Monday, November 17, 2008

Getting to the heart of the matter: seeing arteries in 3-D

OFDI fly-through view of patient's right coronary artery, white arrowheads indicate area of lipid deposits

It may look like an optical illusion, but these images are from a real human coronary artery. A new optical imaging device developed at the Wellman Center for Photomedicine at Massachusetts General Hospital is taking us to places inside the human body once thought unimaginable.

In their report in the journal JACC: Cardiovascular Imaging, the research team describes how their tiny, one of a kind device uses a probe smaller than a human hair to navigate into an actual artery. Using a technology called optical frequency-domain imaging (OFDI), the probe moves at 100 revolutions per second, and gives three-dimensional, microscopic views of patients’ coronary arteries. For the first time ever, doctors are able to see dangerous inflammation and plaque buildup that can cause heart attacks.

"This is the first human demonstration of a technique that has the potential to change how cardiologists look at coronary arteries," says Gary Tearney, MD, PhD, of the Mass General Pathology Department and the Wellman Center for Photomedicine, the study’s lead author. "The wealth of information we can now obtain will undoubtedly improve our ability to understand coronary artery disease and may allow cardiologists to treat plaque before it leads to serious problems."

Tearney’s study enrolled three patients whose detailed images reveal features associated with the type of atherosclerotic plaque that are likely to rupture and cause a heart attack. The dramatic "fly-through" views also expose calcium deposits, cells that could indicate inflammation and detailed views of the stents. With this level of detail and visibility, clinicians would be able to see how well a stent is accepted by the body.

Tearney and his team note that these findings need to be duplicated in a larger group of patients, and the time required to process the "fly-through" images - currently several hours - needs to be reduced to provide the real-time information most useful for clinicians.

"While more work remains, the technology is advancing at a rapid pace. We expect to see commercial devices available in a one to two year time frame," says Brett Bouma, PhD, of the Wellman Center, senior author of the report. "Our goal now is to help put the pieces in place to ensure that this technique will be widely available to interventional cardiologists." The team is currently enrolling patients with coronary artery disease who undergo coronary cauterization for another clinical trial.

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