Histopathological validation of optical frequency domain imaging to quantify various types of coronary calcifications

Abstract

AimsThis study evaluated whether optical frequency domain imaging (OFDI) could identify various coronary calcifications and accurately measure calcification thickness in comparison with histopathology. Methods and resultsA total of 902 pathological cross-sections from 44 coronary artery specimens of human cadavers were examined to compare OFDI and histological images. Histological coronary calcification was classified into four different types: (i) superficial dense calcified plates, (ii) deep intimal calcification, (iii) scattered microcalcification, and (iv) calcified nodule. The thickness of calcification was measured when both the leading and trailing edges of calcification were visible on OFDI. Of the 902 histological cross-sections, 158 (18%) had calcification: 105 (66%) were classified as superficial dense calcified plates, 20 (13%) as deep intimal calcifications, 30 (19%) as scattered microcalcifications, and 3 (2%) as calcified nodules. Superficial dense calcified plates appeared as well-delineated heterogeneous signal-poor regions with sharp borders on OFDI. Deep intimal calcifications could not be identified on OFDI. Scattered microcalcification appeared as homogeneous low intensity areas with indiscriminant borders. Calcified nodule, a high-backscattering protruding mass with an irregular surface, also appeared as a low intensity area with a diffuse border. The ROC analysis identified calcium thicknesses ,893 mm as cut points for the prediction of measurable calcification (72% sensitivity and 91% specificity, area under the curve ¼ 0.893, P , 0.001). ConclusionOur study demonstrated the potential capability of OFDI to characterize various types of coronary calcifications, which may contribute to the understanding of the pathogenesis of coronary atherosclerosis.--

An optical coherence tomography comparison of coronary arterial plaque calcification in patients with end-stage renal disease and diabetes mellitus

“…(5) OCT is prone to inherent limitations including the inability to analyze micro-calcifications as well as a limited penetration depth, which makes identification of the deep trailing edge of calcium and subsequent area measurements of deep deposits difficult. 42,43 Due to this limited penetration depth, it is not possible to image medial calcification in the coronary vessels outside of exceptional cases. Instead, in severely diseased atherosclerotic coronary vessels, it is the atherosclerotic plaque within the medial border which is imaged, and which has eliminated a true intimal layer.…”

Impact of optical coherence tomography‐derived neointimal tissue morphology on development of very late in‐stent restenosis

“…We previously reported that heterogeneous type I tissue showed fibroatheroma formation within the neointima, and Type IV presented with tissue calcium accumulation within the neointima on histology. 9,10,20 The development process of atherosclerotic lesion within neointima, known as neoatherosclerosis, may be gradual compared with that in the native coronary artery. This finding is also supported by previous studies, which reported that the development of atherosclerosis is a gradual and complex process caused by the interaction of various risk factors, endothelial cell dysfunction, and lipid accumulation.…”

“Coral Reef”-Like Calcifications: Communities of Uncomplicated Calcified Nodules

“…Apart from the aorta, there was a solitary lesion of nodular calcifica- Surprisingly, these calcified nodules were benign, meaning they were unlikely to cause coronary events during a three-year follow-up study. More recently, Hao et al 4) and Saita et al 5) also reported uncomplicated calcified nodules, which are not associated with thrombosis. The present case provides further evidence to support their observations in the coronary artery.…”