3rd vp symposium jang
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Transcript of 3rd vp symposium jang
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Optical Coherence Tomography: Optical Biopsy with a Short
Photonic Needle?
I.K. Jang, MDMassachusetts General Hospital
Harvard Medical School
The 3rd Vulnerable Plaque SymposiumAtlanta, March 16, 2002
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Optical Coherence Tomography
• Optical analog of ultrasound
• Cross-sectional imaging
• 10 µm resolution
• 2 mm penetration depth
Low signal High signal
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MGH OCT System Technical Data
Optical wavelength :
Image acquisition rate :
Catheter:
Axial Resolution :
Transverse Resolution :
Data storage :
1300 nm
4-8 images / sec
3.0 F
10 m
25 m
Digital
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Ex Vivo StudyAim
Establish OCT criteria for plaque characterization
Materials and Methods• 357 arterial segments from 90 cadavers
– 78 Coronary; 86 Carotid; 143 Aorta• training set, n=50
validation set, n = 307
• Specimen registration• OCT imaging• Histology processing• Correlation of OCT with histology
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Ex Vivo Study
Type NumberFibrous 11 (22%)Calcific 27 (54%)Lipid pool 12 (24%)
Type NumberFibrous 67 (22%)Calcific 167 (54%)
Lipid pool 73 (24%)
Validation Set (n = 307)Training Set (n = 50)
Histologic Diagnoses
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OCT Characteristics
lp
lp
Homogeneous,Signal-rich
Fibrous Lipid
Echolucent, Diffuse Borders
Echolucent, Sharp Borders
Calcific500 µm
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Intimal Hyperplasia
Low signal High signal
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Fibrous Plaque
F
IMA
F
EELIEL
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lp
n
lp
Lipid-Rich Plaque(with neovascularization)
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Calcific Plaque
C C
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Ex Vivo Study Results
SENS .87 PPV .88SPEC .97 NPV .96
SENS .95 PPV 1.0SPEC 1.0 NPV .95
SENS .92 PPV .81SPEC .94 NPV .97
Accuracy Statistics
Fibrous
Calcific
Lipid pool
Interobserver = 0.88, Intraobserver = 0.91
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Clinical Study 1
Feasibility and Safety:Pre and Post PCI
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Pilot Human Study
Aim: Test feasibility and safety of OCT in patients
Methods• 10 patients (average age 59, 8M/2F)• Coronary angiogrpahy• IVUS + OCT imaging (3.2 F catheter)• PCI• Repeat IVUS + OCT Imaging
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Fibrous Plaque
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Fibrous Plaque
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Lipid-rich Plaque
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Lipid Rich Plaque
g
lplp
f
g
2x
ma
i
iel eel
f
OCT IVUS
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Fibrous Plaque with Calcium
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Fibrous Plaque with Calcium
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Post balloon Dissection
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Cutting balloon
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Stent
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Stent
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Stent
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Pilot Human Study Results No OCT related complications
Variety of pathology imaged and compared with IVUS• 10 patients with 28 plaque segments• 8 dissections• 13 stent locations
Problems• Obstruction by blood• Motion artifacts
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Acknowledgements
Massachusetts General HospitalCardiology DivisionH. Yabushita, B. MacNeill, H. Lowe, M. Hayashi, S. Clarke, E. Pomerantsev, D. DeJoseph, I.K. Jang
Wellman Laboratories of Photomedicine B.E. Bouma, M. Shishkov, C. Kauffman, N. Iftima, G.J. Tearney
Dept. of PathologyS. Houser, H.T. Aretz
CIMITJ. Muller, T. Brady, J. Rosen
Guidant CorporationD. Kilpatrick, J. Ellis, R. Jones, T. Linnemeier