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1 All authors: Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
Received September 19, 2003;
accepted after revision November 7, 2003.
Address correspondence to S. Suzuki.
Abstract
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MATERIALS AND METHODS. Vascular models with three inner diameters
(
3, 4, and 6 mm) filled with contrast medium of three different densities
(
460, 350, and 210 H) were scanned with helical CT. Five convolution
kernels (soft, standard, detail, bone, and lung) were used. We evaluated the
measurement error, defined as the difference between the diameter measured by
the automated software and the true inner diameter of the vascular model.
Statistical analysis involved three-way analysis of variance with repeated
measures.
RESULTS. Significant differences occurred in measurement error among the three vascular model inner diameters, among the three densities of intravascular contrast medium, and among the five convolution kernels (p < 0.01). In all the convolution kernels except lung, measurement errors progressively decreased with higher densities of intravascular contrast medium (p < 0.01). In vascular models filled with contrast medium of 350 H, measurement errors were significantly smaller in soft (mean ± standard deviation [SD], 0.29 ± 0.16 mm) and bone (0.23 ± 0.05 mm) than in other convolution kernels (p < 0.01).
CONCLUSION. The accuracy of diameter measurement was affected by the vascular model inner diameter, the density of contrast medium, and the convolution kernel. A higher density of intravascular contrast medium and selection of the proper convolution kernel will improve accuracy.
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In this study, we evaluated the accuracy in diameter measurement in vitro by automated software for CT angiography and assessed the effect of the vascular model inner diameter, intravascular density of contrast medium, and convolution kernel. To our knowledge, this study is the first to assess the effect of convolution kernel on the accuracy of the measurement.
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3, 4, and 6 mm) filled with contrast medium diluted to three densities
(high, intermediate, and low). The cylinder walls were approximately 1 mm
thick. The inner diameters of the cylinders were measured 10 times with a
micrometer to the nearest twentieth of a millimeter. The average inner
diameters were 3.0, 4.0, and 5.9 mm. For the contrast medium, we used iohexol
(300 mg I/mL). The attenuation values of the contrast medium of the three
densities were 462 ± 8 H, 346 ± 5 H, and 205 ± 4 H.
Two physical phantoms were used. The first one, called P1, was made of six
acrylic cylinders with a 3- or 4-mm inner diameter filled with contrast medium
of all three densities. The six cylinders were fixed in a columnar styrene
container (diameter,
5 cm) filled with salad oil (attenuation value,
120 ± 4 H). The cylinders were located parallel to the central
axis of the styrene container. We fixed the styrene container in a
water-filled columnar polyethylene container (diameter,
10 cm) with their
central axes overlapping (Fig.
1). The second phantom, called P2, was made of three acrylic
cylinders with a 6-mm inner diameter filled with contrast medium of all three
densities. The three cylinders were fixed in a columnar styrene container
inside a columnar polyethylene container in the same way as with P1.
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Helical CT
We scanned each phantom, overlapping the central axis of the columnar
container of the phantoms on the axis of the gantry rotation. Single-detector
helical CT was performed with a HiSpeed Advantage SG (General Electric Medical
Systems). Parameters were 1-mm collimation, pitch of 1.0, 1 sec per gantry
rotation, 48.0-cm field of view, 200 mA, and 120 kV.
Measurement
The raw data were reconstructed in 9.8-cm field of view with a 512 x
512 pixel matrix at a 0.5-mm interval using five convolution kernels. The
convolution kernels were soft, standard, detail, bone, and lung. According to
the information provided by General Electric Medical Systems, contrast
resolution tends to decrease in the following order: soft, standard, detail,
lung, and bone. The reconstructed images were transferred to a workstation
(Advantage Workstation, version 4.0; General Electric Medical Systems) and
analyzed by automated software (Advanced Vessel Analysis, General Electric
Medical Systems). Ten mean diameter measurements were obtained in all vascular
models using the five convolution kernels.
The diameter measurement was composed of three main steps. In the first step, we defined the segment of interest by designating its starting and ending points in planar cross sections. In the second step, the centerline of the vascular model was automatically tracked between the two defined points. In the last step, diameter measurements were performed for the 10 points that we defined along the centerline. At each point, the area of the vascular model cross section was measured in the plane orthogonal to the centerline. The mean diameter was defined as the diameter of the circle that would have the same area as the vascular model cross section.
The measurement error was defined as the difference between the measured diameter minus the true inner diameter of the vascular model. Figures 2 and 3 show the cross section and CT attenuation profile of the 3- and 6-mm models filled with the contrast medium of intermediate density for the five convolution kernels. Figure 4 shows the cross section and CT attenuation profile of the 6-mm models filled with the contrast medium of low density for the five convolution kernels.
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Statistical Analysis
Statistical analysis involved three-way analysis of variance with repeated
measures to assess interactions among combinations of factors and main effects
of single factors. The Student's t test for paired samples was used
to compare parameters, with a p value of less than 0.01 considered to
represent a statistically significant result.
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Significant differences were detected in measurement error among the three vascular model inner diameters, among the three densities of intravascular contrast medium, and among the five convolution kernels (Table 1). Because significant interactions were present among all combinations of the factors, the Student's t test for unpaired samples was used to compare parameters.
