Peripheral application of intravascular ultrasound virtual histology

https://doi.org/10.1053/j.semvascsurg.2004.03.008Get rights and content

Abstract

Intravascular ultrasound (IVUS) provides direct depiction of coronary artery anatomy. Traditional use of this tomographic imaging modality has been in determination of geometric measurements of an artery, such as lumen or plaque size. However, by analyzing the backscattered or radiofrequency (RF) data it is possible to glean information on the composition of plaques. This chapter describes the theory of spectral analysis and its application clinical practice.

Section snippets

IVUS

There are two approaches to transducer construction that have gained popularity over the past decade: electronic arrays and mechanically rotating single element devices. Although these two methods of imaging are fundamentally different, they both produce images by emitting and then receiving an ultrasound pulse. This technique is known as the pulse-echo mode of imaging.

Image analysis

Extensive research has been conducted on IVUS image analysis for determining plaque composition.1, 2, 3 Fibrous or “hard” plaques are generally thought of as advanced lesions that contain dense fibrous tissue, elastin fibers, and proteoglycans. Similar to calcified regions in plaques, dense fibrous plaque components generally reflect ultrasound energy well and thus appear bright and homogeneous on IVUS images.4 However, one of the major problems with many of the image-based studies performed to

Medical application of IVUS backscatter

Spectral analysis is only commercially available to date on the Volcano Therapeutics consoles. These systems have RF spectral analysis built in to the console, termed Virtual Histology and only require an additional external electrocardiograph (ECG) input.

Impact for the peripheral disease

IVUS is currently underutilized in vascular surgery. The short-term expense, the time perceived to perform the procedure, and difficulties in interpreting the images are usually blamed. However, in experienced hands the addition will add only a few minutes to a surgical procedure and the “traffic-light” coloring of the Virtual Histology images makes interpretation easy. It is envisaged that Virtual Histology will aid in the placement of stent-grafts and the selections of sites for bypass

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