Computerized assessment of coronary lumen and atherosclerotic plaque dimensions in three-dimensional intravascular ultrasound correlated with histomorphometry

doi:10.1016/S0002-9149(96)00596-6

The American Journal of Cardiology

Volume 78, Issue 11, 1 December 1996, Pages 1202-1209

https://doi.org/10.1016/S0002-9149(96)00596-6 Get rights and content

Abstract

Intravascular ultrasound (IVUS), which depicts both lumen and plaque, offers the potential to improve on the limitations of angiography for the assessment of the natural history of atherosclerosis and progression or regression of the disease. To facilitate measurements and increase the reproducibility of quantitative IVUS analyses, a computerized contour detection system was developed that detects both the luminal and external vessel boundaries in 3-dimensional sets of IVUS images. To validate this system, atherosclerotic human coronary segments (n = 13) with an area obstruction ≥40% (40% to 61%) were studied in vitro by IVUS. The computerized IVUS measurements (areas and volumes) of the lumen, total vessel, plaque-media complex, and percent obstruction were compared with findings by manual tracing of the IVUS images and of the corresponding histologic cross sections obtained at 2-mm increments (n = 100). Both area and volume measurements by the contour detection system agreed well with the results obtained by manual tracing, showing low mean between-method differences (−3.7% to 0.3%) with SDs not exceeding 6% and high correlation coefficients (r = 0.97 to 0.99). Measurements of the lumen, total vessel, plaque-media complex, and percent obstruction by the contour detection system correlated well with histomorphometry of areas (r = 0.94, 0.88, 0.80, and 0.88) and volumes (r = 0.98, 0.91, 0.83, and 0.91). Systematic differences between the results by the contour detection system and histomorphometry (29%, 13%, −9%, and −22%, respectively) were found, most likely resulting from shrinkage during tissue fixation. The results of this study indicate that this computerized IVUS analysis system is reliable for the assessment of coronary atherosclerosis in vivo.

References (30)

C von Birgelen et al.
Mechanism of high-speed rotational atherectomy and adjunctive balloon angioplasty revisited by quantitative coronary angiography: edge detection versus videodensitometry
Am Heart J
(1995)
EJ Gussenhoven et al.
Arterial wall characteristics determined by intravascular ultrasound imaging: an in-vitro study
J Am Coll Cardiol
(1989)
GS Mintz et al.
Atherosclerosis in angiographically “normal” coronary artery reference segments: an intravascular ultrasound study with clinical correlations
J Am Coll Cardiol
(1995)
D Hausmann et al.
Intracoronary ultrasound imaging: intraobserver and interobserver variability of morphometric measurements
Am Heart J
(1994)
C von Birgelen et al.
Quantification of the minimal luminal cross-sectional area after coronary stenting by two-dimensional and three-dimensional intravascular ultrasound versus edge detection and videodensitometry
Am J Cardiol
(1996)
R Gil et al.
Usefulness of Three-dimensional reconstruction for interpretation and quantitative analysis of intracoronary ultrasound during stent deployment
Am J Cardiol
(1996)
C von Birgelen et al.
Optimized expansion of the Wallstent compared to the Palmaz-Schatz stent: on-line observations with two- and three-dimensional intracoronary ultrasound after angiographic guidance
Am Heart J
(1996)
FA Matar et al.
The contribution of tissue removal to lumen improvement after directional coronary atherectomy
Am J Cardiol
(1994)
GR Dussaillant et al.
Small stent size and intimai hyperplasia contribute to restenosis: a volumetric intravascular ultrasound analysis
J Am Coll Cardiol
(1995)
A van der Lugt et al.
Comparison of intravascular ultrasonic findings after coronary balloon angioplasty evaluated in vitro with histology
Am J Cardiol
(1995)

PJ de Feyter et al.

Quantitative coronary angiography to measure progression and regression of coronary atherosclerosis: value, limitations, and implications for clinical trials

Circulation

(1991)

D Waters et al.

Advantages and limitations of serial coronary arteriography for the assessment of progression and regression of coronary atherosclerosis. Implications for clinical trials

Circulation

(1993)

V Fuster et al.

The pathogenesis of coronary artery disease and the acute coronary syndromes

N Engl J Med

(1992)

GM Stiel et al.

Impact of compensatory enlargement of atherosclerotic coronary arteries on angiographic assessment of coronary artery disease

Circulation

(1989)

J Ge et al.

