Plaque and thrombus evaluation by optical coherence tomography

  • Takashi Kubo
  • Chenyang Xu
  • Zhao Wang
  • Nienke S. van Ditzhuijzen
  • Hiram G. BezerraEmail author
Original Paper


Intravascular Optical Coherence Tomography has been explored as an imaging tool for vessel wall and thrombus characterization. OCT enables a high resolution arterial wall imaging, and light properties allow tissue characterization. It has been proved one of the most valuable imaging modalities for the evaluation of vulnerable plaque and thrombus. OCT has a unique capacity in volumetric quantification of calcium, and unlike ultrasound, light can easily penetrate calcified plaques. Finally, this review paper will address aspects of the validation method of plaque characterization and potential pitfalls and put in perspective new approaches that may help the evolution of the field.


Optical coherence tomography Atherosclerosis Plaque Imaging 


Conflict of interest



  1. 1.
    Huang D, Swanson EA, Lin CP, Schuman JS, Stinson WG, Chang W, Hee MR, Flotte T, Gregory K, Puliafito CA et al (1991) Optical coherence tomography. Science 254:1178–1181PubMedCrossRefGoogle Scholar
  2. 2.
    Brezinski ME, Tearney GJ, Bouma BE, Izatt JA, Hee MR, Swanson EA, Southern JF, Fujimoto JG (1996) Optical coherence tomography for optical biopsy. Properties and demonstration of vascular pathology. Circulation 93:1206–1213PubMedGoogle Scholar
  3. 3.
    Yabushita H, Bouma BE, Houser SL, Aretz HT, Jang IK, Schlendorf KH, Kauffman CR, Shishkov M, Kang DH, Halpern EF, Tearney GJ (2002) Characterization of human atherosclerosis by optical coherence tomography. Circulation 106:1640–1645PubMedCrossRefGoogle Scholar
  4. 4.
    Jang IK, Bouma BE, Kang DH, Park SJ, Park SW, Seung KB, Choi KB, Shishkov M, Schlendorf K, Pomerantsev E, Houser SL, Aretz HT, Tearney GJ (2002) Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography: comparison with intravascular ultrasound. J Am Coll Cardiol 39:604–609PubMedCrossRefGoogle Scholar
  5. 5.
    Tearney GJ, Yabushita H, Houser SL, Aretz HT, Jang IK, Schlendorf KH, Kauffman CR, Shishkov M, Halpern EF, Bouma BE (2003) Quantification of macrophage content in atherosclerotic plaques by optical coherence tomography. Circulation 107:113–119PubMedCrossRefGoogle Scholar
  6. 6.
    Jang IK, Tearney GJ, MacNeill B, Takano M, Moselewski F, Iftima N, Shishkov M, Houser S, Aretz HT, Halpern EF, Bouma BE (2005) In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography. Circulation 111:1551–1555PubMedCrossRefGoogle Scholar
  7. 7.
    Rieber J, Meissner O, Babaryka G, Reim S, Oswald M, Koenig A, Schiele TM, Shapiro M, Theisen K, Reiser MF, Klauss V, Hoffmann U (2006) Diagnostic accuracy of optical coherence tomography and intravascular ultrasound for the detection and characterization of atherosclerotic plaque composition in ex vivo coronary specimens: a comparison with histology. Coron Artery Dis 17:425–430PubMedCrossRefGoogle Scholar
  8. 8.
    Kume T, Akasaka T, Kawamoto T, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K (2006) Assessment of coronary arterial plaque by optical coherence tomography. Am J Cardiol 97:1172–1175PubMedCrossRefGoogle Scholar
  9. 9.
    Sawada T, Shite J, Garcia-Garcia HM, Shinke T, Watanabe S, Otake H, Matsumoto D, Tanino Y, Ogasawara D, Kawamori H, Kato H, Miyoshi N, Yokoyama M, Serruys PW, Hirata K (2008) Feasibility of combined use of intravascular ultrasound radiofrequency data analysis and optical coherence tomography for detecting thin-cap fibroatheroma. Eur Heart J 29:1136–1146PubMedCrossRefGoogle Scholar
  10. 10.
