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Gerbaud E, Weisz G, Tanaka A, Luu R, Osman HASH, Baldwin G, Coste P, Cognet L, Waxman S, Zheng H, Moses JW, Mintz GS, Akasaka T, Maehara A, Tearney GJ. Plaque burden can be assessed using intravascular optical coherence tomography and a dedicated automated processing algorithm: a comparison study with intravascular ultrasound. Eur Heart J Cardiovasc Imaging 2021; 21:640-652. [PMID: 31326995 DOI: 10.1093/ehjci/jez185] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/22/2019] [Accepted: 07/10/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS Plaque burden (PB) measurement using intravascular optical coherence tomography (IVOCT) is currently thought to be inferior to intravascular ultrasound (IVUS). We developed an automated IVOCT image processing algorithm to enhance the external elastic lamina (EEL) contour. Thus, we investigated the accuracies of standard IVOCT and an IVOCT enhancement algorithm for measuring PB using IVUS as the reference standard. METHODS AND RESULTS The EEL-enhancement algorithm combined adaptive attenuation compensation, exponentiation, angular registration, and image averaging using three sequential frames. In two different laboratories with intravascular imaging expertise, PB was quantified on 200 randomized, matched IVOCT and IVUS images by four independent observers. Fibroatheroma, fibrocalcific plaque, fibrous plaque, pathological intimal thickening (PIT), and mixed plaque were included in each set. Pearson's correlation coefficients between IVUS and standard IVOCT measurements of PB were 0.61, 0.67, 0.76, 0.78, and 0.87 for fibroatheromas, mixed plaques, fibrocalcific plaques, fibrous plaques, and PIT plaques, respectively. Pearson's correlation coefficients increased to 0.81, 0.83, 0.83, 0.84, and 0.90 when using the EEL-enhanced images (P = 0.003, P = 0.004, P = 0.08, P = 0.12, and P = 0.23, respectively). EEL-enhanced IVOCT analysis was associated with a lower EEL-area measurement absolute error for fibroatheromas, mixed plaques, and all pooled plaques (P = 0.006, P = 0.02, and P < 0.001, respectively). Compared with standard IVOCT, the EEL-enhanced IVOCT images had a higher sensitivity (79% vs. 28%, P < 0.001) and specificity (98% vs. 85%, P = 0.03) for plaques with an IVUS PB ≥70%. CONCLUSION EEL-enhanced IVOCT can be used to reliably measure PB in all types of coronary atherosclerotic lesions, including fibroatheromas and mixed plaques.
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Affiliation(s)
- Edouard Gerbaud
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, 40 Blossom Street, BHX-604A, Boston, MA 02114, USA.,Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 5 Avenue Magellan, Pessac 33600, France.,Bordeaux Cardio-Thoracic Research Centre, Bordeaux University, U1045, Hôpital Xavier Arnozan, Avenue du Haut Lévêque, Pessac 33600, France
| | - Giora Weisz
- Columbia University Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA.,Montefiore-Einstein Center for Heart and Vascular, The University Hospital for the Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Atsushi Tanaka
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, 40 Blossom Street, BHX-604A, Boston, MA 02114, USA.,Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama Prefecture 641-8509, Japan
| | - Romain Luu
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, 40 Blossom Street, BHX-604A, Boston, MA 02114, USA.,Institut d'Optique Graduate School, CNRS-UMR 5298, Bordeaux University, Rue François Miterrand, Talence 33400, France
| | - Hany Ahmed Salaheldin Hussein Osman
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, 40 Blossom Street, BHX-604A, Boston, MA 02114, USA
| | - Grace Baldwin
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, 40 Blossom Street, BHX-604A, Boston, MA 02114, USA
| | - Pierre Coste
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 5 Avenue Magellan, Pessac 33600, France.,Bordeaux Cardio-Thoracic Research Centre, Bordeaux University, U1045, Hôpital Xavier Arnozan, Avenue du Haut Lévêque, Pessac 33600, France
| | - Laurent Cognet
- Institut d'Optique Graduate School, CNRS-UMR 5298, Bordeaux University, Rue François Miterrand, Talence 33400, France
| | - Sergio Waxman
- Department of Cardiology, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, USA
| | - Hui Zheng
- Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jeffrey W Moses
- Columbia University Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA
| | - Gary S Mintz
- Columbia University Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama Prefecture 641-8509, Japan
| | - Akiko Maehara
- Columbia University Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA
| | - Guillermo J Tearney
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, 40 Blossom Street, BHX-604A, Boston, MA 02114, USA.,Department of Pathology, Massachusetts General Hospital and Harvard Medical School, 40 Blossom Street, Boston, MA 02114, USA.,Harvard-MIT Health Sciences and Technology, Boston, MA, USA
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2
