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Comparative Study
. 2018 Dec 17;13(12):e0209110.
doi: 10.1371/journal.pone.0209110. eCollection 2018.

Comparison of visual assessment and computer image analysis of intracoronary thrombus type by optical coherence tomography

Timo P Kaivosoja  1 , Shengnan Liu  2 , Jouke Dijkstra  2 , Heini Huhtala  3 , Tej Sheth  4 , Olli A Kajander  1
Affiliations
Comparative Study

Comparison of visual assessment and computer image analysis of intracoronary thrombus type by optical coherence tomography

Timo P Kaivosoja et al. PLoS One. .

Abstract

Background: Analysis of intracoronary thrombus type by optical coherence tomography (OCT) imaging is highly subjective. We aimed to compare a newly developed image analysis method to subjective visual classification of thrombus type identified by OCT.

Methods: Thirty patients with acute ST elevation myocardial infarction were included. Thrombus type visually classified by two independent readers was compared with analysis using QCU-CMS software.

Results: Repeatability of the computer-based measurements was good. By using a ROC, area under curve values for discrimination of white and red thrombi were 0.92 (95% confidence intervals (CI) 0.83-1.00) for median attenuation, 0.96 (95% CI 0.89-1.00) for mean backscatter and 0.96 (95% CI 0.89-1.00) for mean grayscale intensity. Median attenuation of 0.57 mm-1 (sensitivity 100%, specificity 71%), mean backscatter of 5.35 (sensitivity 92%, specificity 94%) and mean grayscale intensity of 120.1 (sensitivity 85%, specificity 100%) were identified as the best cut-off values to differentiate between red and white thrombi.

Conclusions: Attenuation, backscatter and grayscale intensity of thrombi in OCT images differentiated red and white thrombi with high sensitivity and specificity. Measurement of these continuous parameters can be used as a less user-dependent method to characterize in vivo thrombi. The clinical significance of these findings needs to be tested in further studies.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Examples of thrombus assessment by the QCU-CMS image analysis software in OCT image frames of two patients with white (A) and red thrombus (D).
After manual tracing of the thrombi (B,E), attenuation analysis was performed including regions with attenuation values above the designated threshold value (displayed in blue) (C,F). Accurate segmentation of the luminal border of the thrombus and the contrast-filled flow area of the vessel can be seen in C and F. *) OCT catheter, #) guidewire artefact, ¤) thrombus, §) vessel wall. OCT, optical coherence tomography.
Fig 2
Fig 2. Intra- and interobserver variability of measurement of thrombus attenuation in OCT images using image analysis software.
Scatterplot (left) and Bland-Altman plot (right) of intraobserver (A) and interobserver (B) comparison for median attenuation. OCT, optical coherence tomography; SD, standard deviation.
Fig 3
Fig 3. Relationship of thrombus attenuation score and parameters measured by image analysis software in thrombus areas in OCT images.
Scatterplots for median attenuation (A), 10th percentile of attenuation (B), mean backscatter (C), 10th percentile of backscatter (D), mean grayscale intensity (E) and 10th percentile of grayscale intensity (F). OCT, optical coherence tomography.
Fig 4
Fig 4. Receiver operating characteristic (ROC) curves of parameters determined by QCU-CMS software in prediction of thrombus type (white vs. red).
Different statistical parameters of attenuation (A), backscatter (B), grayscale intensity (C) and the ratio of 95th percentile of attenuation and median grayscale intensity (D). Perc, percentile.
See this image and copyright information in PMC

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