Diagnostic accuracy of optical coherence tomography and intravascular ultrasound for the detection and characterization of atherosclerotic plaque composition in ex-vivo coronary specimens: a comparison with histology

BackgroundBoth intravascular ultrasound and optical coherence tomography have been purported to accurately detect and characterize coronary atherosclerotic plaque composition. The aim of our study was to directly compare the reproducibility and diagnostic accuracy of optical coherence tomography and intravascular ultrasound for the detection and characterization of coronary plaque composition ex vivo as compared with histology. Methods and resultsIntravascular ultrasound (20 MHz) and optical coherence tomography imaging was performed in eight heart specimens using motorized pullback. Standard histology using hematoxylin–eosin and van Gieson staining was performed on 4 μm thick slices. Each slice was divided into quadrants and accurately matched cross-sections were analyzed for the presence of fibrous, lipid-rich, and calcified coronary plaque using standard definitions for both intravascular ultrasound and optical coherence tomography and correlated with histology. After exclusion of 145/468 quadrants, we analyzed the remaining 323 quadrants with excellent image quality in each procedure. Optical coherence tomography demonstrated a sensitivity and specificity of 91/88% for normal wall, 64/88% for fibrous plaque, 77/94% for lipid-rich plaque, and 67/97% for calcified plaque as compared with histology. Intravascular ultrasound demonstrated a sensitivity and specificity of 55/79% for normal wall, 63/59% for fibrous plaque, 10/96% for lipid-rich plaque, and 76/98% for calcified plaque. Both intravascular ultrasound and optical coherence tomography demonstrated excellent intraobserver and interobserver agreement (optical coherence tomography: κ=0.90, κ=0.82; intravascular ultrasound: κ=0.87, κ=0.86). ConclusionOptical coherence tomography is superior to intravascular ultrasound for the detection and characterization of coronary atherosclerotic plaque composition, specifically for the differentiation of noncalcified, lipid-rich, or fibrous plaque.

[1]  Brett E. Bouma,et al.  In vivo cellular optical coherence tomography imaging , 1998, Nature Medicine.

[2]  B E Bouma,et al.  High resolution in vivo intra-arterial imaging with optical coherence tomography , 1999, Heart.

[3]  W D Wagner,et al.  A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. , 1995, Arteriosclerosis, thrombosis, and vascular biology.

[4]  D. Vince,et al.  Real-time plaque characterization and visualization with spectral analysis of intravascular ultrasound data. , 2005, Studies in health technology and informatics.

[5]  C T Lancée,et al.  Arterial wall characteristics determined by intravascular ultrasound imaging: an in vitro study. , 1989, Journal of the American College of Cardiology.

[6]  H. C. Stary,et al.  Natural history and histological classification of atherosclerotic lesions: an update. , 2000, Arteriosclerosis, thrombosis, and vascular biology.

[7]  K. Takada,et al.  New measurement system for fault location in optical waveguide devices based on an interferometric technique. , 1987, Applied optics.

[8]  N. Obuchowski,et al.  Assessing spectral algorithms to predict atherosclerotic plaque composition with normalized and raw intravascular ultrasound data. , 2001, Ultrasound in Medicine and Biology.

[9]  H Rijsterborgh,et al.  Histopathologic validation of intracoronary ultrasound imaging. , 1994, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[10]  D. Calvetti,et al.  Regularized autoregressive analysis of intravascular ultrasound backscatter: improvement in spatial accuracy of tissue maps , 2004, IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control.

[11]  E. Halpern,et al.  Characterization of Human Atherosclerosis by Optical Coherence Tomography , 2002, Circulation.

[12]  F Prati,et al.  Correlation between high frequency intravascular ultrasound and histomorphology in human coronary arteries , 2001, Heart.

[13]  J M Tobis,et al.  Variability in tissue characterization of atherosclerotic plaque by intravascular ultrasound: a comparison of four intravascular ultrasound systems. , 1996, American journal of cardiac imaging.

[14]  A. van der Lugt,et al.  Rationale and Design for the SARIS Trial; Effect of Statin on Atherosclerosis and Vascular Remodeling Assessed with Intravascular Sonography , 2001, Cardiovascular Drugs and Therapy.

[15]  K. Seung,et al.  Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography: comparison with intravascular ultrasound. , 2002, Journal of the American College of Cardiology.

[16]  J. G. Fujimoto,et al.  Assessing atherosclerotic plaque morphology: comparison of optical coherence tomography and high frequency intravascular ultrasound. , 1997, Heart.

[17]  E. Halpern,et al.  Evaluation of intracoronary stenting by intravascular optical coherence tomography , 2003, Heart.

[18]  C. Tracy,et al.  American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. , 2001, Journal of the American College of Cardiology.

[19]  E. Tuzcu,et al.  Coronary Plaque Classification With Intravascular Ultrasound Radiofrequency Data Analysis , 2002, Circulation.

[20]  Walter L. Henry,et al.  Intravascular Ultrasound Imaging of Human Coronary Arteries In Vivo: Analysis of Tissue Characterizations With Comparison to In Vitro Histological Specimens , 1991, Circulation.

[21]  M. Arai,et al.  Noninvasive quantitative tissue characterization and two-dimensional color-coded map of human atherosclerotic lesions using ultrasound integrated backscatter: comparison between histology and integrated backscatter images. , 2001, Journal of the American College of Cardiology.