, Siebes M, Walford GD. Sources of error in quantitative coronary angiography. Cath Cardiovasc Diagn 1993; 29: 314-321.

    Google Scholar 

  16. Kavanaugh KM, Pinto IMF, McGillem MJ, DeBoe SF, Mancini GBJ. Effects of video frame averaging, smoothing and edge enhancement on the accuracy and precision of quantitative coronary arteriography. Int J Card Imag 1990; 5: 233-239.

    Google Scholar 

  17. Hausleiter J, Nolte CWT, Jost S, Maier-Rudolph W, Stiel GM, Lattermann A, Rudolph W. Progress in quantitative coronary arteriography: Improved accuracy for small vessel diameters with 2nd generation QCA systems. Computers in Cardiology Proceedings, IEEE, 1995, pp 149-152.

  18. Wunderlich W, Fischer F, Linderer T, Nöring J, Schröder R. Vergleich der analytischen Angiogramm-Kalibrierung für ideale Röntgensysteme mit den fehlertolerierenden Methoden. Gemeinsame Jahrestagung der Deutschen, der Österreichischen und der Schweizerischen Gesellschaft für Biomedizinische Technik in Graz 1993, Band 38 (Ergänzungsband).

  19. Gronenschild E, Janssen J, Tijdens F. CAAS II: A second generation system for off-line and on-line quantitative coronary angiography. Cath Cardiovasc Diagn 1994; 33: 61-75.

    Google Scholar 

  20. Hausleiter J, Nolte CWT, Jost S, Wiese B, Sturm M. Lichtlen PR. Comparison of different quantitative coronary analysis systems: ARTREK, CAAS, and CMS. Cath Cardiovasc Diagn 1996; 37: 14-22.

    Google Scholar 

  21. De Scheerder I, De Man F, Herregods MC, Wilczek K, Barrios L, Raymenants E, Desmet W, De Geest H, Piessens J. Intravascular ultrasound versus angiography for measurement of luminal diameters in normal and diseased coronary arteries. Am Heart J 1994; 127: 243-251.

    Google Scholar 

  22. St. Goar FG, Pinto FJ, Alderman EL, Fitzgerald PJ, Stadius ML, Popp RL. Intravascular ultrasound imaging of angiographically normal coronary arteries: an in vivo comparison with quantitative angiography. J Am Coll Cardiol 1991; 18: 952-958.

    Google Scholar 

  23. Nissen SE, Grines CL, Gurley JC, Sublett K, Haynie D, Diaz C, Booth DC, DeMaria AN. Application of a new phasedarray ultrasound imaging catheter in the assessment of vascular dimensions. In vivo comparison to cineangiography. circulation 1990; 81: 660-666.

    Google Scholar 

  24. Wenguang L, Gussenhoven WJ, Zhong Y, The SH, DiMario C, Madretsma S, van Egmond S, de Feyter P, Pieterman H, van Urk H. Validation of quantitative analysis of intravascular ultrasound images. Int J Card Imaging 1991; 6: 247-253.

    Google Scholar 

  25. Bartorelli AL, Neville RF, Keren G, Potkin BN, Almagoa Y, Bonner RF, Gessert JM, Leon MB. In vitro and in vivo intravascular ultrasound imaging. Eur Heart J 1992; 13: 102-108.

    Google Scholar 

  26. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307-310.

    Google Scholar 

  27. Reiber JHC, von Land CD, Koning G, van der Zwet PMJ, von Houdt RCM, Schalij MJ, Lespérance J. Comparison of accuracy and precision of quantitative coronary arterial analysis between cinefilm and digital systems. In: Reiber JHC, Serruys PW (eds). Progess in quantitative coronary arteriography. Kluwer Academic Publishers, Netherlands, 1994, pp. 67-85.

    Google Scholar 

Download references

Author information

Affiliations

  1. 2nd Medical Clinic, Johannes Gutenberg University, Mainz, Germany

    Ulrich Dietz, Hans-Jürgen Rupprecht, Rüdiger Brennecke, Hans-Peter Fritsch, Jochen Woltmann, Stefan Blankenberg & Jürgen Meyer

Authors
  1. Ulrich Dietz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hans-Jürgen Rupprecht
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rüdiger Brennecke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hans-Peter Fritsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jochen Woltmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stefan Blankenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jürgen Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Dietz, U., Rupprecht, HJ., Brennecke, R. et al. Comparison of QCA systems. Int J Cardiovasc Imaging 13, 271–280 (1997). https://doi.org/10.1023/A:1005768523234

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1005768523234

  • quantitative coronary arteriography
  • coronary artery stenosis
  • system precision
  • in vivo validation