Intravascular Image Interpretation

Intravascular Image Interpretation

Katerina K. Naka (University of Ioannina, Greece) and Nikolaos D. Papamichael (University of Ioannina, Greece)
DOI: 10.4018/978-1-61350-095-8.ch002
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Intravascular ultrasound (IVUS) is an imaging modality often used as a supplement to coronary angiography and allows accurate assessment of the lumen, vessel wall, and atherosclerotic plaque. A coherent interpretation of the IVUS images requires identification of the image artefacts that emerge during IVUS interrogation and can often be quite difficult. This chapter describes the morphologic appearance of the structures seen in IVUS, presents the morphologic characteristics of the different types of plaque, and summarizes the nomenclature and definitions used during IVUS interpretation. Moreover, it focuses on the quantitative analysis and reports the measurements obtained during IVUS processing. Finally, it presents some of the clinical (e.g. assessment of the extent and severity of a lesion, treatment planning) and research (e.g. evaluation of atherosclerotic progression/regression, transplant vasculopathy, peripheral arterial disease) applications of this modality aiming to highlight its value in the clinical and research arena.
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Coronary angiography is the principal imaging modality used to assess coronary vessel anatomy and morphology. However, despite the broad implementation and the unanimous acceptance of this technique for the evaluation of the extent and severity of coronary artery disease, it is well known that it has limited ability in assessing the atherosclerotic disease process as the obtained two-dimensional images cannot accurately depict the complex three-dimensional anatomy of the vessel and cannot give any information regarding the type of the plaque and its burden (Mintz et al., 2001). To address these limitations, Intravascular Ultrasound (IVUS) was introduced that provides high resolution cross-sectional imaging of the vessel which permits identification of the lumen, the plaque and the outer vessel wall and accurate evaluation of the plaque burden. Several studies have confirmed that IVUS is safe and thus today it is often used in clinical practice as a complementary to coronary angiography tool (Di Mario et al., 1998; Hausmann et al., 1995). IVUS appears to be useful in assessing the severity of ambiguous lesions and guiding complex percutaneous coronary interventions (PCIs). In addition, is it also valuable in research and has been implemented in a number of studies that examined the impact of several interventional and non-interventional treatments on the evolution of the atherosclerotic process (Schoenhagen et al., 2006). The present chapter focuses on the interpretation of IVUS images and discusses some of the clinical and research applications of this technique.

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