Intravascular ultrasound imaging in angiographically normal coronary arteries: a prospective study in vivo

Br Heart J

(1994)

Cited by (67)

Advanced deep learning methodology for accurate, real-time segmentation of high-resolution intravascular ultrasound images
2021, International Journal of Cardiology
Citation Excerpt :
The automated analysis of IVUS images has been an unmet challenge in interventional research. Over the last 25 years several automated segmentation methodologies have been developed that incorporated edge-tracking and gradient based techniques, [26–29] snake models, [30–33] probabilistic-based approaches, [34] or multiscale expansion-based methodologies [35] for the detection of the EEM and lumen borders. Although validation of most of the proposed methodologies have shown promising results in small datasets [25] they have failed to dominate in clinical practice.
The aim of this study is to develop and validate a deep learning (DL) methodology capable of automated and accurate segmentation of intravascular ultrasound (IVUS) image sequences in real-time.
IVUS segmentation was performed by two experts who manually annotated the external elastic membrane (EEM) and lumen borders in the end-diastolic frames of 197 IVUS sequences portraying the native coronary arteries of 65 patients. The IVUS sequences of 177 randomly-selected vessels were used to train and optimise a novel DL model for the segmentation of IVUS images. Validation of the developed methodology was performed in 20 vessels using the estimations of two expert analysts as the reference standard.
The mean difference for the EEM, lumen and plaque area between the DL-methodology and the analysts was ≤0.23mm² (standard deviation ≤0.85mm²), while the Hausdorff and mean distance differences for the EEM and lumen borders was ≤0.19 mm (standard deviation≤0.17 mm). The agreement between DL and experts was similar to experts' agreement (Williams Index ranges: 0.754–1.061) with similar results in frames portraying calcific plaques or side branches.
The developed DL-methodology appears accurate and capable of segmenting high-resolution real-world IVUS datasets. These features are expected to facilitate its broad adoption and enhance the applications of IVUS in clinical practice and research.
Chapter 11 A cerebrovascular perspective of atherosclerosis
2008, Handbook of Clinical Neurology
Citation Excerpt :
Many other techniques are being appraised for their usefulness in evaluating atherosclerosis, including intravascular ultrasound, MRI and spiral CT. To date, however, no large prospective studies have used these tools to evaluate plaque formation and progression (von Birgelen et al., 1996; Gotsman et al., 1997; Slager et al., 1997; Zimmermann et al., 1997; Estes et al., 1998; Yuan et al., 1998). A variety of risk factors for the development of atherosclerosis have been suggested (Hopkins and Williams, 1981).
therosclerosis is a leading cause of death and disability. Although clinically the complications of atherosclerosis, such as stroke, heart attack, and peripheral arterial disease are usually seen in the elderly, but pathologically atherosclerosis begins early in life. This chapter provides an overview of these factors, and describes the imaging of atherosclerosis, preventative and interventional therapy, and presents an overview of recent research findings. Atherosclerotic plaque formation tends to favor specific sites in the arterial bed. The aorta and carotid arteries are the first to develop fatty streaks that appear in infancy and childhood. Structural and functional differences are found between lesion-prone and non-lesion-prone sites, and these differences may contribute to plaque localization. Lesion-prone sites have augmented endothelial permeability to circulatory macromolecules such as albumin and LDL cholesterol. Atherosclerosis begins in response to injurious stimuli that set plaque development in motion and potentially results in clinical ischemic events. Plaque composition or morphology results in different risks for the development of ischemia. Currently, two imaging techniques have been employed in clinical trials to follow plaque over time: angiography and ultrasound. The risk factors for atherosclerosis include elevated LDL, low HDL, hypertension, and cigarette smoking. As preventative measures are preferable, identifying and reducing risk factors is vitally important. This, and disease modification through improved therapeutic interventions, will significantly reduce the impact of atherosclerosis.
Volumetric quantitative analysis of tissue characteristics of coronary plaques after statin therapy using three-dimensional integrated backscatter intravascular ultrasound
2005, Journal of the American College of Cardiology
Citation Excerpt :
Previously, several 3D reconstruction techniques of conventional IVUS images have been established. Computer-aided 3D reconstruction connecting cross-sectional IVUS images, digitized every 0.2 mm using a motorized pull-back device, allows the reproducible and reliable measurement of plaque volume that reflects the morphologic features of the plaque (23). Volumetric measurements derived from IVUS images are highly reproducible and useful for monitoring the progression and regression of atherosclerotic plaque volume in a longitudinal study (24).
The purpose of the present study was twofold: 1) to evaluate the usefulness of three-dimensional (3D) integrated backscatter (IB) intravascular ultrasound (IVUS) for quantitative tissue characterization of coronary plaques; and 2) to use this imaging technique to determine if six months of statin therapy alters the tissue characteristics of coronary plaques.
Three-dimensional IVUS techniques for quantitative tissue characterization of plaque composition have not been developed.
