Automated coronary border detection techniques sometimes fail to accur
ately identify vessel borders, in part because they identify the left
and right borders independently. We developed a method for simultaneou
s detection of both coronary borders that is based on three-dimensiona
l graph searching principles. The simultaneous border detection method
and our previously reported conventional method were applied to 29 co
ronary images, of which 19 were selected because conventional methods
might be expected to have difficulty due to the presence of poor contr
ast, branching vessels, or nearby or superimposed structures. Coronary
borders identified by the two methods were visually compared. In the
19 difficult images, simultaneous border detection yielded superior re
sults in 7 images and equivalent results in 12 images. Superior or equ
ivalent results were obtained in the remaining 10 typical images. In a
set of 43 uncomplicated images, minimal lumen diameters derived using
simultaneous border detection correlated well with diameters derived
using conventional border detection (r = 0.97), diameters obtained fro
m observer-defined borders (r = 0.91), and with diameters obtained usi
ng the Brown-Dodge quantitative coronary arteriography method (r = 0.8
5). Simultaneous detection of left and right coronary borders provides
improved accuracy in the detection of vessel borders in difficult cor
onary angiograms.