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Ramasamy A, Ng J, White S, Johnson TW, Foin N, Girard MJA, Dijkstra J, Amersey R, Scoltock S, Koganti S, Jones D, Jin C, Räber L, Serruys PW, Torii R, Crake T, Rakhit R, Baumbach A, Mathur A, Bourantas CV. Efficacy and Reproducibility of Attenuation-Compensated Optical Coherence Tomography for Assessing External Elastic Membrane Border and Plaque Composition in Native and Stented Segments - An In Vivo and Histology-Based Study. Circ J 2019; 84:91-100. [PMID: 31735729 DOI: 10.1253/circj.cj-19-0630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Attenuation-compensated (AC) technique was recently introduced to improve the plaque characterization of optical coherence tomography (OCT). Histological validation demonstrated promising results but the efficacy and reproducibility of this technique for assessing in-vivo tissue composition remains unclear.Methods and Results:OCT images portraying native (n=200) and stented (n=200) segments and 31 histological cross-sections were analyzed. AC-OCT appeared superior to conventional (C)-OCT in detecting the external elastic lamina (EEM) borders (76% vs. 65.5%); AC-OCT enabled larger EEM arc detection compared with C-OCT (174.2±58.7° vs. 137.5±57.9°; P<0.001). There was poor agreement between the 2 techniques for detection of lipid in native and lipid and calcific tissue in stented segments (κ range: 0.164-0.466) but the agreement of C-OCT and AC-OCT was high for calcific tissue in native segments (κ=0.825). Intra and interobserver agreement of the 2 analysts was moderate to excellent with C-OCT (κ range: 0.681-0.979) and AC-OCT (κ range: 0.733-0.892) for all tissue types in both native and stented segments. Ex-vivoanalysis demonstrated that C-OCT was superior to AC-OCT (κ=0.545 vs. κ=0.296) for the detection of the lipid component in native segments. CONCLUSIONS The AC technique allows better delineation of the EEM but it remains inferior for lipid pool detection and neointima characterization. Combined AC- and C-OCT imaging may provide additional value for complete assessment of plaque and neointima characteristics.
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Affiliation(s)
- Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust.,William Harvey Research Institute, Queen Mary University London
| | - Jaryl Ng
- Department of Biomedical Engineering, National University of Singapore.,National Heart Centre and Duke-NUS Medical School, National University of Singapore
| | - Stephen White
- Department of Life Sciences, Manchester Metropolitan University
| | | | - Nicolas Foin
- Department of Biomedical Engineering, National University of Singapore.,National Heart Centre and Duke-NUS Medical School, National University of Singapore
| | - Michael J A Girard
- Department of Biomedical Engineering, National University of Singapore.,National Heart Centre and Duke-NUS Medical School, National University of Singapore
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center
| | - Rajiv Amersey
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust
| | | | | | - Daniel Jones
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust.,William Harvey Research Institute, Queen Mary University London
| | - Chongying Jin
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust
| | | | - Patrick W Serruys
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London
| | - Ryo Torii
- Department of Mechanical Engineering, University College London
| | - Tom Crake
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust
| | - Roby Rakhit
- Department of Cardiology, Royal Free London NHS Foundation Trust
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust.,William Harvey Research Institute, Queen Mary University London
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust.,William Harvey Research Institute, Queen Mary University London
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust.,William Harvey Research Institute, Queen Mary University London.,Institute of Cardiovascular Sciences, University College London
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3
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Giannopoulos AA, Benz DC, Gräni C, Buechel RR. Imaging the event-prone coronary artery plaque. J Nucl Cardiol 2019; 26:141-153. [PMID: 28685252 DOI: 10.1007/s12350-017-0982-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 06/19/2017] [Indexed: 12/18/2022]
Abstract
Acute coronary events, the dreaded manifestation of coronary atherosclerosis, remain one of the main contributors to mortality and disability in the developed world. The majority of those events are associated with atherosclerotic plaques-related thrombus formation following an acute disruption, that being rupture or erosion, of an event-prone lesion. These historically termed vulnerable plaques have been the target of numerous benchtop and clinical research endeavors, yet to date without solid results that would allow for early identification and potential treatment. Technological leaps in cardiovascular imaging have provided novel insights into the formation and role of the event-prone plaques. From intracoronary optical coherence tomography that has enhanced our understanding of the pathophysiological mechanisms of plaque disruption, over coronary computed tomography angiography that enables non-invasive serial plaque imaging, and positron emission tomography poised to be rapidly implemented into clinical practice to the budding field of plaque imaging with cardiac magnetic resonance, we summarize the invasive and non-invasive imaging modalities currently available in our armamentarium. Finally, the current status and potential future imaging directions are critically appraised.