    Kubo T, Imanishi T, Takarada S, Kuroi A, Ueno S, Yamano T, Tanimoto T, Matsuo Y, Masho T, Kitabata H, Tsuda K, Tomobuchi Y, Akasaka T (2007) Assessment of culprit lesion morphology in acute myocardial infarction: Ability of optical coherence tomography compared with intravascular ultrasound and coronary angioscopy. J Am Coll Cardiol 50:933–939PubMedCrossRefGoogle Scholar
  11. 11.
    Giattina SD, Courtney BK, Herz PR, Harman M, Shortkroff S, Stamper DL, Liu B, Fujimoto JG, Brezinski ME (2006) Assessment of coronary plaque collagen with polarization sensitive optical coherence tomography (ps-oct). Int J Cardiol 107:400–409PubMedCrossRefGoogle Scholar
  12. 12.
    Nadkarni SK, Pierce MC, Park BH, de Boer JF, Whittaker P, Bouma BE, Bressner JE, Halpern E, Houser SL, Tearney GJ (2007) Measurement of collagen and smooth muscle cell content in atherosclerotic plaques using polarization-sensitive optical coherence tomography. J Am College Cardiol 49:1474–1481CrossRefGoogle Scholar
  13. 13.
    Levitz D, Thrane L, Frosz M, Andersen P, Andersen C, Andersson-Engels S, Valanciunaite J, Swartling J, Hansen P (2004) Determination of optical scattering properties of highly-scattering media in optical coherence tomography images. Opt Express 12:249–259PubMedCrossRefGoogle Scholar
  14. 14.
    van der Meer FJ, Faber DJ, Baraznji Sassoon DM, Aalders MC, Pasterkamp G, van Leeuwen TG (2005) Localized measurement of optical attenuation coefficients of atherosclerotic plaque constituents by quantitative optical coherence tomography. IEEE Trans Med Imaging 24:1369–1376PubMedCrossRefGoogle Scholar
  15. 15.
    Xu C, Schmitt JM, Carlier SG, Virmani R (2008) Characterization of atherosclerosis plaques by measuring both backscattering and attenuation coefficients in optical coherence tomography. J Biomed Opt 13:034003PubMedCrossRefGoogle Scholar
  16. 16.
    van Soest G, Goderie T, Regar E, Koljenovic S, van Leenders GL, Gonzalo N, van Noorden S, Okamura T, Bouma BE, Tearney GJ, Oosterhuis JW, Serruys PW, van der Steen AF (2010) Atherosclerotic tissue characterization in vivo by optical coherence tomography attenuation imaging. J Biomed Opt 15:011105Google Scholar
  17. 17.
    Kume T, Akasaka T, Kawamoto T, Okura H, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K (2006) Measurement of the thickness of the fibrous cap by optical coherence tomography. Am Heart J 152:755 e751–754Google Scholar
  18. 18.
    Kubo T, Imanishi T, Takarada S, Kuroi A, Ueno S, Yamano T, Tanimoto T, Matsuo Y, Masho T, Kitabata H, Tanaka A, Nakamura N, Mizukoshi M, Tomobuchi Y, Akasaka T (2008) Implication of plaque color classification for assessing plaque vulnerability: a coronary angioscopy and optical coherence tomography investigation. JACC Cardiovasc Interv 1:74–80PubMedCrossRefGoogle Scholar
  19. 19.
    Kashiwagi M, Tanaka A, Kitabata H, Tsujioka H, Kataiwa H, Komukai K, Tanimoto T, Takemoto K, Takarada S, Kubo T, Hirata K, Nakamura N, Mizukoshi M, Imanishi T, Akasaka T (2009) Feasibility of noninvasive assessment of thin-cap fibroatheroma by multidetector computed tomography. JACC Cardiovasc Imaging 2:1412–1419PubMedCrossRefGoogle Scholar
  20. 20.
