A vessel segment length as seen in the image is not always indicated as the same X-axis difference in the graph.

The X-axis of the graph is based on pixel positions on the midline and these points are not necessarily equidistant. This is caused by the fact that vessels do not only run perfectly horizontally or vertically, but also at angles.

When a vessel midline is covering a number of pixel positions perfectly horizontal or vertical, it will cover less space in mm compared to a vessel that covers the same number of pixel positions under an angle. When a segment runs perfectly horizontal or vertical, the segment length is equal to the amount of midline pixel points times the pixel separation (each point of the midline is separated exactly the pixel spacing in mm) and the points on the X-axis also represent exactly one pixel space. This is not the case when the vessel runs under an angle. For example an artery that is positioned at a 45 angle, the distance between two points on the midline is 0.7 times the pixel spacing.

As example, the artery consists of 10 elements (n =10); each has a length of 1mm(pixel size). If the MLD was exactly in the center of the artery you would expect the length from 0 to the MLD would be 5 sub segments long, thus 5 mm. This is true if the artery runs horizontal or vertically (assumed aspect ratio is 1).

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If the artery is positioned in a 45º angle then the length of each element is √2 times the pixel size compared to the previous example. Thus the length depends on the angle of the artery.

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