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Direct Comparison of Virtual-Histology Intravascular Ultrasound and Optical Coherence Tomography Imaging for Identification of Thin-Cap Fibroatheroma.

Brown AJ, Obaid DR, Costopoulos C, Parker RA, Calvert PA, Teng Z, Hoole SP, West NE, Goddard M, Bennett MR - Circ Cardiovasc Imaging (2015)

Bottom Line: Combining VH-defined fibroatheroma and fibrous cap thickness ≤85 μm over 3 continuous frames improved TCFA identification, with diagnostic accuracy of 89.0%.Both VH-IVUS and OCT can reliably identify TCFA, although OCT accuracy may be improved using lipid arc ≥80° and fibrous cap thickness ≤85 μm over 3 continuous frames.Combined VH-IVUS/OCT imaging markedly improved TCFA identification.

View Article: PubMed Central - PubMed

Affiliation: From the Division of Cardiovascular Medicine (A.J.B., D.R.O., C.C., P.A.C., M.R.B.), Department of Radiology (Z.T.), and Department of Engineering (Z.T.), University of Cambridge, Cambridge, United Kingdom; Health Services Research Unit, Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine. University of Edinburgh, Edinburgh, United Kingdom (R.A.P.); and Departments of Interventional Cardiology (S.P.H., N.E.J.W.) and Pathology (M.G.), Papworth Hospital NHS Trust, Cambridge, United Kingdom.

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Plaque classification using optical coherence tomography. Optical coherence tomographic images illustrating both nonatherosclerotic vessel (A) and plaque (B), with evidence of focal intimal thickening and loss of layered vessel wall structure in (B). C–F, Further examples of fibrous plaque (C), fibrocalcific plaque (D), thick-cap fibroatheroma (E), and thin-cap fibroatheroma (F). Coronary guidewire artifact is denoted by * in all images.
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Figure 2: Plaque classification using optical coherence tomography. Optical coherence tomographic images illustrating both nonatherosclerotic vessel (A) and plaque (B), with evidence of focal intimal thickening and loss of layered vessel wall structure in (B). C–F, Further examples of fibrous plaque (C), fibrocalcific plaque (D), thick-cap fibroatheroma (E), and thin-cap fibroatheroma (F). Coronary guidewire artifact is denoted by * in all images.

Mentions: Offline OCT analysis was performed using LightLab Imaging workstation (St. Jude Medical) by 2 independent observers blinded to histology and IVUS. Luminal contours were manually adjusted and plaque composition assessed for each frame. Lipid was defined as a signal-poor region within a plaque, with poorly delineated borders and a fast drop-off in OCT signal, whereas calcium was defined as a signal-poor region, but with sharply delineated borders and a gradual drop-off in OCT signal.10 Lipid arc (LA) measurements were recorded within each frame and mean (LAmean) and maximum (LAmax) value calculated. If lipid was present in a frame, minimal FCT (FCTmin) was measured at its thinnest part 3× times and mean value used in subsequent analysis.12 The number of continuous OCT frames with FCTmin ≤85 μm was also documented. OCT Plaque classification was performed according to an international consensus statement (Figure 2)10; an OCT-defined fibroatheroma was defined as plaque with LAmax ≥90°, with an OCT-defined TCFA having an FCTmin ≤85 μm, a value ≈20% higher than the histological definition to account for tissue shrinkage.13 Full details with illustrations of OCT plaque classification can be found in the Methods section of Data Supplement. Interobserver agreement for OCT plaque classification was strong (κ=0.89; 95% CI, 0.83–0.94; Table II in the Data Supplement).


Direct Comparison of Virtual-Histology Intravascular Ultrasound and Optical Coherence Tomography Imaging for Identification of Thin-Cap Fibroatheroma.

Brown AJ, Obaid DR, Costopoulos C, Parker RA, Calvert PA, Teng Z, Hoole SP, West NE, Goddard M, Bennett MR - Circ Cardiovasc Imaging (2015)

Plaque classification using optical coherence tomography. Optical coherence tomographic images illustrating both nonatherosclerotic vessel (A) and plaque (B), with evidence of focal intimal thickening and loss of layered vessel wall structure in (B). C–F, Further examples of fibrous plaque (C), fibrocalcific plaque (D), thick-cap fibroatheroma (E), and thin-cap fibroatheroma (F). Coronary guidewire artifact is denoted by * in all images.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4596008&req=5

Figure 2: Plaque classification using optical coherence tomography. Optical coherence tomographic images illustrating both nonatherosclerotic vessel (A) and plaque (B), with evidence of focal intimal thickening and loss of layered vessel wall structure in (B). C–F, Further examples of fibrous plaque (C), fibrocalcific plaque (D), thick-cap fibroatheroma (E), and thin-cap fibroatheroma (F). Coronary guidewire artifact is denoted by * in all images.
Mentions: Offline OCT analysis was performed using LightLab Imaging workstation (St. Jude Medical) by 2 independent observers blinded to histology and IVUS. Luminal contours were manually adjusted and plaque composition assessed for each frame. Lipid was defined as a signal-poor region within a plaque, with poorly delineated borders and a fast drop-off in OCT signal, whereas calcium was defined as a signal-poor region, but with sharply delineated borders and a gradual drop-off in OCT signal.10 Lipid arc (LA) measurements were recorded within each frame and mean (LAmean) and maximum (LAmax) value calculated. If lipid was present in a frame, minimal FCT (FCTmin) was measured at its thinnest part 3× times and mean value used in subsequent analysis.12 The number of continuous OCT frames with FCTmin ≤85 μm was also documented. OCT Plaque classification was performed according to an international consensus statement (Figure 2)10; an OCT-defined fibroatheroma was defined as plaque with LAmax ≥90°, with an OCT-defined TCFA having an FCTmin ≤85 μm, a value ≈20% higher than the histological definition to account for tissue shrinkage.13 Full details with illustrations of OCT plaque classification can be found in the Methods section of Data Supplement. Interobserver agreement for OCT plaque classification was strong (κ=0.89; 95% CI, 0.83–0.94; Table II in the Data Supplement).

Bottom Line: Combining VH-defined fibroatheroma and fibrous cap thickness ≤85 μm over 3 continuous frames improved TCFA identification, with diagnostic accuracy of 89.0%.Both VH-IVUS and OCT can reliably identify TCFA, although OCT accuracy may be improved using lipid arc ≥80° and fibrous cap thickness ≤85 μm over 3 continuous frames.Combined VH-IVUS/OCT imaging markedly improved TCFA identification.

View Article: PubMed Central - PubMed

Affiliation: From the Division of Cardiovascular Medicine (A.J.B., D.R.O., C.C., P.A.C., M.R.B.), Department of Radiology (Z.T.), and Department of Engineering (Z.T.), University of Cambridge, Cambridge, United Kingdom; Health Services Research Unit, Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine. University of Edinburgh, Edinburgh, United Kingdom (R.A.P.); and Departments of Interventional Cardiology (S.P.H., N.E.J.W.) and Pathology (M.G.), Papworth Hospital NHS Trust, Cambridge, United Kingdom.

Show MeSH
Related in: MedlinePlus