Columbia University

OCT utilization: Summary statistics from the LightLab clinical initiative

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Objectives The study describes the evolution of optical coherence tomography (OCT) adoption and performance during percutaneous coronary intervention (PCI) following implementation of a standardized LightLab (LL) workflow. Background The purpose of the LL Clinical Initiative was to evaluate the impact of a standardized workflow on physician efficiency, decision making, and image quality. Methods The LL Clinical Initiative is a multicenter, prospective, observational clinical program. Data were collected from 48 physicians at 17 U.S. centers from 01/21/19 to 06/08/21. The study included 401 OCT-guided PCIs during the baseline phase and 1898 during the LL workflow phases. The baseline phase consisted of physicians utilizing OCT at their discretion. After completing the baseline phase, the workflow progressed through multiple phases culminating in the expansion phase, which focused on addressing greater procedural complexity. The LL workflow utilized OCT to assess plaque Morpholog...

Combining IVUS + OCT Data, Biomechanical Models and Machine Learning Method for Accurate Coronary Plaque Morphology Quantification and Cap Thickness and Stress/Strain Index Predictions

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Assessment and prediction of vulnerable plaque progression and rupture risk are of utmost importance for diagnosis, management and treatment of cardiovascular diseases and possible prevention of acute cardiovascular events such as heart attack and stroke. However, accurate assessment of plaque vulnerability assessment and prediction of its future changes require accurate plaque cap thickness, tissue component and structure quantifications and mechanical stress/strain calculations. Multi-modality intravascular ultrasound (IVUS), optical coherence tomography (OCT) and angiography image data with follow-up were acquired from ten patients to obtain accurate and reliable plaque morphology for model construction. Three-dimensional thin-slice finite element models were constructed for 228 matched IVUS + OCT slices to obtain plaque stress/strain data for analysis. Quantitative plaque cap thickness and stress/strain indices were introduced as substitute quantitative plaque vulnerability indi...

Image Analytic Tools for Optical Coherence Tomography Tissue Characterization and Robust Learning (Thesis)

The computer-aided analysis is poised to play an increasingly prominent role in medicine and healthcare. Benefiting from the increasing computing power, various machine learning frameworks have been developed in the biomedical field, bringing significant improvements in real-world clinical applications. However, for many diseases, the development of these life-supporting algorithms is still in its infancy. To bridge this gap: This thesis is dedicated to the development of efficient algorithms for better image intervention and addressing data quality challenges in machine learning algorithms to provide direct guidance for real-world clinical applications. With the above goals, three topics are explored in depth. First, we develop a novel tissue analysis framework for cardiac substrate identification and tissue heterogeneity assessment. In particular, we creatively used model uncertainty to measure tissue structure information, offering a means of extracting the tissue heterogen...

Optical Coherence Tomography Angiography (OCTA) Findings in Retinitis Pigmentosa

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Optical coherence tomography angiography (OCTA) is a noninvasive new imaging modality that can be used to diagnose and monitor progression of retinitis pigmentosa (RP). Cohorts and case series have shown correlation between OCTA findings and visual function and disease severity. Although an early use of the technology is promising, there are concerns about segmentation errors and artifacts. There is also a paucity of data on genotype and how that correlates with OCTA findings. Despite its limitations, OCTA remains a useful tool for clinicians managing retinitis pigmentosa patients. ( Read Full Article )

Human Coronary Plaque Optical Coherence Tomography Image Repairing, Multilayer Segmentation and Impact on Plaque Stress/Strain Calculations

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Coronary vessel layer structure may have a considerable impact on plaque stress/strain calculations. Most current plaque models use single-layer vessel structures due to the lack of available multilayer segmentation techniques. In this paper, an automatic multilayer segmentation and repair method was developed to segment coronary optical coherence tomography (OCT) images to obtain multilayer vessel geometries for biomechanical model construction. Intravascular OCT data were acquired from six patients (one male; mean age: 70.0) using a protocol approved by the local institutional review board with informed consent obtained. A total of 436 OCT slices were selected in this study. Manually segmented data were used as the gold standard for method development and validation. The edge detection method and cubic spline surface fitting were applied to detect and repair the internal elastic membrane (IEM), external elastic membrane (EEM) and adventitia-periadventitia interface (ADV). The mean...

