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CLINICAL STUDY: CORONARY ARTERY DISEASE

Noninvasive quantitative tissue characterization and two-dimensional color-coded map of human atherosclerotic lesions using ultrasound integrated backscatter

Comparison between histology and integrated backscatter images

^a Second Department of Internal Medicine, Gifu University School of Medicine, Gifu, Japan

Manuscript received December 30, 2000; revised manuscript received April 11, 2001, accepted April 25, 2001.

Reprint requests and correspondence: Dr. Hisayoshi Fujiwara, Second Department of Internal Medicine, Gifu University School of Medicine, 40 Tsukasa-machi, Gifu 500-8705, Japan
gifuim-gif{at}umin.ac.jp

OBJECTIVES

The purpose of the present study was to define clinicopathologically whether integrated backscatter (IB) combined with conventional two-dimensional echo (2DE) can differentiate the tissue characteristics of calcification (CL), fibrosis (FI), lipid pool (LP) with fibrous cap, intimal hyperplasia (IH) and thrombus (TH) and can construct two-dimensional tissue plaque structure in vivo.

BACKGROUND

It is difficult to characterize the components of plaque using conventional 2DE techniques.

METHODS

Integrated backscatter values of plaques were measured in the right common carotid and femoral arteries (total 24 segments) both during life and after autopsy in 12 patients (age 68 to 84 years, 10 men and two women). Integrated backscatter values were determined using a 5–12 MHz multifrequency transducer, setting the region of interests (ROIs) (11 x 11 pixels) on the echo tomography of the entire arterial wall (55 ± 10 ROI/segment) and comparing it with histologic features in the autopsied arterial specimens.

RESULTS

Corrected IB values obtained before death and at autopsy were significantly correlated (r = 0.93, p < 0.01). Corresponding to the histologic features, corrected IB values on the rectangle ROIs obtained during life were divided into five categories: category 1 (TH) 4 < IB 6; category 2 (media and IH or LP in the intima) 7 < IB 13; category 3 (FI) 13 < IB 18, category 4 (mixed lesion) 18 < IB 27 and category 5 (CL) 28 < IB 33. In category 2, media and intima were differentiated using conventional 2DE. Under the above procedures, color-coded maps constructed with IB-2DE obtained during life precisely reflected the histologic features of media and intima.

CONCLUSIONS

Integrated backscatter with 2DE represents a useful noninvasive tool for evaluating the tissue structure of human plaque.

Abbreviations and Acronyms   CL = calcification   dB = decibels   2D = two-dimensional   2DE = two-dimensional echo   FI = fibrosis   IB = integrated backscatter   IH = intimal hyperplasia   LP = lipid pool   ML = mixed lesion   ROI = region of interest   TH = thrombus

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