Optical coherence tomography of the pulmonary arteries: A systematic review

Abstract

Optical coherence tomography (OCT) is an imaging technique extensively used for visualizing the coronary circulation, where it assists clinical decision-making. Along with the new interventional procedures being introduced for pulmonary vascular disease, there is an increasing need for intravascular imaging of the pulmonary arteries. Additionally, measurements of the wall thickness of the pulmonary arteries of patients with various types of pulmonary hypertension (PH) may provide relevant diagnostic and prognostic information. The aim of this review is to summarize all the available evidence on the use of OCT for imaging the pulmonary bed and to describe a simple protocol for OCT image acquisition. We conducted a systematic review of the literature using electronic reference databases through February 2015 (MEDLINE, Cochrane Library, Web of Knowledge, and references cited in other studies) and the search terms "optical coherence tomography," "pulmonary hypertension," and "pulmonary arteries." Studies in which OCT was used to image the pulmonary vessels were considered for inclusion. We identified 14 studies reporting OCT imaging data from the pulmonary arteries. OCT was able to identify intravascular thrombi in patients with chronic thromboembolic PH (CTEPH), and an increase in vessel wall thickness was found in most patients with PH, compared with the controls. OCT has also been reported to be useful for the selection of balloon size in the setting of balloon pulmonary angioplasty for CTEPH. The main limitations include lack of standardization, little data on outcomes, cost, and the technical limitations involved in visualizing small-diameter (<1mm) pulmonary vessels. OCT has become a potential tool for the in vivo study of vascular changes in the pulmonary arteries, and may provide additional information in the assessment of patients with PH. Prospective high-quality studies assessing the safety, validity, and clinical impact of OCT imaging for pulmonary vessels are warranted.

Optical coherence tomography for observing development of pulmonary arterial vasa vasorum after bidirectional cavopulmonary connection in children

“…The technique of optical coherence tomography (OCT) has led to significant advancements in intravascular imaging, which has enabled precise examination of PA morphology. Recent reports have shown that OCT is useful not only for the diagnosis of pulmonary hypertension, but also for evaluation of the response to treatment [7,8].…”

Optical coherence tomography evaluation of pulmonary arterial vasculopathy in Systemic Sclerosis

“…As in previous OCT imaging studies we found that PH per se is associated with a significant thickening of pulmonary arteries 13 15 16 . Due to the novelty of OCT imaging in pulmonary arteries there is a lack of standardization as yet 17 . Previous OCT studies reported on more proximal vessels, usually 3–4 mm in diameter, where changes observed are likely to reflect secondary consequences of elevated pressures rather than the site of underlying pathology in the muscular pulmonary arterioles.…”

Optical methods for quantitative and label-free sensing in living human tissues: principles, techniques, and applications

“…This decision to focus primarily on non-OCT based coherence based optical tissue sensing stems from the fact that OCT is a very well-established clinical technique that has previously been extensively reviewed [29–38]. We also note that recent advances in Fourier and spectral domain Doppler-OCT have been developed to enable functional sensing of blood flow velocities within intact tissues – also termed optical microangiography – and are well-described elsewhere [39–42].…”