Multi-modality intra-coronary plaque characterization: A pilot study

Background: The risk of rupture and subsequent thrombosis of the atherosclerotic coronary plaques is related to the presence of necrotic core with high lipid content. We conducted an exploratory pilot trial to compare the capability for lipid tissue detection using four intra-coronary diagnostic techniques: greyscale intravascular ultrasound (GS IVUS), IVUS radiofrequency data (IVUS RFD) analysis, optical coherence tomography (OCT) and intravascular magnetic resonance spectroscopy (IVMR). Methods: Twenty-four matched target plaques were analyzed with the 4 techniques in non-culprit lesions in five patients with stable angina. Following IVUS pullback, OCT and IVMR was performed. Plaque composition was assessed using established criteria of each technology. Results: Atherosclerotic plaques classified as soft by GS IVUS were mainly composed by fibro-fatty (80%) or necrotic core (20%) by IVUS RFD. These soft plaques were classified as "lipid-rich" by OCT in the majority of cases (80%). IVMR confirmed the presence of lipid with a lipid fraction index ranging between 36 and 79 in these soft plaques. Besides this good agreement for soft plaques, GS IVUS, IVUS RFD and OCT had 100% agreement in the identification of calcified plaques. Conclusion: The present study explored multi-modality imaging of atherosclerotic plaque in-vivo. Assessing specifically lipid-rich plaques, there was generally good agreement for plaque components identified as soft by traditional GS IVUS with RFD and OCT whereas IVMR showed a varying amount of lipid in these regions. Nevertheless there continues to remain inherent variation, namely as a result of the different imaging resolutions and the lack of common nomenclature and classification.