Radiofrequency (RF) signals were obtained using an IVUS system with a 40-MHz catheter. The IB values of the RF signal were calculated and color-coded. The 3D reconstruction of the color-coded map was performed by computer software. A total of 18 IB IVUS images were captured at an interval of 1 mm in each plaque. A total of 52 patients with hyperlipidemia were randomized to treatment with pravastatin (20 mg/day, n = 17), atorvastatin (20 mg/day, n = 18), or diet (n = 17) for six months. The tissue characteristics of arterial plaque in each patient (one arterial segment per patient) were analyzed with 3D IB IVUS before and after treatment.
Significant increases of fibrous volume (pravastatin: 25.4 ± 6.5% to 28.1 ± 6.1%; atorvastatin: 26.2 ± 5.7% to 30.1 ± 5.5%) and mixed lesion volume (atorvastatin: 25.5 ± 6.6% to 28.7 ± 5.1%) and a reduction of lipid volume (pravastatin: 25.5 ± 5.7% to 21.9 ± 5.3%; atorvastatin: 26.5 ± 5.2% to 19.9 ± 5.5%) were observed after statin therapy.
Statin therapy reduced the lipid component in patients with stable angina without reducing the degree of stenosis. Three-dimensional IB IVUS offers the potential for quantitative volumetric tissue characterization of coronary atherosclerosis.
Angiographically silent left main disease detected by intravascular ultrasound: A marker for future adverse cardiac events
2003, American Heart Journal
Concomitant moderate obstructive left main (LM) disease is associated with future cardiac events and poor prognosis in patients undergoing percutaneous intervention (PCI). Whether prognosis is similarly effected by LM disease not detected by angiography, but evident on intravascular ultrasound (IVUS) imaging, is not known. The purpose of this study was to evaluate the long-term prognosis of patients with angiographically insignificant LM coronary artery disease undergoing PCI.
One hundred and seven consecutive patients undergoing PCI with angiographically normal or mild LM disease had 2- and 3-dimensional IVUS imaging. IVUS images were digitized, and 3-dimensional reconstruction was performed. Percent diameter and area stenosis by angiography were 4.8% ± 3.5% and 18.2% ± 9.8%, respectively. IVUS mean luminal area and area stenosis were 17.9 ± 5.6 mm² and 30.2% ± 14.7%, respectively. Long-term follow-up was available in 102 (95%) patients at a median of 29 (range 8–52) months. Major adverse cardiac events, defined as death (6), myocardial infarction (4), repeat PCI (13), or CABG (16), were associated with female sex (P = .04), diabetes (P = .02), angiographic minimum lumen diameter (P = .04), and IVUS minimum (P = .01) and mean (P = .01) lumen area. Multivariate predictors of late cardiac events were diabetes (hazard ratio 2.69, P = .014) and minimum lumen area by IVUS (hazard ratio 0.59, P = .015).
Despite being angiographically silent, LM disease detected by IVUS is an independent predictor of cardiac events and may serve as a marker for such events. These data extend the spectrum of LM disease severity and its relationship to cardiac prognosis in patients undergoing PCI.
Automated three-dimensional assessment of coronary artery anatomy with intravascular ultrasound scanning
2003, American Heart Journal
Citation Excerpt :
This is performed in 2-D frames, and the results are propagated down the sequence by using the identified 2-D contours to limit the search region. A similar approach developed by Li et al36,37 uses cost values to find longitudinal contours along the volumetric data and uses these contours to guide the cost function minimization in the transverse 2-D images. Alternatively, Haas et al38 use statistical patterns in the ultrasound scanning speckle and probabilistic a priori information about the contours.
Angiography allows the definition of advanced, severe stages of coronary artery disease, but early atherosclerotic lesions, which do not lead to luminal stenosis, are not identified reliably. In contrast, intravascular ultrasound scanning allows the precise characterization and quantification of a wide range of atherosclerotic lesions, independent of the severity of luminal stenosis.
Three-dimensional (3-D) reconstruction of entire coronary segments is possible with the integration of sequential 2-dimensional tomographic images and allows volumetric analysis of coronary arteries.
Automated systems able to recognize lumen and vessel borders and to display 3-D images are becoming available.
These systems have the potential for on-line 3-D image reconstruction for clinical decision-making and fast routine volumetric analysis in research studies. This review describes 3-D intravascular ultrasound scanning acquisition, analysis, and processing, and the associated technical challenges.
Relation between plaque composition and vascular remodeling in coronary lesions with different degrees of lumen narrowing as assessed with three-dimensional intravascular ultrasound in patients with stable angina pectoris
2003, American Journal of Cardiology

View all citing articles on Scopus

^☆: This project was partly supported by the Dutch Heart Foundation (Grants 94.016 and 94.006).

¹: Dr. von Birgelen was supported by a fellowship of the German Research Society (Bonn, Germany).

View full text

Computerized assessment of coronary lumen and atherosclerotic plaque dimensions in three-dimensional intravascular ultrasound correlated with histomorphometry☆

Abstract

Am Heart J

J Am Coll Cardiol

J Am Coll Cardiol

Am Heart J

Am J Cardiol

Am J Cardiol

Am Heart J

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

Quantitative coronary angiography to measure progression and regression of coronary atherosclerosis: value, limitations, and implications for clinical trials

Circulation

Advantages and limitations of serial coronary arteriography for the assessment of progression and regression of coronary atherosclerosis. Implications for clinical trials

Circulation

The pathogenesis of coronary artery disease and the acute coronary syndromes

N Engl J Med

Impact of compensatory enlargement of atherosclerotic coronary arteries on angiographic assessment of coronary artery disease

Circulation

Intravascular ultrasound imaging in angiographically normal coronary arteries: a prospective study in vivo

Br Heart J