  Thin-cap fibroatheroma (TCFA) and plaque rupture have been recognized as the
most frequent risk factor for thrombosis and acute coronary syndrome.
Intravascular optical coherence tomography (IVOCT) can identify TCFA and assess
cap thickness, which provides an opportunity to assess plaque vulnerability. We
developed an automated method that can detect lipidous plaque and assess
fibrous cap thickness in IVOCT images. This study analyzed a total of 4,360
IVOCT image frames of 77 lesions among 41 patients. To improve segmentation
performance, preprocessing included lumen segmentation, pixel-shifting, and
noise filtering on the raw polar (r, theta) IVOCT images. We used the
DeepLab-v3 plus deep learning model to classify lipidous plaque pixels. After
lipid detection, we automatically detected the outer border of the fibrous cap
using a special dynamic programming algorithm and assessed the cap thickness.
Our method provided excellent discriminability of lipid plaque with a
sensitivity of 85.8% and A-line Dice coefficient of 0.837. By comparing lipid
angle measurements between two analysts following editing of our automated
software, we found good agreement by Bland-Altman analysis (difference 6.7+/-17
degree; mean 196 degree). Our method accurately detected the fibrous cap from
the detected lipid plaque. Automated analysis required a significant
modification for only 5.5% frames. Furthermore, our method showed a good
agreement of fibrous cap thickness between two analysts with Bland-Altman
analysis (4.2+/-14.6 micron; mean 175 micron), indicating little bias between
users and good reproducibility of the measurement. We developed a fully
automated method for fibrous cap quantification in IVOCT images, resulting in
good agreement with determinations by analysts. The method has great potential
to enable highly automated, repeatable, and comprehensive evaluations of TCFAs.