    Fujii K, Masutani M, Okumura T, Kawasaki D, Akagami T, Ezumi A, Sakoda T, Masuyama T, Ohyanagi M (2008) Frequency and predictor of coronary thin-cap fibroatheroma in patients with acute myocardial infarction and stable angina pectoris a 3-vessel optical coherence tomography study. J Am Coll Cardiol 52:787–788PubMedCrossRefGoogle Scholar
  21. 21.
    Kume T, Akasaka T, Kawamoto T, Ogasawara Y, Watanabe N, Toyota E, Neishi Y, Sukmawan R, Sadahira Y, Yoshida K (2006) Assessment of coronary arterial thrombus by optical coherence tomography. Am J Cardiol 97:1713–1717PubMedCrossRefGoogle Scholar
  22. 22.
    Wexler L, Brundage B, Crouse J, Detrano R, Fuster V, Maddahi J, Rumberger J, Stanford W, White R, Taubert K (1996) Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications. A statement for health professionals from the american heart association. Writing group. Circulation 94:1175–1192PubMedGoogle Scholar
  23. 23.
    Greenland P, Bonow RO, Brundage BH, Budoff MJ, Eisenberg MJ, Grundy SM, Lauer MS, Post WS, Raggi P, Redberg RF, Rodgers GP, Shaw LJ, Taylor AJ, Weintraub WS (2007) Accf/aha 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the american college of cardiology foundation clinical expert consensus task force (accf/aha writing committee to update the 2000 expert consensus document on electron beam computed tomography) developed in collaboration with the society of atherosclerosis imaging and prevention and the society of cardiovascular computed tomography. J Am Coll Cardiol 49:378–402PubMedCrossRefGoogle Scholar
  24. 24.
    Mintz GS, Popma JJ, Pichard AD, Kent KM, Satler LF, Chuang YC, Ditrano CJ, Leon MB (1995) Patterns of calcification in coronary artery disease. A statistical analysis of intravascular ultrasound and coronary angiography in 1155 lesions. Circulation 91:1959–1965PubMedGoogle Scholar
  25. 25.
    Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832PubMedCrossRefGoogle Scholar
  26. 26.
    Carr JJ, Nelson JC, Wong ND, McNitt-Gray M, Arad Y, Jacobs DR Jr, Sidney S, Bild DE, Williams OD, Detrano RC (2005) Calcified coronary artery plaque measurement with cardiac ct in population-based studies: standardized protocol of multi-ethnic study of atherosclerosis (mesa) and coronary artery risk development in young adults (cardia) study. Radiology 234:35–43PubMedCrossRefGoogle Scholar
  27. 27.
    Callister TQ, Cooil B, Raya SP, Lippolis NJ, Russo DJ, Raggi P (1998) Coronary artery disease: improved reproducibility of calcium scoring with an electron-beam ct volumetric method. Radiology 208:807–814PubMedGoogle Scholar
  28. 28.
    Mintz GS, Pichard AD, Kovach JA, Kent KM, Satler LF, Javier SP, Popma JJ, Leon MB (1994) Impact of preintervention intravascular ultrasound imaging on transcatheter treatment strategies in coronary artery disease. Am J Cardiol 73:423–430PubMedCrossRefGoogle Scholar
  29. 29.
    Moussa I, Di Mario C, Moses J, Reimers B, Di Francesco L, Martini G, Tobis J, Colombo A (1997) Coronary stenting after rotational atherectomy in calcified and complex lesions. Angiographic and clinical follow-up results. Circulation 96:128–136PubMedGoogle Scholar
  30. 30.
    Wang Z, Kyono H, Bezerra HG, Wang H, Gargesha M, Alraies C, Xu C, Schmitt JM, Wilson DL, Costa MA, Rollins AM (2010) Semi-automatic segmentation and quantification of calcified plaques in intracoronary optical coherence tomography images. J Biomed Opt 15:061711PubMedCrossRefGoogle Scholar
  31. 31.
