Imaging Vulnerable Plaque by Ultrasound
Anthony N. DeMaria, MD, MACC*,a,*,
Jagat Narula, MD, PhD, FACC ,
Ehtisham Mahmud, MD, FACC* and
Sotirios Tsimikas, MD, FACC*
* Division of Cardiology, University of California San Diego, San Diego, California, USA
Division of Cardiology, University of California-Irvine School of Medicine, Irvine, California, USA
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Figure 1 (A) Three-dimensional (3D) color-coded maps of the coronary arterial plaques constructed by 3D intravascular ultrasound with integrated back scatter. (B) 3D color-coded maps of each characteristic. The number of voxels of each tissue characteristic was automatically calculated. Reprinted with permission from Kawasaki et al. (29).
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Figure 2 Color-coded maps of the coronary arterial plaques constructed by three-dimensional (3D) intravascular ultrasound with integrated back scatter imaging at baseline and after statin therapy. (A) At baseline. The plaque consists of a large lipid core (blue) that is covered with a fibrous cap (green). (B) After statin therapies. The lipid core (blue) decreased and the fibrous area (green) increased. (C) Cut out image of 3D color-coded map at baseline. There was a small lipid core (blue) in the center of the plaque. (D) Cut-out image of 3D color-coded map after statin therapy. Note the reduction in the lipid core. Red = high signal lesion; yellow = mixed lesion. Reprinted with permission from Kawasaki et al. (29).
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Figure 3 Representative examples of in vitro Wavelet analysis of radiofrequency (RF) intravascular ultrasound (IVUS) signals from a lipid-laden plaque (A) and from a fibrous plaque without a lipid core (B). The upper panel shows RF signals, the middle panel, the results of Wavelet analysis, and the lower panel, histologic specimen of the corresponding arterial cross-section with Masson’s trichrome. In the time-scale domain color-coded mapping of Wavelet analysis, an apparently different pattern of pink area from an RF signal vector of a lipid-laden plaque is observed between scale 20 and scale 30, compared with the fibrous plaque. F = fibrous area; L = lipid core. Reprinted with permission from Murashige et al. (30).
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Figure 4 Representative examples of in vivo Wavelet analysis of radiofrequency (RF) intravascular ultrasound (IVUS) signals from a lipid-laden plaque (A) and from a fibrous plaque without a lipid core (B). The left panel shows conventional IVUS images, the middle panel, the results of Wavelet analysis, the right panel, histologic cross section of the corresponding directional coronary atherectomy specimen with Hematoxylin-Eosin and Azan stains. A similar pattern of color mapping was observed from the RF signal vector of a lipid-laden plaque as seen in the in vitro study. Reprinted with permission from Murashige et al. (30).
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Figure 5 The top panel shows the dissected intact aorta (left) and the opened aorta (right) showing yellow plaques. In the middle panel, (A) shows baseline ultrasound image of the aortic plaque (arrow), (B) shows microbubbles in the aortic lumen soon after intravenous injection, and (C) shows microbubble enhancement of the aortic plaque about 25 min after injection. The lumen is free of circulating microbubbles, and high mechanical index ultrasound imaging was done after 25 min. Note the brighter appearance of the plaque. The lower panel shows another example in which the figure on the left is the baseline image of a plaque and the figure on the right is color-coded, baseline-subtracted, videointensity image of the microbubble-enhanced atheroma.
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