Distinguishing Healthy From Glaucomatous Eyes With Optical Coherence Tomography Global Circumpapillary Retinal Nerve Fiber Thickness in the Bottom 5th Percentile

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Précis: Two novel, quantitative metrics, and 1 traditional metric were able to distinguish between many, but not all healthy and glaucomatous eyes in the bottom 5th percentile of global circumpapillary retinal nerve fiber layer ( cpRNFL ) thickness. Purpose: To test the hypothesis that objective optical coherence tomography measures can distinguish between a healthy control with global cpRNFL thickness within the lower 5% of normal and a glaucoma patient with an equivalent cpRNFL thickness. Patients and Methods: A total of 37 healthy eyes from over 700 normative eyes fell within the bottom 5th percentile in global cpRNFL thickness. The global cpRNFL thickness of 35 glaucomatous eyes from 188 patients fell within the same range. For the traditional methods, the global cpRNFL thickness percentile and the global ganglion cell layer (GCL) thickness percentile for the central ±8 degrees, were calculated for all 72 eyes. For the novel cpRNFL method, the normalized root mean ...

Optical coherence tomography versus angiography and intravascular ultrasound to guide coronary stent implantation: A systematic review and meta-analysis

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Background: Optical coherence tomography (OCT) is an adjunct to angiography-guided coronary stent placement. However, in the absence of dedicated, appropriately powered randomized controlled trials, the impact of OCT on clinical outcomes is unclear. Objective: To conduct a systematic review and meta-analysis of all available studies comparing OCT-guided versus angiography-guided and intravascular ultrasound (IVUS)-guided coronary stent implantation. Methods: MEDLINE and Cochrane Central were queried from their inception through July 2022 for all studies that sought to compare OCT-guided percutaneous coronary intervention (PCI) to angiography-guided and IVUS-guided PCI. The primary endpoint was minimal stent area (MSA) compared between modalities. Clinical endpoints of interest were all-cause and cardiovascular mortality, major adverse cardiovascular events (MACE), myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thro...

Coronary morphological features in women with non-ST-segment elevation MINOCA and MI-CAD as assessed by optical coherence tomography

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Aims We aimed to use optical coherence tomography (OCT) to identify differences in atherosclerotic culprit lesion morphology in women with myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) compared with MI with obstructive coronary artery disease (MI-CAD). Methods and results Women with an OCT-determined atherosclerotic aetiology of non-ST segment elevation (NSTE)-MINOCA (angiographic diameter stenosis <50%) who were enrolled in the multicentre Women’s Heart Attack Research Program (HARP) study were compared with a consecutive series of women with NSTE-MI-CAD who underwent OCT prior to coronary intervention at a single institution. Atherosclerotic pathologies identified by OCT included plaque rupture, plaque erosion, intraplaque haemorrhage (IPH, a region of low signal intensity with minimum attenuation adjacent to a lipidic plaque without fibrous cap disruption), layered plaque (superficial layer with clear demarcation from the underlying plaque in...

Long-term outcomes of patients with normal fractional flow reserve and thin-cap fibroatheroma

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Background: The long-term prognostic implications of fractional flow reserve (FFR)-negative lesions hosting vulnerable plaques remain unsettled. Aims: The aim of this study was to evaluate the association of non-ischaemic lesions hosting optical coherence tomography (OCT)-detected thin-cap fibroatheromas (TCFA) with first and recurrent cardiovascular events during follow-up up to 5 years in a diabetes mellitus (DM) patient population. Methods: COMBINE OCT-FFR is a prospective, international, double-blind, natural history study. Patients with DM and with ≥1 FFR-negative lesion were classified into 2 groups based on the presence or absence of ≥1 TCFA lesion. The primary endpoint (PE) is a composite of cardiac mortality, target vessel-related myocardial infarction (TV-MI), clinically driven target lesion revascularisation (TLR), or unstable angina (UA) requiring hospitalisation during follow-up up to 5 years. Results: Among 390 DM patients (age 67.5±9 years; 37% female) wi...

Optical coherence tomography holds promise to transform the diagnostic anatomic pathology gross evaluation process

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Significance : Real-time histology can close a variety of gaps in tissue diagnostics. Currently, gross pathology analysis of excised tissue is dependent upon visual inspection and palpation to identify regions of interest for histopathological processing. Such analysis is limited by the variable correlation between macroscopic and microscopic findings. The current standard of care is costly, burdensome, and inefficient. Aim : We are the first to address this gap by introducing optical coherence tomography (OCT) to be integrated in real-time during the pathology grossing process. Approach : This is achieved by our high-resolution, ultrahigh-speed, large field-of-view OCT device designed for this clinical application. Results : We demonstrate the feasibility of imaging tissue sections from multiple human organs (breast, prostate, lung, and pancreas) in a clinical gross pathology setting without interrupting standard workflows. Conclusions : OCT-based real-time histology evaluation hol...

