Three - dimensional Reconstruction of Intracoronary Ultrasound

Although intracoronary ultrasonography allows detailed tomographic imaging of the arterial wall, it fails to provide data on the structural architecture and longitudinal extent of arterial disease. This information is essential for decision making during therapeutic interventions. Three-dimensional reconstruction techniques offer visualization of the complex longitudinal architecture of atherosclerotic plaques in composite display. Progress in computer hardware and software technology have shortened the reconstruction process and reduced operator interaction considerably, generating three-dimensional images with delineation of mural anatomy and pathology. The indications for intravascular ultrasonography will grow as the technique offers the unique capability of providing ultrasonic histology of the arterial wall, and the need for a three-dimensional display format for comprehensive Although the experienced medical mind is capable of three-dimensional conceptualization of complex structural morphology and pathology, objective computerized three-dimensional reconstructions would facilitate both qualitative and quantitative analysis and enhance our diagnostic capabilities. Intracoronary ultrasound provides tomographic images of the arterial lumen and wall components that are displayed in a sequential fashion on the monitor screen. Conceptualization of the spatial relations of these components and their pathology requires repeated review of the recorded tomographic images. Computerized three-dimensional reconstruction allows the display of these tomographic images in their longitudinal relation to the proximal and distal segments and provides an objective spatial picture and a potential gateway to quantification. Other clinical advantages are a better understanding of the pathoanatomy of the vessel wall and the application of new parameters of wall dynamics, both of which may help in guiding intracoronary interventions. Recently, real-time three-dimensional reconstruction algorithms have become available for on-line routine clinical use and allow the arterial segment to be viewed in sagittal and cylindrical display formats. In this report, we review Received January 13, 1994; revision accepted April 12, 1994. From the Thoraxcenter, Division of Cardiology, University Hospital Rotterdam-Dijkzigt and Erasmus University, Rotterdam, The Netherlands, and Tufts New England Medical Center, Boston, Mass. Correspondence to Jos R.T.C. Roelandt, MD, Thoraxcenter, Bd 408, PO Box 1738, 3000 DR Rotterdam, The Netherlands. © 1994 American Heart Association, Inc. analysis is increasingly recognized. Consequently, three-dimensional imaging is being rapidly implemented in the catheterization laboratories for guidance of intracoronary interventions and detailed assessment of their results. However exciting the prospects may be, three-dimensional reconstructions at present remain partially artificial because the true spatial position of the imaging catheter tip is not recorded, and shifts in its location and curves of the arterial lumen result in pseudoreconstructions rather than true reconstructions. In this report, we address the principles of three-dimensional reconstruction with a critical review of its limitations. Potential solutions for refinement of this exciting imaging modality are presented. (Circulation. 1994;90:1044-1055.)