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Research Papers

Combining IVUS and Optical Coherence Tomography for More Accurate Coronary Cap Thickness Quantification and Stress/Strain Calculations: A Patient-Specific Three-Dimensional Fluid-Structure Interaction Modeling Approach

[+] Author and Article Information
Xiaoya Guo

Department of Mathematics,
Southeast University,
Nanjing 210096, China

Don P. Giddens

Department of Medicine,
Emory University School of Medicine,
Atlanta, GA 30307;
The Wallace H. Coulter Department
of Biomedical Engineering,
Georgia Institute of Technology,
Atlanta, GA 30332

David Molony, Habib Samady

Department of Medicine,
Emory University School of Medicine,
Atlanta, GA 30307

Chun Yang

Mathematical Sciences Department,
Worcester Polytechnic Institute,
Worcester, MA 01609

Jie Zheng

Mallinckrodt Institute of Radiology,
Washington University,
St. Louis, MO 63110

Gary S. Mintz, Akiko Maehara

The Cardiovascular Research Foundation,
Columbia University,
New York, NY 10022

Liang Wang

Mathematical Sciences Department,
Worcester Polytechnic Institute,
Worcester, MA 01609

Xuan Pei, Zhi-Yong Li

School of Biological Science
& Medical Engineering,
Southeast University,
Nanjing 210096, China

Dalin Tang

Department of Mathematics,
Southeast University,
Nanjing 210096, China;
Mathematical Sciences Department,
Worcester Polytechnic Institute,
Worcester, MA 01609

1Corresponding author.

Manuscript received May 28, 2017; final manuscript received October 4, 2017; published online January 23, 2018. Assoc. Editor: Alison Marsden.

J Biomech Eng 140(4), 041005 (Jan 23, 2018) (12 pages) Paper No: BIO-17-1228; doi: 10.1115/1.4038263 History: Received May 28, 2017; Revised October 04, 2017

Accurate cap thickness and stress/strain quantifications are of fundamental importance for vulnerable plaque research. Virtual histology intravascular ultrasound (VH-IVUS) sets cap thickness to zero when cap is under resolution limit and IVUS does not see it. An innovative modeling approach combining IVUS and optical coherence tomography (OCT) is introduced for cap thickness quantification and more accurate cap stress/strain calculations. In vivo IVUS and OCT coronary plaque data were acquired with informed consent obtained. IVUS and OCT images were merged to form the IVUS + OCT data set, with biplane angiography providing three-dimensional (3D) vessel curvature. For components where VH-IVUS set zero cap thickness (i.e., no cap), a cap was added with minimum cap thickness set as 50 and 180 μm to generate IVUS50 and IVUS180 data sets for model construction, respectively. 3D fluid–structure interaction (FSI) models based on IVUS + OCT, IVUS50, and IVUS180 data sets were constructed to investigate cap thickness impact on stress/strain calculations. Compared to IVUS + OCT, IVUS50 underestimated mean cap thickness (27 slices) by 34.5%, overestimated mean cap stress by 45.8%, (96.4 versus 66.1 kPa). IVUS50 maximum cap stress was 59.2% higher than that from IVUS + OCT model (564.2 versus 354.5 kPa). Differences between IVUS and IVUS + OCT models for cap strain and flow shear stress (FSS) were modest (cap strain <12%; FSS <6%). IVUS + OCT data and models could provide more accurate cap thickness and stress/strain calculations which will serve as basis for further plaque investigations.

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Figures

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Fig. 1

Plaque rupture: a coronary plaque sample with IVUS, OCT, and angiography showing rupture: (a) OCT slices showing plaque rupture, (b) matching grayscale IVUS, possible rupture identified site, (c) segmented OCT, (d) angiography, and (e) colors used in (c)

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Fig. 2

Merging VH-IVUS and OCT for more accurate cap thickness quantification (calcification ignored in this plot): (a) VH-IVUS slice, (b) contours directly from VH-IVUS showing zero cap thickness, (c) VH-IVUS contours with a thin cap added, (d) matching OCT Slice, (e) contours from OCT showing accurate cap thickness, and (f) IVUS+OCT has entire vessel with accurate cap thickness

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Fig. 3

IVUS and OCT segmentation, merging, and 3D reconstruction process. Slice numbers are original VH-IVUS numbers (referred to as S1–S9 in the rest of the paper): (a) selected IVUS slices, (b) matching OCT slices and segmented contours, (c) IVUS and OCT combined, after smooth (IVUS + OCT model), and (d) reconstructed 3D geometry.

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Fig. 4

Three-dimensional vessel curvature reconstructed from biplane angiography: (a) reconstructed 3D curvature, (b) 3D vessel geometry with nine IVUS+OCT slices marked, (c) a angiography frame showing IVUS guidewire, and (d) vessel center line. The red part is the selected 86 slices: s50–s135 (color figure displayed online).

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Fig. 5

Bar plots of mean, maximum and minimum slice cap thickness show differences from IVUS + OCT, IVUS50, and IVUS180 sets. Unit: mm. Mean cap thickness and max cap thickness are average of slice values. Min cap thickness is min of slice min cap thickness. 2P min average is the patient min cap thickness average: (a) patient 1 (nine slices), (b) patient 2 (18 slices), and (c) P1 and P2 combined (27slices).

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Fig. 6

Stress distribution on lumen and cross section cuts showing differences from IVUS + OCT and IVUS50 models of patient 1. Bar plots of mean, maximum, and minimum cap stress are showing differences from IVUS + OCT, IVUS50 and IVUS180 models of two patients. Mean cap stress and min cap stress are average of cap values. Max cap stress is max of max slice cap stresses: (a) P1, IVUS + OCT model, stress distribution on lumen, (b) P1, IVUS50 model, stress distribution on lumen, (c) P1, IVUS + OCT model, stress on cross sections, (d) P1, IVUS50 model, stress on cross sections, (e) P1, cap stress (kPa), and (f) P2, cap stress (kPa).

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Fig. 7

Strain distribution on lumen and cross section cuts showing differences from IVUS + OCT and IVUS50 models of patient 1. Bar plots of mean, maximum and minimum cap strain showing differences from IVUS + OCT, IVUS50, and IVUS180 models of two patients. Mean cap strain and min cap strain are average of cap values. Max cap strain is max of max slice cap strain values: (a) P1, IVUS+OCT model, stress distribution on lumen, (b) P1, IVUS50 model, stress distribution on lumen, (c) P1, IVUS+OCT model, stress on cross sections, (d) P1, IVUS50 model, stress on cross sections, (e) P1, cap strain (kPa), and (f) P2, cap strain (kPa).

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Fig. 8

Fluid maximum shear stress (FSS) distribution on lumen and cross section cuts showing differences from IVUS + OCT and IVUS50 models of patient 1. Bar plots of mean, maximum, and minimum cap FSS showing differences from IVUS + OCT, IVUS50, and IVUS180 models of two patients. Mean cap FSS and min cap FSS are average of cap values. Max cap FSS is max of max slice cap FSS values: (a) P1, IVUS + OCT model, FSS distribution on lumen, (b) P1, IVUS50 model, FSS distribution on lumen, (c) P1, IVUS + OCT model, FSS on cross sections (dyn/cm2), (d) P1, IVUS50 model, stress on cross sections (dyn/cm2), (e) P1, FSS, and (f) P2, FSS.

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