Accuracy of OCT, grayscale IVUS, and their combination for the diagnosis of coronary TCFA: An ex vivo validation study

Kenichi Fujii, Hiroyuki Hao, Masahiko Shibuya, Takahiro Imanaka, Masashi Fukunaga, Kojiro Miki, Hiroto Tamaru, Hisashi Sawada, Yoshiro Naito, Mitsumasa Ohyanagi, Seiichi Hirota, Tohru Masuyama

Research output: Contribution to journalArticlepeer-review

125 Scopus citations

Abstract

Objectives This study sought to assess the accuracy of optical coherence tomography (OCT), gray-scale intravascular ultrasound (IVUS), and their combination for detecting thin-cap fibroatheromas (TCFA). Background The extent to which the imaging characteristics of OCT and IVUS correlate with histologically defined TCFA is unknown. Methods IVUS and OCT examinations identified focal plaques in 165 coronary arteries from 60 autopsy hearts. A total of 685 pairs of images of OCT and IVUS were compared with histology. By OCT, a TCFA was defined as a signal-poor region with diffuse borders and cap thickness <65 μm. By IVUS, a TCFA was defined by the presence of echolucent zones and/or ultrasound attenuation in areas of positive remodeling. By histology, 12 of 685 focal plaques were classified as TCFAs. Results With histology as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy for OCT-derived TCFA were 100%, 97%, 41%, 100%, and 98%, respectively. The corresponding numbers for IVUS-derived TCFA were 92%, 93%, 19%, 99%, and 93%, respectively. The histological findings underlying the false positive diagnoses of OCT for TCFA included large amounts of foam cell accumulation on the luminal surface, large amounts of microcalcifications at the surface, large amounts of hemosiderin accumulation, or organized thrombus. In contrast, histological causes of mischaracterization of TCFA by IVUS were mostly TCFA. When both OCT and IVUS criteria for TCFA were required to be met, the sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy were 92%, 99%, 69%, 99%, and 99%, respectively. Conclusions In the present study, neither OCT nor IVUS were optimal to detect TCFA. The combined use of OCT and IVUS may improve TCFA detection accuracy.

Original languageEnglish
Pages (from-to)451-460
Number of pages10
JournalJACC: Cardiovascular Imaging
Volume8
Issue number4
DOIs
StatePublished - Apr 1 2015

Bibliographical note

Publisher Copyright:
© 2015 American College of Cardiology Foundation.

Keywords

  • intravascular ultrasound
  • optical coherence tomography
  • vulnerable plaque

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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