Plaque burden can be assessed using intravascular optical coherence tomography and a dedicated automated processing algorithm: a comparison study with intravascular ultrasound

Edouard Gerbaud; Giora Weisz; Atsushi Tanaka; Romain Luu; Hany Ahmed Salaheldin Hussein Osman; Grace Baldwin; Pierre Coste; Laurent Cognet; Sergio Waxman; Hui Zheng; Jeffrey W Moses; Gary S Mintz; Takashi Akasaka; Akiko Maehara; Guillermo J Tearney

doi:10.1093/ehjci/jez185

Plaque burden can be assessed using intravascular optical coherence tomography and a dedicated automated processing algorithm: a comparison study with intravascular ultrasound

Eur Heart J Cardiovasc Imaging. 2020 Jun 1;21(6):640-652. doi: 10.1093/ehjci/jez185.

Authors

Edouard Gerbaud^{1

2

3}, Giora Weisz^{4

5

6}, Atsushi Tanaka^{1

7}, Romain Luu^{1

8}, Hany Ahmed Salaheldin Hussein Osman¹, Grace Baldwin¹, Pierre Coste^{2

3}, Laurent Cognet⁸, Sergio Waxman⁹, Hui Zheng¹⁰, Jeffrey W Moses^{4

5}, Gary S Mintz^{4

5}, Takashi Akasaka⁷, Akiko Maehara^{4

5}, Guillermo J Tearney^{1

11

12}

Affiliations

¹ Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, 40 Blossom Street, BHX-604A, Boston, MA 02114, USA.
² Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 5 Avenue Magellan, Pessac 33600, France.
³ Bordeaux Cardio-Thoracic Research Centre, Bordeaux University, U1045, Hôpital Xavier Arnozan, Avenue du Haut Lévêque, Pessac 33600, France.
⁴ Columbia University Medical Center, New York, NY, USA.
⁵ Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA.
⁶ Montefiore-Einstein Center for Heart and Vascular, The University Hospital for the Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
⁷ Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama Prefecture 641-8509, Japan.
⁸ Institut d'Optique Graduate School, CNRS-UMR 5298, Bordeaux University, Rue François Miterrand, Talence 33400, France.
⁹ Department of Cardiology, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, USA.
¹⁰ Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
¹¹ Department of Pathology, Massachusetts General Hospital and Harvard Medical School, 40 Blossom Street, Boston, MA 02114, USA.
¹² Harvard-MIT Health Sciences and Technology, Boston, MA, USA.

Abstract

Aims: Plaque burden (PB) measurement using intravascular optical coherence tomography (IVOCT) is currently thought to be inferior to intravascular ultrasound (IVUS). We developed an automated IVOCT image processing algorithm to enhance the external elastic lamina (EEL) contour. Thus, we investigated the accuracies of standard IVOCT and an IVOCT enhancement algorithm for measuring PB using IVUS as the reference standard.

Methods and results: The EEL-enhancement algorithm combined adaptive attenuation compensation, exponentiation, angular registration, and image averaging using three sequential frames. In two different laboratories with intravascular imaging expertise, PB was quantified on 200 randomized, matched IVOCT and IVUS images by four independent observers. Fibroatheroma, fibrocalcific plaque, fibrous plaque, pathological intimal thickening (PIT), and mixed plaque were included in each set. Pearson's correlation coefficients between IVUS and standard IVOCT measurements of PB were 0.61, 0.67, 0.76, 0.78, and 0.87 for fibroatheromas, mixed plaques, fibrocalcific plaques, fibrous plaques, and PIT plaques, respectively. Pearson's correlation coefficients increased to 0.81, 0.83, 0.83, 0.84, and 0.90 when using the EEL-enhanced images (P = 0.003, P = 0.004, P = 0.08, P = 0.12, and P = 0.23, respectively). EEL-enhanced IVOCT analysis was associated with a lower EEL-area measurement absolute error for fibroatheromas, mixed plaques, and all pooled plaques (P = 0.006, P = 0.02, and P < 0.001, respectively). Compared with standard IVOCT, the EEL-enhanced IVOCT images had a higher sensitivity (79% vs. 28%, P < 0.001) and specificity (98% vs. 85%, P = 0.03) for plaques with an IVUS PB ≥70%.

Conclusion: EEL-enhanced IVOCT can be used to reliably measure PB in all types of coronary atherosclerotic lesions, including fibroatheromas and mixed plaques.

Keywords: algorithm; intravascular ultrasound; optical coherence tomography; plaque burden.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Algorithms
Coronary Artery Disease* / diagnostic imaging
Coronary Vessels / diagnostic imaging
Humans
Plaque, Atherosclerotic* / diagnostic imaging
Predictive Value of Tests
Reproducibility of Results
Tomography, Optical Coherence
Ultrasonography, Interventional

Grants and funding

R01 HL076398/HL/NHLBI NIH HHS/United States