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- 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. Optical Coherence Tomography • Optical analog of ultrasound • Cross-sectional imaging • 10 µm resolution • 2 mm penetration depth Low signal High signal
- 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. 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. 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. OCT Characteristics lp lp Homogeneous, Signal-rich Fibrous Lipid Echolucent, Diffuse Borders Echolucent, Sharp Borders Calcific 500 µm
- 7. Intimal Hyperplasia Low signal High signal
- 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. Clinical Study 1 Feasibility and Safety: Pre and Post PCI
- 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. Fibrous Plaque
- 15. Fibrous Plaque
- 17. Lipid Rich Plaque g lplp f g 2x m a i iel eel f OCT IVUS
- 18. Fibrous Plaque with Calcium
- 19. Fibrous Plaque with Calcium
- 21. Cutting balloon
- 22. Stent
- 23. Stent
- 24. Stent
- 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. 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
Notas del editor
- To date, there are two MGH prototype systems, with another under construction. All optics and electronics reside within a portable enclosure that can easily be transported to the clinical site. A photograph of one the the MGH OCT systems is shown in the upper right hand corner of this slide. A videoendoscopy image, present in the lower right hand corner of this slide, shows the typical view of the OCT catheter protruding through the accessory port. Light emanates from the OCT catheter in a direction that is perpendicular to the axis of the endoscope. The beam scans along the side of the hollow organ in a linear fashion.