    Lusis AJ (2000) Atherosclerosis. Nature 407:233–241PubMedCrossRefGoogle Scholar
  32. 32.
    Moreno PR, Falk E, Palacios IF, Newell JB, Fuster V, Fallon JT (1994) Macrophage infiltration in acute coronary syndromes. Implications for plaque rupture. Circulation 90:775–778PubMedGoogle Scholar
  33. 33.
    MacNeill BD, Bouma BE, Yabushita H, Jang IK, Tearney GJ (2005) Intravascular optical coherence tomography: cellular imaging. J Nucl Cardiol 12:460–465PubMedCrossRefGoogle Scholar
  34. 34.
    MacNeill BD, Jang IK, Bouma BE, Iftimia N, Takano M, Yabushita H, Shishkov M, Kauffman CR, Houser SL, Aretz HT, DeJoseph D, Halpern EF, Tearney GJ (2004) Focal and multi-focal plaque macrophage distributions in patients with acute and stable presentations of coronary artery disease. J Am Coll Cardiol 44:972–979PubMedCrossRefGoogle Scholar
  35. 35.
    Drexler W, Morgner U, Kartner FX, Pitris C, Boppart SA, Li XD, Ippen EP, Fujimoto JG (1999) In vivo ultrahigh-resolution optical coherence tomography. Opt Lett 24:1221–1223PubMedCrossRefGoogle Scholar
  36. 36.
    Nadkarni SK, Pierce MC, Park BH, de Boer JF, Whittaker P, Bouma BE, Bressner JE, Halpern E, Houser SL, Tearney GJ (2007) Measurement of collagen and smooth muscle cell content in atherosclerotic plaques using polarization-sensitive optical coherence tomography. J Am Coll Cardiol 49:1474–1481PubMedCrossRefGoogle Scholar
  37. 37.
    Bezerra HG, Costa MA (2010) Will intravascular OCT shed light on vascular biology? JACC Cardiovasc Imaging 3:85–87PubMedCrossRefGoogle Scholar
  38. 38.
    Meissner OA, Rieber J, Babaryka G, Oswald M, Reim S, Siebert U, Redel T, Reiser M, Mueller-Lisse U (2006) Intravascular optical coherence tomography: comparison with histopathology in atherosclerotic peripheral artery specimens. J Vasc Interv Radiol 17:343–349PubMedCrossRefGoogle Scholar
  39. 39.
    Salvado O, Roy D, Heinzel M, McKinley E, Wilson D (2006) 3d cryo-section/imaging of blood vessel lesions for validation of mri data. Proc Soc Photo Opt Instrum Eng 6142:377–386PubMedGoogle Scholar
  40. 40.
    Roy D, Breen M, Salvado O, Heinzel M, McKinley E, Wilson D (2006) Imaging system for creating 3d block-face cryo-images of whole mice. Proc Soc Photo Opt Instrum Eng 6143:nihpa112282Google Scholar
  41. 41.
    Nguyen MS, Salvado O, Roy D, Steyer G, Stone ME, Hoffman RD, Wilson DL (2008) Ex vivo characterization of human atherosclerotic iliac plaque components using cryo-imaging. J Microsc 232:432–441PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  • Takashi Kubo
    • 1
  • Chenyang Xu
    • 2
  • Zhao Wang
    • 3
  • Nienke S. van Ditzhuijzen
    • 4
  • Hiram G. Bezerra
    • 4
    Email author
  1. 1.Department of Cardiovascular MedicineWakayama Medical UniversityWakayamaJapan
  2. 2.Lightlab Imaging Inc.WestfordUSA
  3. 3.Department of Biomedical EngineeringCase Western Reserve UniversityClevelandUSA
  4. 4.Harrington-McLaughlin Heart and Vascular Institute, Cardiovascular Imaging Core Laboratory, University Hospitals Medical CenterCase Western Reserve University School of MedicineClevelandUSA

Personalised recommendations