Carotid plaque vulnerability assessment by microscopic morphology analysis, ultrasound and 3D model reconstruction

Abstract

Research suggests that plaque morphology plays a crucial role in determining plaque vulnerability. However the relationship between plaque morphology and rupture is still not clearly understood due to the limited information of plaque morphology. The aim of this study is to improve our understanding of the relationship between plaque morphology and rupture, and to use this to predict the risk of plaque rupture from the morphology at the molecular level. This can enable the identification of culprit lesions in clinical situations for assessing plaque rupture risk. Histological assessments were carried out on 18 carotid plaque specimens. The 3-D collagen, lipid and macrophage distributions along the entire length of the plaque were analysed in both ruptured and non-ruptured symptomatic plaques. In addition, plaque morphology on the rupture sites were examined and compared with the surrounding regions. It was found that ruptured plaques had thinner fibrous caps and larger lipid cores compared to non-ruptured plaques. Also, ruptured plaques had lower collagen content compared to non-ruptured plaques, and higher collagen contents upstream compared to downstream region from the plaque throat. At the rupture site there was lower collagen content, and a larger lipid core thickness behind a thin fibrous cap compared with the mean for the longitudinally adjacent and circumferential regions. Macrophage cells were located nearer to the boundary of the luminal wall in ruptured plaques. For both groups, the area occupied by macrophages is greater at the upstream shoulder of the plaque. There is a positive correlation between macrophage area and lipid core area, a negative correlation between macrophage area and collagen content, and between lipid core size and collagen content for both plaque groups. 3D reconstruction of ex-vivo specimens of carotid plaques were carried out by a combined analysis of US imaging and histology. To reconstruct accurate 3D plaque morphology, the non-linear tissue distortion in histological images caused by specimen preparation was corrected by a finite element (FE) based deformable registration procedure. This study shows that it is possible to generate a 3D patient specific plaque model using this method. In addition, the study also quantitatively assesses the tissue distortion caused by histological procedures. It shows that at least 30% tissue shrinkage is expected for plaque tissues. The histology analysis result was also used to evaluate ultrasound (US) tissue characterization accuracy. An ex-vivo 2D ultrasound scan set-up was used to obtain serial transverse images through an atherosclerotic plaque. The different plaque component region obtained from ultrasound images was compared with the associated histology result and photograph of the sections. Plaque tissue characterisation using ex-vivo US can be performed qualitatively, whereas lipid core assessment from ultrasound scan can be semi-quantitative. This finding combined with the negative correlation between lipid core size and collagen content, suggests the ability of US to indirectly quantify plaque collagen content. This study may serve as a platform for future studies on improving ultrasound tissue characterization, and may also potentially be used in risk assessment of plaque rupture.