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E. Diethrich, M. Margolis, Donald Reid, A. Burke, V. Ramaiah, J. Rodriguez‐Lopez, G. Wheatley, D. Olsen, R. Virmani (2007)
Virtual Histology Intravascular Ultrasound Assessment of Carotid Artery Disease: The Carotid Artery Plaque Virtual Histology Evaluation (CAPITAL) StudyThe Journal of Endovascular Therapy, 14
K. Nasu, E. Tsuchikane, O. Katoh, D. Vince, R. Virmani, J. Surmely, A. Murata, Y. Takeda, Tatsuya Ito, M. Ehara, T. Matsubara, M. Terashima, Takahiko Suzuki (2006)
Accuracy of in vivo coronary plaque morphology assessment: a validation study of in vivo virtual histology compared with in vitro histopathology.Journal of the American College of Cardiology, 47 12
Pavan Cheruvu, A. Finn, C. Gardner, Jay Caplan, J. Goldstein, G. Stone, R. Virmani, J. Muller (2007)
Frequency and distribution of thin-cap fibroatheroma and ruptured plaques in human coronary arteries: a pathologic study.Journal of the American College of Cardiology, 50 10
R. Funada, Y. Oikawa, J. Yajima, H. Kirigaya, K. Nagashima, K. Ogasawara, S. Matsuno, T. Inaba, Y. Nakagawa, Michinari Nakamura, M. Kurabayashi, T. Aizawa (2009)
The potential of RF backscattered IVUS data and multidetector-row computed tomography images for tissue characterization of human coronary atherosclerotic plaquesThe International Journal of Cardiovascular Imaging, 25
T. Thim, M. Hagensen, David Wallace-Bradley, J. Granada, G. Kaluza, L. Drouet, W. Paaske, H. Bøtker, E. Falk (2010)
Unreliable Assessment of Necrotic Core by Virtual Histology Intravascular Ultrasound in Porcine Coronary Artery DiseaseCirculation: Cardiovascular Imaging, 3
A. Nair, Margolis Mp, B. Kuban, D. Vince (2007)
Automated coronary plaque characterisation with intravascular ultrasound backscatter: ex vivo validation.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 3 1
S. Cramer (2004)
International variation in histologic grading is large and persistent feedback does not improve reproducibility.The American journal of surgical pathology, 28 2
J. Rosai (1991)
Borderline Epithelial Lesions of the BreastThe American Journal of Surgical Pathology, 15
Correspondence limitation, geometric transformation was used in the validation Letter by Stone and Mintz Regarding Article, studies to correct for fixation artifacts. “Unreliable Assessment of Necrotic Core by Lastly, and of greatest relevance to the human condition, the Virtual Histology Intravascular Ultrasound in prognostic utility of VH IVUS recently has been demonstrated in the Porcine Coronary Artery Disease” Providing Regional Observations to Study Predictors of Events in To the Editor: the Coronary Tree (PROSPECT) study where 2800 coronary We read with interest the article by Thim et al in which no lesions in 697 patients were assessed by VH IVUS and prospectively correlation was found between the size of necrotic core determined followed for 3 years. By multivariable analysis, lesions determined by virtual histology intravascular ultrasound (VH IVUS) and actual to be thin-cap fibroatheromas by VH IVUS had a 3-fold increased histology in adult atherosclerosis-prone minipigs. The authors’ hazard of resulting in future major adverse cardiovascular events, implication that caution is therefore warranted “in the interpretation independent of clinical characteristics, biomarkers, and other gray- of [human] studies relying on VH IVUS for monitoring of treatment scale IVUS characteristics. effects, event prediction, and validation of other imaging modalities” would appear to exceed what may reliably be concluded from this Disclosures study on several grounds. Dr Stone is a consultant to Volcano Corp and InfraReDx and is a First, although the authors acknowledge that coregistration of VH member of the scientific advisory board for and has received IVUS frames and histological sections may be problematic, IVUS honoraria from Boston Scientific. Dr Mintz has received honoraria images are sampled every 0.5 mm on average, compared to every and grant support from Volcano Corp and Boston Scientific and is 4 mm for pathological sections in the study by Thim et al, consultant to Volcano Corp. introducing even greater error in matching (which cannot be over- Gregg W. Stone, MD come by use of fiduciary branch points or use of balloon angioplasty Gary S. Mintz, MD footprints). Moreover, tissue sections usually are 4 to 5 min Columbia University Medical Center and the thickness compared to VH images, which are produced from IVUS Cardiovascular Research Foundation beams typically 200 to 300 m in thickness. Therefore, given the New York, NY marked longitudinal pathological variability that can be present every few micrometers, it is inappropriate to align a given histo- logical section to an IVUS frame and expect high correlation in References quantification of individual tissue components. 