American Heart Journal

2000

DOI: 10.1067/mhj.2000.109217

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Tissue characterization of atherosclerotic plaques by intravascular ultrasound radiofrequency signal analysis: An in vitro study of human coronary arteries

Nobuyuki Komiyama¹,

Gerald J. Berry²,

Matthew L. Kolz³

et al.

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Intravascular Palpography Is a Technique Based On Intravascu1

Three-dimensional Palpography1

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Cited by 84 publications

(47 citation statements)

References 39 publications

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“…Prati et al 4 found a sensitivity of 65% and a specificity of 95%. In another study by Komiyami et al, 3 a sensitivity and a specificity of 53% and 72%, respectively, were found. This corroborates our findings in vitro in which we found a high correlation between strain and plaque composition and no relation between echogenicity and plaque components.…”

Section: Discussionmentioning

confidence: 97%

“…However, the sensitivity and specificity to detect lipid cores remains low. 3,4 IVUS elastography assesses the local radial strain in the tissue caused by an intraluminal pressure differential. In vitro experiments revealed different strain values in fibrous and fatty plaques in human coronary and femoral arteries.…”

mentioning

confidence: 99%

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Identification of Atherosclerotic Plaque Components With Intravascular Ultrasound Elastography In Vivo

¹

,

²

,

³

et al. 2002

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Background-Intravascular ultrasound elastography assesses the local strain of the atherosclerotic vessel wall. In the present study, the potential to identify different plaque components in vivo was investigated. Methods and Results-Atherosclerotic external iliac and femoral arteries (nϭ24) of 6 Yucatan pigs were investigated.Before termination, elastographic data were acquired with a 20-MHz Visions catheter. Two frames acquired at end-diastole with a pressure differential of Ϸ4 mm Hg were acquired to obtain the elastograms. Before dissection, x-ray was used to identify the arterial segments that had been investigated by ultrasound. Specimens were stained for collagen, fat, and macrophages. Plaques were classified as absent, early fibrous lesion, early fatty lesion, or advanced fibrous plaque. The average strains in the plaque-free arterial wall (0.21%) and the early (0.24%) and advanced fibrous plaques (0.22%) were similar. Higher average strain values were observed in fatty lesions (0.46%) compared with fibrous plaques (Pϭ0.007). After correction for confounding by lipid content, no additional differences in average strain were found between plaques with and without macrophages (Pϭ0.966). Receiver operating characteristic analysis revealed a sensitivity and a specificity of 100% and 80%, respectively, to identify fatty plaques. The presence of a high-strain spot (strain Ͼ1%) has 92% sensitivity and 92% specificity to identify macrophages. Conclusions-To the best of our knowledge, this is the first time that intravascular ultrasound elastography has been validated in vivo. Intravascular ultrasound (IVUS) has proven to be a powerful technique to assess the geometry of the vessel wall and plaque. However, the sensitivity and specificity to detect lipid cores remains low. 3,4 IVUS elastography assesses the local radial strain in the tissue caused by an intraluminal pressure differential. In vitro experiments revealed different strain values in fibrous and fatty plaques in human coronary and femoral arteries. 5 Feasibility experiments in patients showed that reproducible elastograms could be obtained. 6 The aim of this study was to validate IVUS elastography in vivo with an atherosclerotic Yucatan minipig model. Additionally, we studied whether atheroma and macrophages were related with strain values. Methods AnimalsSix atherosclerotic Yucatan pigs, average weight 40 kg, were studied. To induce atherosclerosis, pigs were put on an atherogenic diet. Two weeks thereafter, the external iliac and femoral arteries were denuded with a 4-F endothelial Fogarty catheter. The atherogenic diet was continued for 9 to 10 months after which femoral and internal iliac arteries were stented for the purpose of another study. Subsequently, the atherogenic diet was replaced by a regular diet. No intervention was performed in the denuded external iliac arteries that were visualized for the present study. The following 42 days, 3 pigs were treated with a drug and 3 pigs served as controls for the purpose of another study. ANOVA reveale...

“…Prati et al 4 found a sensitivity of 65% and a specificity of 95%. In another study by Komiyami et al, 3 a sensitivity and a specificity of 53% and 72%, respectively, were found. This corroborates our findings in vitro in which we found a high correlation between strain and plaque composition and no relation between echogenicity and plaque components.…”

Section: Discussionmentioning

confidence: 97%

“…However, the sensitivity and specificity to detect lipid cores remains low. 3,4 IVUS elastography assesses the local radial strain in the tissue caused by an intraluminal pressure differential. In vitro experiments revealed different strain values in fibrous and fatty plaques in human coronary and femoral arteries.…”

mentioning

confidence: 99%

Identification of Atherosclerotic Plaque Components With Intravascular Ultrasound Elastography In Vivo

