DETECTION OF INTRALESIONAL CALCIUM BY INTRACORONARY ULTRASOUND DEPENDS ON THE HISTOLOGIC PATTERN

This study was designed to examine the accuracy of intravascular ultrasound in detecting different histologic types of calcium pattern in human coronary artery atherosclerotic lesions. Previous studies have shown that calcium deposits in atherosclerotic lesions may occur in various forms and that intravascular ultrasound is a sensitive technique to detect calcium in atherosclerotic lesions. However, them has been no distinction between varying image representations of calcium and different histologic patterns of intralesional calcific deposits. Calcific lesions have an important clinical impact on the outcome of intracoronary transcatheter therapy, and the varying types of calcium may also play a role in the guidance of intracoronary interventions. Fifty fresh coronary vessel segments were studied by intracoronary ultrasound imaging and the images compared with the corresponding histologic sections. With intracoronary ultrasound imaging, calcium was defined as bright echo with corresponding sharp edged shadowing in the distal field. Three different histologic types of calcification were defined, and the sensitivity and specificity of the detection by intravascular ultrasound were determined for each type. Dense calcified plaques (type 1) were found in 18 cases, microcalcification (small flecks of calcium) with single calcium fleck size less than or equal to 0.05 mm (type 2) in 12 cases, and combination of calcified plaque surrounded by small calcium flecks (type 3) in 3 cases. In 17 (34%) coronary vessel segments, histologic analysis detected no calcium. Intracoronary ultrasound correctly detected 16 (89%) of 18 cases of type 1 calcification, 2 (17%) of 12 type 2, and all 3 (100%) type 3. Sensitivity for detection of type 1 and 3 calcification was 90%, with specificity of 100%. Including type 2 calcification, sensitivity was only 64%; specificity was 100%. We conclude that intracoronary ultrasound is able to detect dense, coherent calcified deposits with high sensitivity and specificity, but is limited in visualizing accumulations of microcalcification. This may be an important distinction with respect to guidance of intracoronary interventions in calcified coronary lesions.