title: Differentiation of early from advanced coronary atherosclerotic lesions: systematic comparison of CT, intravascular US, and optical frequency domain imaging with histopathologic examination in ex vivo human hearts.
abstract: OBJECTIVE
  To establish an ex vivo experimental setup for imaging coronary atherosclerosis with coronary computed tomographic (CT) angiography, intravascular ultrasonography (US), and optical frequency domain imaging (OFDI) and to investigate their ability to help differentiate early from advanced coronary plaques.
  
  
  METHODS
  All procedures were performed in accordance with local and federal regulations and the Declaration of Helsinki. Approval of the local Ethics Committee was obtained. Overall, 379 histologic cuts from nine coronary arteries from three donor hearts were acquired, coregistered among modalities, and assessed for the presence and composition of atherosclerotic plaque. To assess the discriminatory capacity of the different modalities in the detection of advanced lesions, c statistic analysis was used. Interobserver agreement was assessed with the Cohen κ statistic.
  
  
  RESULTS
  Cross sections without plaque at coronary CT angiography and with fibrous plaque at OFDI almost never showed advanced lesions at histopathologic examination (odds ratio [OR]: 0.02 and 0.06, respectively; both P<.0001), while mixed plaque at coronary CT angiography, calcified plaque at intravascular US, and lipid-rich plaque at OFDI were associated with advanced lesions (OR: 2.49, P=.0003; OR: 2.60, P=.002; and OR: 31.2, P<.0001, respectively). OFDI had higher accuracy for discriminating early from advanced lesions than intravascular US and coronary CT angiography (area under the receiver operating characteristic curve: 0.858 [95% confidence interval {CI}: 0.802, 0.913], 0.631 [95% CI: 0.554, 0.709], and 0.679 [95% CI: 0.618, 0.740]; respectively, P<.0001). Interobserver agreement was excellent for OFDI and coronary CT angiography (κ=0.87 and 0.85, respectively) and was good for intravascular US (κ=0.66).
  
  
  CONCLUSIONS
  Systematic and standardized comparison between invasive and noninvasive modalities for coronary plaque characterization in ex vivo specimens demonstrated that coronary CT angiography and intravascular US are reasonably associated with plaque composition and lesion grading according to histopathologic findings, while OFDI was strongly associated. These data may help to develop initial concepts of sequential imaging strategies to identify patients with advanced coronary plaques.
authors.affiliation: Cardiac MR PET CT Program of the Department of Radiology, Cardiology Division, and Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge St, Suite 400, Boston, MA 02114, USA.
authors.forename: Pál
authors.initials: P
authors.lastname: Maurovich-Horvat
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Schlett
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
authors.forename: Masataka
authors.initials: M
authors.lastname: Nakano
authors.forename: Paul
authors.initials: P
authors.lastname: Stolzmann
authors.forename: Marc
authors.initials: M
authors.lastname: Vorpahl
authors.forename: Hans
authors.initials: H
authors.lastname: Scheffel
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tanaka
authors.forename: William C
authors.initials: WC
authors.lastname: Warger
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.forename: Shixin
authors.initials: S
authors.lastname: Ma
authors.forename: Matthias F
authors.initials: MF
authors.lastname: Kriegel
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Kaple
authors.forename: Harald
authors.initials: H
authors.lastname: Seifarth
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Guillermo J
authors.initials: GJ
authors.lastname: Tearney
authors.forename: Renu
authors.initials: R
authors.lastname: Virmani
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
mesh_terms: D002102:Cadaver; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D041623:Tomography, Optical Coherence / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*