Abstract
Background and Purpose: The Active Connection Matrixes (ACMs) are unsupervised artificial adaptive systems able to extract from digital images features of interest (edges, tissue differentiation, etc.) unnoticeable with conventional systems. In this proof-of-concept study, we assessed the potentiality of ACMs to increase measurement precision of morphological structures (e.g., stenosis and lumen diameter) and to grasp morphological features (arterial walls) from quantitative coronary angiography (QCA), unnoticeable on the original images.Methods: Archive images of QCA and intravascular ultrasound (IVUS) of 10 patients (8 men, age 69.1 ± 9.7 years) who underwent both procedures for clinical reasons were retrospectively analyzed. Arterial features derived from “IVUS images,” “conventional QCA images,” and “ACM-reprocessed QCA images” were measured in 21 coronary segments. Portions of 1-mm length (263 for lumen and 526 for arterial walls) were head-to-head compared to assess quali-quantitative between-methods agreement.Results: When stenosis was calculated on “ACM-reprocessed QCA images,” the bias vs. IVUS (gold standard) did not improve, but the correlation coefficient of the QCA–IVUS relationship increased from 0.47 to 0.83. When IVUS-derived lumen diameters were compared with diameters obtained on ACM-reprocessed QCA images, the bias (−0.25 mm) was significantly smaller (p < 0.01) than that observed with original QCA images (0.58 mm). ACMs were also able to extract arterial wall features from QCA. The bias between the measures of arterial walls obtained with IVUS and ACMs, although significant (p < 0.01), was small [0.09 mm, 95% CI (0.03, 0.14)] and the correlation was fairly good (r = 0.63; p < 0.0001).Conclusions: This study provides proof of concept that ACMs increase the measurement precision of coronary lumen diameter and allow extracting from QCA images hidden features that mirror well the arterial walls derived by IVUS.
Highlights
Analysis of luminal stenosis by quantitative coronary angiography (QCA) has been the reference method for angiographic diagnosis of coronary narrowing [1, 2], for guiding revascularization procedures [1], and for the assessment of coronary artery disease (CAD) [3]
Diagnosis and therapeutic decision-making processes about coronary atheroma are supported by the intravascular ultrasound (IVUS), which allows the direct assessment of coronary arterial wall geometry [6]
The qualitative concordance of the shape of lumen and arterial wall silhouettes derived by Active Connection Matrixes (ACMs)-reprocessed QCA images and IVUS images of all the 21 segments considered are shown in Supplementary Figures 8–18
Summary
Analysis of luminal stenosis by quantitative coronary angiography (QCA) has been the reference method for angiographic diagnosis of coronary narrowing [1, 2], for guiding revascularization procedures [1], and for the assessment of coronary artery disease (CAD) [3]. Diagnosis and therapeutic decision-making processes about coronary atheroma are supported by the intravascular ultrasound (IVUS), which allows the direct assessment of coronary arterial wall geometry [6]. The Active Connection Matrixes (ACMs) are unsupervised artificial adaptive systems able to extract from digital images features of interest (edges, tissue differentiation, etc.) unnoticeable with conventional systems. In this proof-of-concept study, we assessed the potentiality of ACMs to increase measurement precision of morphological structures (e.g., stenosis and lumen diameter) and to grasp morphological features (arterial walls) from quantitative coronary angiography (QCA), unnoticeable on the original images
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