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Assessment of Vulnerable Plaques Causing Acute Coronary Syndrome Using Integrated Backscatter Intravascular Ultrasound

Keiji Sano, MD, PhD^_*, Masanori Kawasaki, MD, PhD^_*,_*, Yoshiyuki Ishihara, MD^_*, Munenori Okubo, MD^_*, Kunihiko Tsuchiya, MD, PhD^_*, Kazuhiko Nishigaki, MD, PhD^_*, Xiangrong Zhou, PhD, Shinya Minatoguchi, MD, PhD^_*, Hiroshi Fujita, PhD and Hisayoshi Fujiwara, MD, PhD^_*

^_* Division of Regeneration and Advanced Medical Science, Gifu University Graduate School of Medicine, Gifu, Japan
Department of Intelligent Image Information, Gifu University Graduate School of Medicine, Gifu, Japan

View larger version (119K): [in a new window]   Figure 1 Images of the culprit lesion causing acute coronary syndrome. (A) Angiography of the left coronary artery. (Upper) The arrowhead indicates a lesion, in which intravascular ultrasound (IVUS) measurements were recorded at baseline. (Lower) The arrowhead indicates the culprit lesion at follow-up. (B) Conventional IVUS image of segment indicated by the arrowhead in A. (C) Integrated backscatter (IB)-IVUS image of Cartesian coordinates, constructed using conventional color gradation, of the segment indicated by the arrowhead in A. The asterisk indicates the guidewire artifact. Note the large lipid core (blue) with fibrous cap (green). (D) IB-IVUS image of Cartesian coordinates, constructed using another color gradation, of the segment indicated by the arrowhead in A. This type of color-coded map illustrates the difference between lipid pool and fibrous tissue. The asterisk indicates the guidewire artifact. Note the large lipid core (blue) with fibrous cap (red or white). CL = calcification. Bar = 1 mm.

View larger version (119K): [in a new window]   Figure 2 Images of the culprit lesion causing acute coronary syndrome. (A) Angiography of the circumflex coronary artery. (Upper) The arrowhead indicates a lesion, in which IVUS measurements were recorded at baseline. (Lower) The arrowhead indicates the culprit lesion at follow-up. (B) Conventional intravascular ultrasound (IVUS) image of the segment indicated by the arrowhead in A. (C) Integrated backscatter (IB)-IVUS image of Cartesian coordinates, constructed using conventional color gradation, of the segment indicated by the arrowhead in A. The asterisk indicates the guidewire artifact. Note the large lipid core (blue) with fibrous cap (green). (D) IB-IVUS image of Cartesian coordinates, constructed using another color gradation, of the segment indicated by the arrowhead in A. The asterisk indicates the guidewire artifact. Note the large lipid core (blue) with fibrous cap (red or white). CL = calcification. Bar = 1 mm.

View larger version (122K): [in a new window]   Figure 3 Images of the lesion not causing acute coronary syndrome. (A) Angiography of the left coronary artery. (Upper) The arrowhead indicates a lesion, in which intravascular ultrasound (IVUS) measurements were recorded at baseline. (Lower) the arrowhead indicates the segment indicated by the arrowhead at baseline after the follow-up period. (B) Conventional IVUS image of the segment indicated by the arrowhead in A. (C) Integrated backscatter (IB)-IVUS image of Cartesian coordinates, constructed using conventional color gradation, of the segment indicated by the arrowhead in A. The asterisk indicates the guidewire artifact. Note the small lipid core (blue) with large fibrous tissue (green). (D) IB-IVUS image of Cartesian coordinates, constructed using another color gradation, of the segment indicated by the arrowhead in A. The asterisk indicates the guidewire artifact. Note the small lipid core (blue) with large fibrous tissue (red or white). CL = calcification. Bar = 1 mm.

View larger version (22K): [in a new window]   Figure 4 Receiver operating characteristic curves for each intravascular ultrasound parameter. Optimal cutoffs are indicated by underlining. Secondary selected cutoffs were indicated without underline. Note that area under curves (AUCs) show that percentage fibrous area was the most sensitive parameter for classifying the plaques causing acute coronary syndrome.