Yoshifumi Saijo’s research while affiliated with Tohoku University and other places

The objectives were to compare the performance of a segmentation algorithm, based on the minimization of an uncertainty function, to delineate contours of external elastic membrane and lumen of human coronary arteries imaged with 40 and 60 MHz IVUS, and to use values of this function to delineate portions of contours with highest uncertainty. For 8 patients, 40 and 60 MHz IVUS coronary data acquired pre- and post-interventions were used, for a total of 68,516 images. Manual segmentations of contours (on 2312 images) performed by experts at three core laboratories were the gold-standards. Inter-expert variability was highest on contour points with largest values of the uncertainty function (p < 0.001). Inter-expert variability was lower at 60 than 40 MHz for external elastic membrane (p = 0.013) and lumen (p = 0.024). Average differences in plaque (and atheroma) burden between algorithmic contours and experts’ contours were within inter-expert variability (p < 0.001).

Mechanical response and properties of the arterial wall can be used to identify the biomechanical instability of plaques and predict their vulnerability to rupture. Shear strain elastography (SSE) is proposed to identify vulnerable plaque features attributed to mechanical structural heterogeneities. The aims of this study were: 1) to report on the potential of SSE to identify atherosclerotic plaques; and 2) to use SSE maps to highlight biomechanical changes in lesion characteristics after directional coronary atherectomy (DCA) interventions. For this purpose, SSE was imaged using in vivo intravascular ultrasound (IVUS) radio-frequency data collected from 12 atherosclerotic patients before and after DCA intervention. Coronary atherosclerotic plaques (pre-DCA) showed high SSE magnitudes with large affected areas. There were good correlations between SSE levels and soft plaque content (i.e., cellular fibrosis, thrombosis and fibrin) (mean |SSE| vs. soft plaque content: r = 0.82, p < 0.01). Significant differences were noticed between SSE images before and after DCA. Stable arteries (post-DCA) exhibited lower values than pre-DCA vessels (e.g., pre-DCA: mean |SSE| = 3.9 ± 0.2% vs. 1.1 ± 0.2% post-DCA, p < 0.001). Furthermore, SSE magnitude was statistically higher in plaques with a high level of inflammation (e.g., mean |SSE| had values of 4.8 ± 0.4% in plaques with high inflammation, whereas it was reduced to 1.8 ± 0.2% with no inflammation, p < 0.01). This study demonstrates the potential of the IVUS-based SSE technique to detect vulnerable plaques in vivo.

Plaque elasticity (i.e., modulogram) and morphology are good predictors of plaque vulnerability. Recently, our group developed an intravascular ultrasound (IVUS) elasticity reconstruction method which was successfully implemented in vitro using vessel phantoms. In vivo IVUS modulography, however, remains a major challenge as the motion of the heart prevents accurate strain field estimation. We therefore designed a technique to extract accurate strain fields and modulograms from recorded IVUS sequences. We identified a set of four criteria based on tissue overlapping, RF-correlation coefficient between two successive frames, performance of the elasticity reconstruction method to recover the measured radial strain, and reproducibility of the computed modulograms over the cardiac cycle. This four-criterion selection procedure (4-CSP) was successfully tested on IVUS sequences obtained in twelve patients referred for a directional coronary atherectomy intervention. This study demonstrates the potential of the IVUS modulography technique based on the proposed 4-CSP to detect vulnerable plaques in vivo.