{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T21:08:19Z","timestamp":1783717699102,"version":"3.55.0"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2012,1]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Recent studies show that virtual histology intravascular ultrasound (VH-IVUS) can identify plaques at high risk of rupture, such as thin-capped fibroatheromata, raising the possibility of immediate targeted intervention. However, plaque classification entails border recognition and subjective assessment of plaque architecture, introducing inter-observer variability without confirmation by core-labs. Furthermore, the accuracy of local versus core-laboratory VH-IVUS plaque classification and effects of different plaque definitions have not been examined.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>Local observers classified 100 VH-IVUS-defined coronary plaques to determine single center inter-observer variability; multi-center variability was determined by comparison with VH-IVUS core-laboratory analysis, and compared with gray-scale IVUS. Frequency of plaque types using different published plaque definitions also was determined. Single-center VH-IVUS inter-observer agreement was strong (kappa=0.86), but lower for thin-capped fibroatheromatas (k=0.59) because of observer judgments on presence and location of confluent necrotic core. Multi-center inter-observer agreement for plaque classification was lower again (k=0.71), particularly for thin-capped fibroatheromatas (k=0.56). Different plaque definitions further reduced VH-IVUS-defined thin-capped fibroatheromata numbers by 44%. The diagnostic accuracy of gray-scale IVUS to identify thin-capped fibroatheromata was poor for both observers (21 and 29% correct), with low inter-observer agreement (k=0.14).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>VH-IVUS plaque classification, and particularly VH-IVUS-defined thin-capped fibroatheromata identification, varies significantly between local observers, and particularly in comparison with core-laboratory analysis. Differences in VH-IVUS plaque definitions introduce further variability between studies. These factors reduce the use of VH-IVUS plaque classification to guide intervention in a \u201clive\u201d clinical setting, and also affect comparison of diagnostic accuracy and natural history of plaques between studies.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.111.965442","type":"journal-article","created":{"date-parts":[[2011,11,23]],"date-time":"2011-11-23T06:45:15Z","timestamp":1322030715000},"page":"86-93","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Identification of Coronary Plaque Sub-Types Using Virtual Histology Intravascular Ultrasound Is Affected by Inter-Observer Variability and Differences in Plaque Definitions"],"prefix":"10.1161","volume":"5","author":[{"given":"Daniel R.","family":"Obaid","sequence":"first","affiliation":[{"name":"From the Division of Cardiovascular Medicine (D.R.O., P.A.C., M.R.B.), University of Cambridge; Papworth Hospital NHS Foundation Trust (D.R.O., P.A.C., D.M., N.E.J.W.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick A.","family":"Calvert","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Medicine (D.R.O., P.A.C., M.R.B.), University of Cambridge; Papworth Hospital NHS Foundation Trust (D.R.O., P.A.C., D.M., N.E.J.W.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duncan","family":"McNab","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Medicine (D.R.O., P.A.C., M.R.B.), University of Cambridge; Papworth Hospital NHS Foundation Trust (D.R.O., P.A.C., D.M., N.E.J.W.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick E.J.","family":"West","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Medicine (D.R.O., P.A.C., M.R.B.), University of Cambridge; Papworth Hospital NHS Foundation Trust (D.R.O., P.A.C., D.M., N.E.J.W.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin R.","family":"Bennett","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Medicine (D.R.O., P.A.C., M.R.B.), University of Cambridge; Papworth Hospital NHS Foundation Trust (D.R.O., P.A.C., D.M., N.E.J.W.)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199705013361802"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198405033101801"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.ATV.20.5.1262"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000035654.18341.5E"},{"key":"e_1_3_3_6_2","first-page":"113","article-title":"Automated coronary plaque characterisation with intravascular ultrasound backscatter: ex vivo validation","volume":"3","author":"Nair A","year":"2007","unstructured":"Nair A, Margolis MP, Kuban BD, Vince G . 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