International Circulation：Imaging is the key point to successful PCI， such as IVUS， VH-IVUS， OCT and NIRS， controversy remain in which is better to guide PCI. According to your experiences， which is the right technology in different clinical conditions?

　　《国际循环》：IVUS、VH-IVUS、OCT及NIRS等技术层出不穷，用哪种影像技术指导下的PCI更好，临床一直存在争论。依据您多年的经验，您认为这些技术分别适合在何种情况下应用？

　　Dr. Mintz: It is not a simple question to answer. The first thing to realize is that even though you listed 4 technologies there are 2 fundamental technologies， IVUS based or OCT based. So VH-IVUS is really IVUS with radiofrequency tissue characterization and near infrared spectroscopy， NIRS is combined with IVUS so we are really talking about IVUS versus OCT. When you are guiding stent implantation， the goal is to get the best possible stent result so it may not be really whether IVUS is better or OCT is better but the fact that either of them is better than angiography alone. That said， if you look at the available data there are probably 25 studies comparing IVUS with angiography alone， and only 1 study comparing OCT with angiography alone. The combined IVUS studies probably include more than 30，000 patients and the Meta analyses， of which there are 4， indicate that IVUS guidance improves outcomes compared to angiography alone. As far as OCT， the one small study in only several hundred patients shows the same thing. Right now there are no IVUS versus OCT comparative studies but I suspect that they are roughly equivalent in that kind of study. So the issue is not IVUS versus OCT， the issue is that you should probably use one of those two techniques rather than just angiography alone.

　　Mintz教授：这不是一个容易回答的简单问题。首先，我们需要知道尽管列举了4项技术，实际上只有两项基础性技术，那就是基于IVUS的技术或是基于OCT的技术。实际上VH-IVUS就是具有组织射频特征的IVUS，近红外光谱（NIRS）则可与IVUS联用，因此我们实际上谈论的是IVUS与OCT的对比。就指导支架置入而言，我们的目标是尽可能获得最好的支架结局。因此，我们需要探讨的不是IVUS与OCT何者更好，而是这两者中的其中之一与血管造影联用是否优于单纯应用血管造影。从现有数据来看，大概有25项有关IVUS与血管造影联用与单纯应用血管造影的对比研究，有一项有关OCT与血管造影联用与单纯应用血管造影的对比研究。其中有关联用IVUS的研究大概共计入选3万余例患者，其中4项荟萃分析提示，与单纯应用血管造影相比，选择IVUS指导支架植入能改善患者结局。就OCT而言，仅有的一项对比研究入选数百例患者，结果显示，与单纯应用血管造影相比，选择OCT指导支架植入可改善患者结局。现在尚无有关IVUS与OCT的对比研究，但我猜想两者的效果应该是相当的。因此，现在的问题不是到底选择IVUS还是OCT，而是我们应尽可能从两种者选择一种与血管造影联用而非是仅仅行血管造影。

　　International Circulation：There could be bias in imaging assessment， or some rare clinical phenomenon such as spontaneous dissection and calcified nodule. Could you please introduce some successful experiences to make it more accurate?

　　《国际循环》：当然，很多时候影像学检查也会出现偏差，或者一些临床不太常见的现象，如自发夹层、钙化结节等。在您的中心有哪些成功的技巧和经验推荐？

　　Dr. Mintz: Well actually it is interesting. Those are 2 of the easiest things to diagnose using either IVUS or OCT. The imagining characteristics are absolutely clear and once you see 2 or 3， you know exactly what to look for. The best answer is that it takes experience. It is not hard， there are no tricks， and it is just a matter of having enough experience to recognize these 2 phenomenons， which are not that common. If you only see something once in a while obviously it can be a big surprise， but after you see several of them， then the diagnosis is usually very clear.

　　Mintz教授：实际上，这是非常有趣的。在这些需要早期诊断的现象中有两个最容易的可采用IVUS或OCT来发现。这些现象的影像学特征绝对是非常清楚的，一旦你看到存在两个或三个特征，就可以知道可能会发现些什么。最佳答案就是它需要经验。其实，要想发现这两种不常见的现象并不难，没有什么技巧，只是需要具备足够的经验。如果你仅仅是偶尔发现上述现象，可能对你来说是个很大的惊喜。但是，你当看到过几次后，通常就能很清楚地作出诊断。