Simpson's rule for the volumetric ultrasound assessment of atherosclerotic coronary arteries: A study with ECG-gated three-dimensional intravascular ultrasound

Background. Volumetric intravascular ultrasound (IVUS) assessment provides complementary information on atherosclerotic plaques. The volumes can be calculated by applying Simpson's rule to cross-sectional area data of multiple IVUS images, acquired with a fixed sample spacing, which is the distance (along the vessel's axis) between two images. Objective. To evaluate the effect of different sample spacings on the results of volumetric IVUS measurements. Methods. A stepwise electrocardiographically gated IVUS image-acquisition and automated three-dimensional analysis approach was applied to 26 patients. Twenty-eight coronary segments with mild-to-moderate coronary atherosclerosis were examined. Volumetric measurements of five images per mm (i.e. sample spacing 0.2 mm), representing a complete scanning of the coronary segment, were considered the optimal standard, against which volumetric measurements of three, one, and one-half images per mm (i.e. larger sample spacings) were compared. Results. The lumen, total vessel, and plaque volumes obtained with five images per mm were 183.3 ± 2.8, 350.6 ± 141.6, and 167.3 ± 89.2 mm³. There was an excellent correlation (r = 0.99, P < 0.001) between these data and volumetric measurements with larger sample spacings. The volumetric measurements with larger sample spacings differed on average only by a little (< 0.7%) from the optimal standard measurements. However, a relatively small, but significant, increase in SD of these differences was associated with the wider sample spacings (< 3.6%, P < 0.05). Conclusions. The width of the sample spacing has a relatively small but significant impact on the variability of volumetric intravascular ultrasound measurements. This should be considered when designing future volumetric studies. The electrocardiographically gated acquisition of five IVUS images per mm axial length during a stepwise transducer pull-back is an ideal approach, particularly when addressing with IVUS volumetric changes that are assumed small, such as those expected in studies of the progression and regression of atherosclerosis.