Comparison of diagnostic accuracy between multidetector computed tomography and virtual histology intravascular ultrasound for detecting optical coherence tomography-derived fibroatheroma

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Abstract
Histopathological studies have reported that optical coherence tomography (OCT) can accurately detect fibroatheroma that is involved in not only culprit lesion of acute coronary syndrome but also no-reflow phenomenon after percutaneous coronary intervention. Studies have demonstrated superiority of OCT in plaque characterization and interruption of arterial wall component. At current, multidetector computed tomography (MDCT) and virtual histology intravascular ultrasound (VH-IVUS) are considered as alternative imaging devices for coronary plaque characterization. This study aimed to compare the diagnostic accuracy for detecting fibroatheroma between MDCT and VH-IVUS using OCT as the reference standard. Forty-three lesions from 27 patients assessed by MDCT, VH-IVUS, and OCT were included in this study. Fibroatheroma was defined by OCT as a signal-poor region with a fast signal drop-off and little or no signal backscattering within the lesion. From 43 lesions, OCT revealed 21 fibroatheromas. Ring-like sign assessed by MDCT and positive remodeling assessed by IVUS were more frequently observed in OCT-fibroatheroma than non-OCT-fibroatheroma. The remodeling index of OCT-fibroatheroma assessed by MDCT and IVUS were higher than those of non-OCT-fibroatheroma. The sensitivity, specificity, positive predict values, negative predict values and accuracy of ring-like sign by MDCT and VH-IVUS for detecting OCT-fibroatheroma were 43, 95, 90, 64, 70 % and 71, 45, 56, 63, 58 %, respectively. Our results suggest that both accuracies of MDCT and VH-IVUS to detect OCT-fibroatheroma are insufficient. We need to apply appropriate device for searching vulnerable plaque.

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