Optimisation of post-mortem cardiac computed tomography compared to optical coherence tomography and histopathology – Technical note

Abstract

Dear Sir/Madam, It is with interest that we read the recently published technical note from Precht et al. We agree with the authors that minimally invasive techniques hold considerable potential to enhance current imaging approaches to the post-mortem assessment of coronary artery disease. We have previously reported an intact cadaveric approach for minimally invasive post-mortem computed tomography coronary angiography (PMCTA) validated against histology [1]. Developing on this system we described the first use of post-mortem coronary optical coherence tomography virtual-histology in our intact cadaveric model [2]. Extending the use of these approaches holds the potential to substantially enhance the information obtained from PMCTA by providing a much higher resolution 3-dimensional geometry of cadaveric coronary arteries in healthy and diseased subjects. Whilst PMCTA can be used to assess coronary artery calcification and lumenal topography at low resolution, many of the coronary events leading to death, such as atherosclerotic plaque rupture or coronary artery dissection, are not visible using PMCTA alone. Inadequate resolution of coronary imaging is therefore a major limitation of current minimally invasive autopsy approaches. Optical coherence tomography (OCT) is a tool that can provide high-resolution images (10–20 μm) of the coronary vessel wall. It is increasingly used clinically to characterise atherosclerosis and the response to pharmacological and invasive treatments. We and others have been previously demonstrated that OCT can provide novel insights into the mechanisms of clinical presentation, disease progression and response to intervention [3]. In particular OCT enables the clear identification of thin-capped fibroatheroma, including areas of plaque rupture, the process that leads to coronary thrombosis and potentially myocardial infarction. The ability to investigate coronary virtual histology without recourse to the invasive (and potentially tissue distorting), time consuming and relatively costly process of coronary sectioning and histological slide preparation is also a substantial potential advance. Translating and validating these techniques into a practical and deliverable new approach to autopsy practice is a primary challenge for future research in this area.