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Affiliation(s)
- Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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4
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Teo JC, Foin N, Otsuka F, Bulluck H, Fam JM, Wong P, Low FH, Leo HL, Mari JM, Joner M, Girard MJA, Virmani R. Optimization of coronary optical coherence tomography imaging using the attenuation-compensated technique: a validation study. Eur Heart J Cardiovasc Imaging 2018; 18:880-887. [PMID: 27469587 DOI: 10.1093/ehjci/jew153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/28/2016] [Indexed: 01/08/2023] Open
Abstract
Aim To optimize conventional coronary optical coherence tomography (OCT) images using the attenuation-compensated technique to improve identification of plaques and the external elastic lamina (EEL) contour. Methods and Results The attenuation-compensated technique was optimized via manipulating contrast exponent C, and compression exponent N, to achieve an optimal contrast and signal-to-noise ratio (SNR). This was applied to 60 human coronary lesions (38 native and 22 stented) ex vivo conventional coronary OCT images acquired from heart autopsies of 10 patients and matching histology was available as reference. Three independent reviewers assessed the conventional and attenuation-compensated OCT images blindly for plaque characteristics and EEL detection. Conventional OCT and compensated OCT assessment were compared against histology. Using an optimized algorithm, the attenuation-compensated OCT images had a 2-fold improvement in contrast between different tissues in both stented and non-stented epicardial coronaries (P < 0.05). Overall sensitivity and specificity for plaque classification increased from 84 to 89% and from 92 to 94%, respectively, with substantial agreement among the three reviewers (Fleiss' Kappa k, 0.72 and 0.71, respectively). Furthermore, operators were 2.5 times more likely to identify the EEL contour in the attenuation-compensated OCT images (k = 0.72) than in the conventional OCT images (k = 0.36). Conclusion The attenuation-compensated technique can be retrospectively applied to conventional OCT images and improves the detection of plaque characteristics and the EEL contour. This approach could complement conventional OCT imaging in the evaluation of plaque characteristics and quantify plaque burden in the clinical setting.
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Affiliation(s)
- Jing Chun Teo
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609.,Department of Biomedical Engineering and Duke-NUS Medical School, National University Singapore, Singapore
| | - Nicolas Foin
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609.,Department of Biomedical Engineering and Duke-NUS Medical School, National University Singapore, Singapore
| | - Fumiyuki Otsuka
- CV Path Institute, Gaithersburg, MD, USA.,National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Heerajnarain Bulluck
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609.,Department of Biomedical Engineering and Duke-NUS Medical School, National University Singapore, Singapore
| | - Jiang Ming Fam
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609
| | - Philip Wong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609
| | - Fatt Hoe Low
- Department of Cardiology, National University Heart Center, Singapore
| | - Hwa Liang Leo
- Department of Biomedical Engineering and Duke-NUS Medical School, National University Singapore, Singapore
| | | | | | - Michael J A Girard
- Department of Biomedical Engineering and Duke-NUS Medical School, National University Singapore, Singapore.,Singapore Eye Research Institute Singapore National Eye Centre, Singapore
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5
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Liu S, Sotomi Y, Eggermont J, Nakazawa G, Torii S, Ijichi T, Onuma Y, Serruys PW, Lelieveldt BPF, Dijkstra J. Tissue characterization with depth-resolved attenuation coefficient and backscatter term in intravascular optical coherence tomography images. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:1-16. [PMID: 28901053 DOI: 10.1117/1.jbo.22.9.096004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/21/2017] [Indexed: 05/08/2023]
Abstract
An important application of intravascular optical coherence tomography (IVOCT) for atherosclerotic tissue analysis is using it to estimate attenuation and backscatter coefficients. This work aims at exploring the potential of the attenuation coefficient, a proposed backscatter term, and image intensities in distinguishing different atherosclerotic tissue types with a robust implementation of depth-resolved (DR) approach. Therefore, the DR model is introduced to estimate the attenuation coefficient and further extended to estimate the backscatter-related term in IVOCT images, such that values can be estimated per pixel without predefining any delineation for the estimation. In order to exclude noisy regions with a weak signal, an automated algorithm is implemented to determine the cut-off border in IVOCT images. The attenuation coefficient, backscatter term, and the image intensity are further analyzed in regions of interest, which have been delineated referring to their pathology counterparts. Local statistical values were reported and their distributions were further compared with a two-sample t-test to evaluate the potential for distinguishing six types of tissues. Results show that the IVOCT intensity, DR attenuation coefficient, and backscatter term extracted with the reported implementation are complementary to each other on characterizing six tissue types: mixed, calcification, fibrous, lipid-rich, macrophages, and necrotic core.
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Affiliation(s)
- Shengnan Liu
- Leiden University Medical Center, Division of Imaging Processing, Department of Radiology, Leiden, The Netherlands
| | - Yohei Sotomi
- University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Jeroen Eggermont
- Leiden University Medical Center, Division of Imaging Processing, Department of Radiology, Leiden, The Netherlands
| | - Gaku Nakazawa
- Tokai University School of Medicine, Department of Cardiology, Kanaagawa, Japan
| | - Sho Torii
- Tokai University School of Medicine, Department of Cardiology, Kanaagawa, Japan
| | - Takeshi Ijichi
- Tokai University School of Medicine, Department of Cardiology, Kanaagawa, Japan
| | - Yoshinobu Onuma
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
- Cardialysis, Rotterdam, The Netherlands
| | - Patrick W Serruys
- International Centre for Circulatory Health, the National Heart and Lung Institute, Imperial College, United Kingdom
| | - Boudewijn P F Lelieveldt
- Leiden University Medical Center, Division of Imaging Processing, Department of Radiology, Leiden, The Netherlands
- Delft University of Technology, Department of Intelligent Systems, Delft, The Netherlands
| | - Jouke Dijkstra
- Leiden University Medical Center, Division of Imaging Processing, Department of Radiology, Leiden, The Netherlands
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