The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Tangential Signal Dropout Mimicking the Appearance of Lipid-rich Plaques and Macrophage Infiltration on Optical Frequency Domain Imaging

DOI: 10.4244/EIJ-D-20-00014

1. Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Japan, Japan
2. Division of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Japan
3. Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan

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Aims: This study evaluated the optical frequency domain imaging (OFDI) artifact of tangential signal dropout (TSD), which mimics the appearance of lipid-rich plaque and macrophage (Mø) infiltration.

Methods and results: A total of 1,019 histological cross-sections from 23 autopsy hearts were matched with the corresponding OFDI images. Of those, 232 OFDI cross-sections that contained signal-poor regions with diffuse borders were classified as lipid-rich plaques. The angle θ was calculated between the OFDI beam that strikes the edge of the luminal surface of the low-intensity region and that which strikes the surface line of the low-intensity region. On histological evaluation, 182 (78%) cross-sections were classified as histologically lipidic/Mø infiltration, while the remaining 50 (22%) cross-sections as histologically non-lipidic/Mø infiltration. The angle θ was significantly smaller in the non-lipidic/Mø infiltration group than in the lipidic/Mø infiltration group (12±6° versus 37±14°, p<0.001). Receiver operating curve analysis revealed that the optimal cutoff value of the incident angle for predicting TSD was 23° with area under the curve 0.98.

Conclusions: When the OFDI imaging beam strikes the tissue at an angle q<23°, TSD artifact could occur. To eliminate image misinterpretation, our findings suggest that the OFDI catheter geometry should be considered for the accurate diagnosis of lipid-rich plaques and Mø infiltration.

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