Columbia University Receives NIH Grant for Reconstruction of three-dimensional organ of Corti micromechanical motion patterns via optical coherence tomography

Columbia University Received a 2022 NIH Grant for $46,752 for Reconstruction of three-dimensional organ of Corti micromechanical motion patterns via optical coherence tomography. The principal investigator is Brian Frost. Below is a summary of the proposed work. Optical coherence tomography (OCT) is used in cochlear mechanics research to image and measure vibrations in the organ of Corti complex (OCC), the sensory tissue that spirals within the cochlea. OCT can be used to measure sub-nanometer vibrations at many points along the optical axis simultaneously. However, this optical axis does not generally bear a straightforward relation to the anatomy of the cochlea. This results in two ambiguities: 1) the measured motion is a projection of the true three- dimensional motion onto an axis that is not anatomically important, and 2) the relative locations of measured structures are known only along the optical axis, which is not sufficient to relate the structures anatomically. This resul...

Frequency of Optical Coherence Tomography Testing to Detect Progression in Glaucoma

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Purpose: To investigate the time to detect progression in glaucomatous eyes using different optical coherence tomography (OCT) test intervals. Methods: Participants with manifest glaucoma from the African Descent and Glaucoma Evaluation Study (ADAGES), a multicenter, prospective, observational cohort study, were included. A total of 2,699 OCT tests from 171 glaucomatous and 149 normal eyes of 182 participants, with at least 5 tests and 2 years of follow-up, were analyzed. Computer simulations (n=10,000 eyes) were performed to estimate time to detect progression of global circumpapillary retinal nerve fiber layer thickness (cpRNFL) measured with OCT tests. Simulations were based on different testing paradigms (every 4, 6, 12 and 24 mo) and different rates of change (µm/year). Time to detect significant progression (P<0.05) at 80% and 90% power were calculated for each paradigm and rate of cpRNFL change. Results: As expected, more frequent testing resulted in shorter time to ...

Reproducibility of Neuroretinal Rim Measurements Obtained from High-Density Spectral Domain Optical Coherence Tomography Volume Scans

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Purpose: To compare the reproducibility of two-dimensional (2D) peripapillary retinal nerve fiber layer (RNFL) thickness and three-dimensional (3D) neuroretinal rim measurements using spectral domain optical coherence tomography (SDOCT) in normal and glaucoma subjects. Methods: One eye per subject for 27 normal and 40 glaucoma subjects underwent repeat SDOCT RNFL thickness scans and optic nerve volume scans on the same day. From the volume scan, custom software calculated five neuroretinal rim parameters: 3D minimum distance band (MDB) thickness, 3D MDB area, 3D rim volume, 2D rim area, and 2D rim thickness. Within-subject variance (Sw), coefficient of variation (CV), and intraclass correlation coefficient (ICC) were analyzed. Results: MDB thickness and RNFL thickness have similar reproducibility among normal and glaucoma subjects (eg, global MDB thickness CVs of 2.4% and 3.6%, and global RNFL thickness CVs of 1.3% and 2.2%; P > 0.05 for both comparisons). Reproducibility of MDB ...

Columbia University Receives NIH Grant for Multidimensional OCT Imaging Enabled by Compressed Sensing

Columbia University Received a 2022 NIH Grant for $76,932 for Multidimensional OCT Imaging Enabled by Compressed Sensing. The principal investigator is Christine Hendon. Below is a summary of the proposed work. Recent advances in the temporal speed and resolution of optical coherence tomography (OCT) imaging systems have opened the door for new possibilities in time-lapse imaging of dynamic biological processes and imaging samples with large surface area with micron scale resolution. Both spectral domain OCT (SD-OCT) and swept source OCT (SS-OCT) systems frequently boast a-line rates well above 100 kHz and as high as 400 kHz. The consequence of higher scan-rates is reduced motion artifacts and also higher data through-put. Modern endoscopic OCT system are proposing scan-rates that result in data rates upwards of 1GB/s. This approaches the data transfer rate and write speeds of modern PCs. Compressing this data at acquisition would have a massive impact on these specific challenges....

Correlation of Diabetic Disease Severity to Degree of Quadrant Asymmetry in En Face OCTA Metrics

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Purpose: To determine if diabetic retinopathy (DR) severity affects quadrant asymmetry (QA) of optical coherence tomography angiography (OCTA) metrics differentially. Methods: Ninety eyes (60 patients) with no diabetes mellitus (DM) (n = 39) or varying levels of DR (n = 51) had OCTA images (3 × 3 mm, Cirrus5000) acquired five times and averaged. The vessel length density (VLD) and perfusion density (PD) of the superficial retinal layer (SRL) and deep retinal layer (DRL) were measured. QA was defined as the maximum minus minimum value among four parafoveal Early Treatment Diabetic Retinopathy quadrants, and compared with DR severity by linear regression including fixed effects for each individual and eye. Results: The mean patient age was 55.5 years (range, 24-88 years) and 60% were male. Comparing severe nonproliferative DR or proliferative DR versus no DM/DR eyes, QA was significantly higher for SRL VLD, and PD (+0.67 ± 0.16 and +0.014 ± 0.003; P < 0.001) and...


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