The intravascular ultrasound elasticity-palpography technique revisited: a reliable tool for the in vivo detection of vulnerable coronary atherosclerotic plaques.

Critical to the detection of vulnerable plaques (VPs) is quantification of their mechanical properties. On the basis of intravascular ultrasound (IVUS) echograms and strain images, E. I. Céspedes, C. L. de Korte CL and A. F. van der Steen (Ultrasound Med Biol 2000;26:385-396) proposed an elasticity-palpography technique (E-PT) to estimate the apparent stress-strain modulus palpogram of the thick endoluminal layer of the arterial wall. However, this approach suffers from major limitations because it was developed for homogeneous, circular and concentric VPs. The present study was therefore designed to improve the E-PT by considering the anatomic shape of the VP. This improved E-PT was successfully applied to six coronary lesions of patients imaged in vivo with IVUS. Our results indicate that the mean relative error of the stress-strain modulus decreased from 61.02 ± 9.01% to 15.12 ± 12.57% when the IE-PT was used instead of the E-PT. The accuracy of the stress-strain modulus palpograms computed using the improved theoretical framework was also investigated with respect to noise, which may affect prediction of plaque vulnerability.