Characterization of human atherosclerosis by optical coherence tomography
Characterization of human atherosclerosis by optical coherence tomography
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DOI：
10.1161/01.cir.0000029927.92825.f6
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发表时间：
2002-09-24
期刊：
影响因子：
37.8
通讯作者：
Tearney, GJ
中科院分区：
文献类型：
--
作者：
Yabushita, H;Bourna, BE;Tearney, GJ
背景-动脉粥样硬化斑块形态的高分辨率可视化对于识别导致急性冠状动脉事件的冠状动脉斑块可能是必不可少的。光学相干断层成像(OCT)是一种血管内成像方式，能够提供分辨率为10微米的组织横断面图像。到目前为止，OCT成像还没有得到足够详细的研究，以评估其表征动脉粥样硬化斑块的准确性。本研究的目的是在体外建立动脉粥样硬化斑块的OCT图像客观标准。方法和结果：尸检获得的357个动脉粥样硬化节段的OCT图像与组织学对照。通过分析动脉节段的一个子集(n=50)，制定了3种斑块的OCT图像标准。纤维斑块的OCT图像以均匀的信号丰富区为特征；纤维钙化斑块的特征是边界清晰的信号贫乏区；而富脂斑块的特征是信号贫乏区边界弥漫。用2个OCT阅读器对其余节段(n=307)的这些标准进行独立验证，显示出纤维斑块的灵敏度和特异度分别为71%~79%和97%~98%，纤维钙化斑块的灵敏度和特异度分别为95%~96%和97%，富脂斑块的灵敏度和特异度分别为90%~94%和90%~92%(总体一致，kappa=0.83~0.84)。OCT的观察者间和观察者内的可信度较高(kappa值分别为0.88和0.91)。结论：客观的OCT标准对不同类型的动脉粥样硬化斑块具有高度的敏感性和特异性。这些结果代表了验证这种新的血管内成像方式的重要一步，MID将为解释从患者获得的冠状动脉内OCT图像提供基础。
Background-High-resolution visualization of atherosclerotic plaque morphology may be essential for identifying coronary plaques that cause acute coronary events. Optical coherence tomography (OCT) is an intravascular imaging modality capable of providing cross-sectional images of tissue with a resolution of 10 mum. To date, OCT imaging has not been investigated in sufficient detail to assess its accuracy for characterizing atherosclerotic plaques. The aim of this study was to establish objective OCT image criteria for atherosclerotic plaque characterization in vitro.Methods and Results-OCT images of 357 (diseased) atherosclerotic arterial segments obtained at autopsy were correlated with histology. OCT image criteria for 3 types of plaque were formulated by analysis of a subset (n=50) of arterial segments. OCT images of fibrous plaques were characterized by homogeneous, signal-rich regions; fibrocalcific plaques by well-delineated, signal-poor regions with sharp borders; and lipid-rich plaques by signal-poor regions with diffuse borders. Independent validation of these criteria by 2 OCT readers for the remaining segments (n=307) demonstrated a sensitivity and specificity ranging from 71% to 79% and 97% to 98% for fibrous plaques, 95% to 96%, and 97% for fibrocalcific plaques, and 90% to 94% and 90% to 92% for lipid-rich plaques, respectively (overall agreement, kappa=0.83 to 0.84). The interobserver and intraobserver reliabilities of OCT assessment were high (kappa values of 0.88 and 0.91, respectively).Conclusions-Objective OCT criteria are highly sensitive and specific for characterizing different types of atherosclerotic plaques. These results represent an important step in validating this new intravascular imaging modality mid will provide a basis for the interpretation of intracoronary OCT images obtained from patients.