¹

,

²

,

³

et al. 2002

View full text Add to dashboard Cite

Background-Intravascular ultrasound elastography assesses the local strain of the atherosclerotic vessel wall. In the present study, the potential to identify different plaque components in vivo was investigated. Methods and Results-Atherosclerotic external iliac and femoral arteries (nϭ24) of 6 Yucatan pigs were investigated.Before termination, elastographic data were acquired with a 20-MHz Visions catheter. Two frames acquired at end-diastole with a pressure differential of Ϸ4 mm Hg were acquired to obtain the elastograms. Before dissection, x-ray was used to identify the arterial segments that had been investigated by ultrasound. Specimens were stained for collagen, fat, and macrophages. Plaques were classified as absent, early fibrous lesion, early fatty lesion, or advanced fibrous plaque. The average strains in the plaque-free arterial wall (0.21%) and the early (0.24%) and advanced fibrous plaques (0.22%) were similar. Higher average strain values were observed in fatty lesions (0.46%) compared with fibrous plaques (Pϭ0.007). After correction for confounding by lipid content, no additional differences in average strain were found between plaques with and without macrophages (Pϭ0.966). Receiver operating characteristic analysis revealed a sensitivity and a specificity of 100% and 80%, respectively, to identify fatty plaques. The presence of a high-strain spot (strain Ͼ1%) has 92% sensitivity and 92% specificity to identify macrophages. Conclusions-To the best of our knowledge, this is the first time that intravascular ultrasound elastography has been validated in vivo. Intravascular ultrasound (IVUS) has proven to be a powerful technique to assess the geometry of the vessel wall and plaque. However, the sensitivity and specificity to detect lipid cores remains low. 3,4 IVUS elastography assesses the local radial strain in the tissue caused by an intraluminal pressure differential. In vitro experiments revealed different strain values in fibrous and fatty plaques in human coronary and femoral arteries. 5 Feasibility experiments in patients showed that reproducible elastograms could be obtained. 6 The aim of this study was to validate IVUS elastography in vivo with an atherosclerotic Yucatan minipig model. Additionally, we studied whether atheroma and macrophages were related with strain values. Methods AnimalsSix atherosclerotic Yucatan pigs, average weight 40 kg, were studied. To induce atherosclerosis, pigs were put on an atherogenic diet. Two weeks thereafter, the external iliac and femoral arteries were denuded with a 4-F endothelial Fogarty catheter. The atherogenic diet was continued for 9 to 10 months after which femoral and internal iliac arteries were stented for the purpose of another study. Subsequently, the atherogenic diet was replaced by a regular diet. No intervention was performed in the denuded external iliac arteries that were visualized for the present study. The following 42 days, 3 pigs were treated with a drug and 3 pigs served as controls for the purpose of another study. ANOVA reveale...

“…Furthermore, calcified and noncalcified plaque components can be identified. However, the sensitivity to identify fatty plaque components remains low [8,9]. Recent rf-(radiofrequency) based tissue identification strategies appear to have better performance [9,10].…”

Section: Intravascular Palpography Is a Technique Based On Intravascumentioning

confidence: 99%

“…However, the distribution of the strain in the three-dimensional (3-D) geometry of an artery is an important tool to identify the presence of high-strain spots, their amount and distribution. Especially, since the correlation between plaque vulnerability and parameters provided by the echogram is low [8,9] selection of cross-sections based on the IVUS echogram introduces selection bias and increases the chance to miss the vulnerable spot. Additionally, during longitudinal monitoring of patients it is extremely difficult to refind the same spot after some months.…”

Section: Three-dimensional Palpographymentioning

confidence: 99%

Intravascular Palpography for High-Risk Vulnerable Plaque Assessment

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,

²

,

et al. 2003

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Background:The composition of an atherosclerotic plaque is considered more important than the degree of stenosis. An unstable lesion may rupture and cause an acute thrombotic reaction. Most of these lesions contain a large lipid pool covered by an inflamed thin fibrous cap. The stress in the cap increases with decreasing cap thickness and increasing macrophage infiltration. Intravascular ultrasound (IVUS) palpography might be an ideal technique to assess the mechanical properties of high-risk plaques. Technique: Palpography assesses the local mechanical properties of tissue using its deformation caused by the intraluminal pressure. In Vitro Validation:The technique was validated in vitro using diseased human coronary and femoral arteries. Especially between fibrous and fatty tissue, a highly significant difference in strain (p = 0.0012) was found. Additionally, the predictive value to identify the vulnerable plaque was investigated. A high-strain region at the lumen-vessel wall boundary has an Intravaskuläre Palpographie zur Erfassung vulnerabler Hochrisikoplaques

“…The most utilized today is intravascular ultrasound (IVUS). IVUS has been shown to be able to accurately image the vessel wall and characterize tissue when compared to ex vivo specimens [26,27,28]. IVUS has been used to distinguish plaque characteristics in patients presenting with acute coronary syndromes [29,30].…”

Section: Limitationsmentioning

confidence: 99%

MRI of atherosclerosis: diagnosis and monitoring therapy

¹

,

²

2007

Expert Review of Cardiovascular Therapy

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SummaryAtherosclerosis is a prevalent disease affecting millions of Americans. Despite our advances in diagnosis and treatment, atherosclerosis is the leading cause of death in America. High resolution MRI has overcome the limitations of current angiographic techniques and has emerged as a leading noninvasive imaging modality of atherosclerotic disease. Atherosclerosis of the arterial wall of human carotid, aortic, peripheral, and coronary arteries have all been successfully evaluated. In addition, the power of MRI to differentiate the major components of atherosclerotic plaque has been validated. The ability to image the vessel wall and risk stratify atherosclerotic plaque will create management decisions not previously faced and has the potential to change the way atherosclerosis is treated.

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