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Circulation, Vol 84, 109-117, Copyright © 1991 by American Heart Association
RJ Siegel, M Ariani, MC Fishbein, JS Chae, JC Park, G Maurer and JS Forrester
BACKGROUND. To establish a histopathologic basis for angioscopic and
ultrasound image interpretation we studied 70 postmortem human arterial
segments in vitro. METHODS AND RESULTS. We used 7- to 9-French fiber- optic
angioscopes and 20- to 30-MHz intravascular ultrasound imaging catheters.
Three observers assigned an angioscopic and ultrasound image classification
to each vessel segment. The image and histological classification
categories were then compared. The sensitivity, specificity, and accuracy
of both methods separately or in combination for normal vessels were each
greater than or equal to 95%. The predictive value was better for
angioscopy than for ultrasound due to incorrect ultrasound interpretations
of normal anatomy in the presence of thrombus. For stable atheroma the
sensitivity, specificity, and accuracy of the individual methods were each
greater than 90%. However, both angioscopy and ultrasound had
classification errors in that disrupted atheroma was identified and
classified as stable atheroma. Consequently, the predictive value was 74%
for angioscopy and 78% for ultrasound. For disrupted atheroma the
sensitivities for angioscopy and ultrasound were only moderate (73% and
81%, respectively), whereas the specificity, accuracy, and predictive value
were each high (greater than 90%). For thrombus detection, the specificity,
accuracy, and predictive value were high (greater than 93%) for each
method. The sensitivity of angioscopy was 100%. However, sensitivity was
lower for ultrasound (57%) due to false-negative interpretation of laminar
clots in normal vessels and an inability to distinguish disrupted or stable
atheroma from intraluminal thrombus. CONCLUSIONS. Contingency analyses
showed that each imaging method alone or combined had significant agreement
with the results obtained from histology (p less than 0.001). When
assessing all cases in which angioscopy and ultrasound were concordant,
there was a 92% agreement with the histological classification.
ARTICLES
Histopathologic validation of angioscopy and intravascular ultrasound
Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048-0750.
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