Coronary Artery Lumen Segmentation Using Location–Adaptive Threshold in Coronary Computed Tomographic Angiography: A Proof-of-Concept

OBJECTIVE: To compare the lumen parameters measured by the location-adaptive threshold method (LATM), in which the inter- and intra-scan attenuation variabilities of coronary computed tomographic angiography (CCTA) were corrected, and the scan-adaptive threshold method (SATM), in which only the inter-scan variability was corrected, with the reference standard measurement by intravascular ultrasonography (IVUS). MATERIALS AND METHODS: The Hounsfield unit (HU) values of whole voxels and the centerline in each of the cross-sections of the 22 target coronary artery segments were obtained from 15 patients between March 2009 and June 2010, in addition to the corresponding voxel size. Lumen volume was calculated mathematically as the voxel volume multiplied by the number of voxels with HU within a given range, defined as the lumen for each method, and compared with the IVUS-derived reference standard. Subgroup analysis of the lumen area was performed to investigate the effect of lumen size on the studied methods. Bland-Altman plots were used to evaluate the agreement between the measurements. RESULTS: Lumen volumes measured by SATM was significantly smaller than that measured by IVUS (mean difference, 14.6 mm(3); 95% confidence interval [CI], 4.9–24.3 mm(3)); the lumen volumes measured by LATM and IVUS were not significantly different (mean difference, −0.7 mm(3); 95% CI, −9.1–7.7 mm(3)). The lumen area measured by SATM was significantly smaller than that measured by LATM in the smaller lumen area group (mean of difference, 1.07 mm(2); 95% CI, 0.89–1.25 mm(2)) but not in the larger lumen area group (mean of difference, −0.07 mm(2); 95% CI, −0.22–0.08 mm(2)). In the smaller lumen group, the mean difference was lower in the Bland-Altman plot of IVUS and LATM (0.46 mm(2); 95% CI, 0.27–0.65 mm(2)) than in that of IVUS and SATM (1.53 mm(2); 95% CI, 1.27–1.79 mm(2)). CONCLUSION: SATM underestimated the lumen parameters for computed lumen segmentation in CCTA, and this may be overcome by using LATM.