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Optical Coherence
Tomography: Optical Biopsy
with a Short Photonic
Needle?
I.K. Jang, MD
Massachusetts General Hospital
Ha...
Optical Coherence
Tomography
• Optical analog of ultrasound
• Cross-sectional imaging
• 10 µm resolution
• 2 mm penetratio...
MGH OCT
System Technical
Data
Optical wavelength :
Image acquisition rate :
Catheter:
Axial Resolution :
Transverse Resolu...
Ex Vivo Study
Aim
Establish OCT criteria for plaque
characterization
Materials and Methods
• 357 arterial segments from 90...
Ex Vivo Study
Type Number
Fibrous 11 (22%)
Calcific 27 (54%)
Lipid pool 12 (24%)
Type Number
Fibrous 67 (22%)
Calcific 167...
OCT Characteristics
lp
lp
Homogeneous,
Signal-rich
Fibrous Lipid
Echolucent,
Diffuse Borders
Echolucent,
Sharp Borders
Cal...
Intimal Hyperplasia
Low signal High signal
Fibrous Plaque
F
I
M
A
F
EEL
IEL
lp
n
lp
Lipid-Rich Plaque
(with neovascularization)
Calcific Plaque
C
C
Ex Vivo Study Results
SENS .87 PPV .88
SPEC .97 NPV .96
SENS .95 PPV 1.0
SPEC 1.0 NPV .95
SENS .92 PPV .81
SPEC .94 NPV .9...
Clinical Study 1
Feasibility and Safety:
Pre and Post PCI
Pilot Human Study
Aim: Test feasibility and safety of OCT in
patients
Methods
• 10 patients (average age 59, 8M/2F)
• Coro...
Fibrous Plaque
Fibrous Plaque
Lipid-rich Plaque
Lipid Rich Plaque
g
lplp
f
g
2x
m
a
i
iel eel
f
OCT IVUS
Fibrous Plaque with Calcium
Fibrous Plaque with Calcium
Post balloon Dissection
Cutting balloon
Stent
Stent
Stent
Pilot Human Study Results
 No OCT related complications
 Variety of pathology imaged and
compared with IVUS
• 10 patient...
Acknowledgements
Massachusetts General Hospital
Cardiology Division
H. Yabushita, B. MacNeill, H. Lowe, M. Hayashi, S. Cla...
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Oct with shourt phontonic needle

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Oct with shourt phontonic needle

  1. 1. Optical Coherence Tomography: Optical Biopsy with a Short Photonic Needle? I.K. Jang, MD Massachusetts General Hospital Harvard Medical School The 3rd Vulnerable Plaque Symposium Atlanta, March 16, 2002
  2. 2. Optical Coherence Tomography • Optical analog of ultrasound • Cross-sectional imaging • 10 µm resolution • 2 mm penetration depth Low signal High signal
  3. 3. 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 µm 25 µm Digital
  4. 4. Ex Vivo Study Aim 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
  5. 5. Ex Vivo Study Type Number Fibrous 11 (22%) Calcific 27 (54%) Lipid pool 12 (24%) Type Number Fibrous 67 (22%) Calcific 167 (54%) Lipid pool 73 (24%) Validation Set (n = 307)Training Set (n = 50) Histologic Diagnoses
  6. 6. OCT Characteristics lp lp Homogeneous, Signal-rich Fibrous Lipid Echolucent, Diffuse Borders Echolucent, Sharp Borders Calcific 500 µm
  7. 7. Intimal Hyperplasia Low signal High signal
  8. 8. Fibrous Plaque F I M A F EEL IEL
  9. 9. lp n lp Lipid-Rich Plaque (with neovascularization)
  10. 10. Calcific Plaque C C
  11. 11. Ex Vivo Study Results SENS .87 PPV .88 SPEC .97 NPV .96 SENS .95 PPV 1.0 SPEC 1.0 NPV .95 SENS .92 PPV .81 SPEC .94 NPV .97 Accuracy Statistics Fibrous Calcific Lipid pool Interobserver κ = 0.88, Intraobserver κ = 0.91
  12. 12. Clinical Study 1 Feasibility and Safety: Pre and Post PCI
  13. 13. 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
  14. 14. Fibrous Plaque
  15. 15. Fibrous Plaque
  16. 16. Lipid-rich Plaque
  17. 17. Lipid Rich Plaque g lplp f g 2x m a i iel eel f OCT IVUS
  18. 18. Fibrous Plaque with Calcium
  19. 19. Fibrous Plaque with Calcium
  20. 20. Post balloon Dissection
  21. 21. Cutting balloon
  22. 22. Stent
  23. 23. Stent
  24. 24. Stent
  25. 25. 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
  26. 26. Acknowledgements Massachusetts General Hospital Cardiology Division H. 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 Pathology S. Houser, H.T. Aretz CIMIT J. Muller, T. Brady, J. Rosen Guidant Corporation D. Kilpatrick, J. Ellis, R. Jones, T. Linnemeier

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