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Effect of Densities of Intravascular Contrast Medium
In all the convolution kernels except lung, measurement errors
progressively decreased with higher densities of the intravascular contrast
medium (p < 0.01). In these four convolution kernels, the absolute
measurement errors were more than 0.8 mm for low-density vascular models, less
than 0.5 mm for intermediate-density vascular models, and less than 0.3 mm for
high-density vascular models (Table
2). In lung, the absolute measurement errors progressively
decreased with higher densities of the intravascular contrast medium only in
the 3-mm inner diameter models. On the other hand, the absolute measurement
errors in lung were about 2 mm in the 4- and 6-mm inner diameter models,
regardless of the density of intravascular contrast medium (Figs.
5,
6,
7).
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Effect of Convolution Kernels
For low-density vascular models, the overall measurement error increased in
the following order: soft, standard, detail, lung, and bone (p <
0.01) (Table 2). The overall
measurement error was 0.84 mm for soft and 1.00 mm for standard.
For intermediate-density vascular models, the overall measurement errors were significantly smaller for soft (mean error, 0.29 mm) and bone (mean error, 0.23 mm) than for the other convolution kernels (Table 2). No significant difference occurred between soft and bone, but the measurement errors were more affected by the inner diameter for soft than for bone (Fig. 6). The error range was 0.100.45 mm for soft and 0.180.28 mm for bone.
For high-density vascular models, the overall measurement error increased in the following order: soft, bone, standard, detail, and lung (p < 0.01) (Table 2). The absolute overall measurement error was 0.05 mm for soft and 0.19 mm for bone.
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Some investigators have proposed the optimal value for arterial contrast enhancement for CT angiography [16, 24, 29]. Claves et al. [24] found that attenuation values of 150 and 200 H produced the best results in vessel measurement without automated software on CT angiography, and a density of 100 H or greater than 250 H significantly increased the error. However, in our study with automated software, measurement errors progressively decreased with higher densities of the intravascular contrast medium in all the convolution kernels except lung. The automated software recognizes the vascular inner contour by application of watershed transformation. In this process, the original images are transformed into gradient images. The measurement error is probably affected by the slope of the profile curves corresponding to the vascular inner contour. We believe that the slope of the profile curve probably becomes progressively steeper with higher densities of intravascular contrast medium, and therefore the measurement accuracy is improved.
Standard is commonly used as the convolution kernel in vascular measurement with the automated software provided by General Electric Medical Systems. When standard was used as the convolution kernel, the overall measurement error was 1.00 mm for the 210-H models, 0.45 mm for the 350-H models, and 0.25 mm for the 460-H models in our study. These results may exert significant practical impact on the diameter estimation of small arteries.
In the 210-H models, the overall measurement error in soft was 0.84 mm and was significantly smaller in standard. When the density of intravascular contrast medium is not sufficient, measurement error may be decreased using a convolution kernel with more emphasis on contrast resolution such as soft.
In bone and lung, the measurement errors were approximately 2 mm in the
210-H models. Taking into account the wall thickness of the vascular models
(
1 mm), the automated software seemed to measure the outer diameter with
these convolution kernels (Fig.
4). The automated software probably missed the difference in
attenuation values between the vascular wall and lumen with a convolution
kernel that emphasizes edge recognition such as bone or lung.
In vascular models filled with contrast medium of 350 or 460 H, the overall measurement errors were significantly smaller in bone than in standard, as shown in Table 2. When the density of intravascular contrast medium is adequate, the automated software seems to recognize more exactly the vascular inner contour with bone than with standard, because the slope of the profile curve is steeper with the former convolution kernel (Figs. 2 and 3). However, these results may be affected by the thickness of the vascular wall.
Although lung also emphasizes edge recognition, the measurement errors in lung were larger than in the other convolution kernels. In the 4- and 6-mm diameter models, lung has such large overshoots on the profile curve that the automated software seems to recognize the plateau between the overshoots as the vascular lumen and underestimates the vascular diameter, as shown in Figure 3. In the 3-mm diameter models, the overshoots are close to each other, and no plateau exists between the overshoots, as shown in Figure 2. Overall, underestimation did not occur in the 3-mm diameter models.
In this study, soft was better than standard in vascular measurement for 350- and 460-H models. These results are difficult to explain by only the slope of the profile curve. These results may be affected by the thickness and density of the vascular wall and material around the vessel.
This study has some limitations. First, our CT scanner was a single-detector unit, although MDCT is generally used for CT angiography at present [3033]. We intentionally used single-detector helical CT, considering that measurement accuracy would be affected by the "corn beam" artifact peculiar to MDCT.
Second, we only used automated software provided by General Electric Medical Systems. Recently, some automated software has been provided on CT workstations, and the difference in software probably affects the measurement accuracy. However, as mentioned previously, the accuracy of diameter measurement is probably affected by the slope of profile curves corresponding to the vascular inner contour. As a result, a higher density of intravascular contrast medium and use of the proper convolution kernel will improve the accuracy with another automated software.
Third, we did not sufficiently assess the effect of noise on measurement accuracy. The noise increases with convolution kernels that emphasize edge recognition and will affect the recognition of the vessel boundaries. Further limiting factors are vascular wall thickness, vascular orientation to the axial plane, and size of field of view. The next step will be to evaluate the effect of these factors on measurement accuracy.
In conclusion, the accuracy of diameter measurement using automated software for CT angiography is affected by the vessel inner diameter, intravascular density of contrast medium, and convolution kernel. A higher density of intravascular contrast medium and selection of the proper convolution kernel will improve the accuracy.
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