1. Thim T, Hagensen MK, Wallace-Bradley D, Granada JF, Kaluza GL, Second, despite this limitation, the lack of correlation between VH Drouet L, Paaske WP, Bøtker HE, Falk E. Unreliable assessment of IVUS and histology, necrotic core area in the present report was necrotic core by virtual histology intravascular ultrasound in porcine driven primarily by 1 point in the upper left quadrant of Figure 1A. coronary artery disease. Circ Cardiovasc Imaging. 2010;3:384–391. 2. Cheruvu PK, Finn AV, Gardner C, Caplan J, Goldstein J, Stone GW, Using the data in this graph, if this outlier is removed, one can Virmani R, Muller JE. Frequency and distribution of thin-cap fibroather- calculate that r0.79 (P0.0003), indicating very good correlation. oma and ruptured plaques in human coronary arteries: a pathologic study. Third (and not commonly appreciated), there often is major J Am Coll Cardiol. 2007;50:940–949. 3,4 disagreement between pathologists when assessing histology. 3. Rosai J. Borderline epithelial lesions of the breast. Am J Surg Path. Pertinent to the present report, from a study in which 4 highly 1991;15:209–221. experienced cardiac pathologists assessed 30 Movat pentachrome 4. Cramer S. International variation in histologic grading is large and per- coronary histology slides, in only 7 (23%) cases was there agreement sistent feedback does not improve reproducibility. Am J Surg Path. 2004; about histological classification among all, with the greatest source 28:273–275. of variability being in the location and quantity of necrotic core 5. Nair A, Margolis MP, Kuban BD, Vince DG. Automated coronary plaque (G.M. Sangiorgi, oral communication, May 18, 2010). characterisation with intravascular ultrasound backscatter: ex vivo vali- Fourth, the authors state that “for grayscale IVUS, it is generally dation. EuroIntervention. 2007;3:113–120. agreed that echolucent plaque areas represent collagen-poor areas 6. Nasu K, Tsuchikane E, Katoh O, Vince DG, Virmani R, Surmely JF, with high lipid content within a preserved (lipid pool) or degraded Murata A, Takeda Y, Ito T, Ehara M, Matsubara T, Terashima M, Suzuki (necrotic core) extracellular matrix. Thereby grayscale IVUS offers T. Accuracy of in vivo coronary plaque morphology assessment: a vali- dation study of in vivo virtual histology compared with in vitro histopa- tissue characterization to some extent.” This statement is incorrect. Echolucency is a sign of tissue homogeneity, whereas necrotic core thology. J Am Coll Cardiol. 2006;47:2405–2412. 7. Funada R, Oikawa Y, Yajima J, Kirigaya H, Nagashima K, Ogasawara K, tissue is heterogeneous with multiple tissue interfaces and therefore Matsuno S, Inaba T, Nakagawa Y, Nakamura M, Kurabayashi M, Aizawa is often hyperechoic. T. The potential of RF backscattered IVUS data and multidetector-row Fifth, the VH IVUS algorithm was “trained” from human histol- computed tomography images for tissue characterization of human ogy, with which it has been shown to highly correlate. Indeed, high coronary atherosclerotic plaques. Int J Cardiovasc Imaging. 2009;25: correlation also has been observed in vivo between human histology 471–478. and VH IVUS plaque composition from both coronary atherec- 8. Diethrich EB, Pauliina Margolis M, Reid DB, Burke A, Ramaiah V, 6,7 8 tomy and carotid endarterectomy specimens. To the extent that Rodriguez-Lopez JA, Wheatley G, Olsen D, Virmani R. Virtual histology the chemical composition of the necrotic core from miniswine and intravascular ultrasound assessment of carotid artery disease: the Carotid human beings differ may explain the lack of correlation observed in Artery Plaque Virtual Histology Evaluation (CAPITAL) study. J Endovasc the present experimental study. Ther. 2007;14:676–686. Sixth, the IVUS contours of the lumen and external elastic 9. Stone GW. PROSPECT: a natural history study of atherosclerosis using membrane seen in the examples in the article are very different from multimodality intracoronary imaging to prospectively identify vulnerable histological borders because of fixation artifact, which can signifi- plaque. http://www.tctmd.com/show.aspx?id84116. Accessed May 25, cantly distort absolute necrotic core measures. To overcome this 2010. (Circ Cardiovasc Imaging. 2010;3:e4.) © 2010 American Heart Association, Inc. Circ Cardiovasc Imaging is available at http://circimaging.ahajournals.org DOI: 10.1161/CIRCIMAGING.110.958553 e4
Circulation: Cardiovascular Imaging – Wolters Kluwer Health
Published: Sep 1, 2010
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