Direct Comparison of Virtual-Histology Intravascular Ultrasound and Optical Coherence Tomography Imaging for Identification of Thin-Cap Fibroatheroma
Direct Comparison of Virtual-Histology Intravascular Ultrasound and Optical Coherence Tomography Imaging for Identification of Thin-Cap Fibroatheroma
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DOI：
10.1161/circimaging.115.003487
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发表时间：
2015-10-01
影响因子：
7.5
通讯作者：
Bennett, Martin R.
中科院分区：
文献类型：
--
作者：
Brown, Adam J.;Obaid, Daniel R.;Bennett, Martin R.
背景——尽管薄帽纤维粥样斑块 (TCFA) 破裂是大多数心肌梗塞的基础，但可靠的 TCFA 识别仍然具有挑战性。虚拟组织学血管内超声 (VH-IVUS) 和光学相干断层扫描 (OCT) 可以评估组织成分并对斑块进行分类。然而，VH-IVUS 和 OCT 之间缺乏直接比较，并且尚不清楚组合这些方式是否可以改善 TCFA 识别。方法和结果 - 从尸检人体心脏中获得 258 个感兴趣区域，通过组织学评估斑块组成和分类，并与联合配准的离体 VH-IVUS 和 OCT 进行比较。 67 个感兴趣区域在组织学上被归类为纤维粥样硬化，其中 22 个符合 TCFA 标准。在 VH-IVUS 上，与其他纤维粥样斑块相比，TCFA 中的斑块（10.91 +/- 4.82 对比 8.42 +/- 4.57 mm(2)；P=0.01）和坏死核心区域（1.59 +/- 0.99 对比 1.03 +/- 0.85 mm(2)；P=0.02）增加。在 OCT 上，尽管最小纤维帽厚度相似（71.8 +/- 44.1 μm 与 72.6 +/- 32.4；P=0.30），但纤维帽厚度 = 80 度的连续帧数量是最佳截止值。使用现有标准，VH-IVUS TCFA 识别的敏感性、特异性和诊断准确性分别为 63.6%、78.1% 和 76.5%，OCT 分别为 72.7%、79.8% 和 79.0%。结合 VH 定义的纤维粥样斑块和纤维帽厚度 = 80 度和纤维帽厚度
Background-Although rupture of thin-cap fibroatheroma (TCFA) underlies most myocardial infarctions, reliable TCFA identification remains challenging. Virtual-histology intravascular ultrasound (VH-IVUS) and optical coherence tomography (OCT) can assess tissue composition and classify plaques. However, direct comparisons between VH-IVUS and OCT are lacking and it remains unknown whether combining these modalities improves TCFA identification.Methods and Results-Two hundred fifty-eight regions-of-interest were obtained from autopsied human hearts, with plaque composition and classification assessed by histology and compared with coregistered ex vivo VH-IVUS and OCT. Sixty-seven regions-of-interest were classified as fibroatheroma on histology, with 22 meeting criteria for TCFA. On VH-IVUS, plaque (10.91 +/- 4.82 versus 8.42 +/- 4.57 mm(2); P=0.01) and necrotic core areas (1.59 +/- 0.99 versus 1.03 +/- 0.85 mm(2); P=0.02) were increased in TCFA versus other fibroatheroma. On OCT, although minimal fibrous cap thickness was similar (71.8 +/- 44.1 mu m versus 72.6 +/- 32.4; P=0.30), the number of continuous frames with fibrous cap thickness = 80 degrees the optimal cut-off value. Using existing criteria, the sensitivity, specificity, and diagnostic accuracy for TCFA identification was 63.6%, 78.1%, and 76.5% for VH-IVUS and 72.7%, 79.8%, and 79.0% for OCT. Combining VH-defined fibroatheroma and fibrous cap thickness = 80 degrees and fibrous cap thickness