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Intravascular ultrasound (IVUS) remains the gold standard for, precise, high-quality visualization of atherosclerotic plaque on the vessel wall.1 Conventional grey-scale IVUS provides unique insights into the underlying substrate of atherosclerotic disease, and classical studies have demonstrated that plaque echogenicity correlated with its histological composition. However, despite its ability to provide direct insight on plaque composition, grey-scale IVUS has been unable to identify vulnerable plaques.2 The reason for this appears to be multifaceted. First, the current resolution of the technique is unable to define some subtle characteristics of these plaques, including the thickness of the fibrous cap. Secondly, ‘thrombotic-prone’ plaques have several pathological substrates apart from the classical ‘vulnerable plaque’ (i.e. thin cap fibroateroma) and, phenotypically, constitute a moving target. Thirdly, further accuracy to identify better the distinct histological components of atherosclerotic plaques with IVUS is clearly required.Some technological developments have attempted to overcome the limitations of conventional IVUS to elucidate plaque components.2–6 All of them rely on sophisticated mathematical analyses of the raw radiofrequency signal, aim to obtain real-time clinically meaningful tissue characterization, and provide a “ rainbow ” of appealing colours encoding different plaque components.2–6 Direct use of radiofrequency data avoids signal alterations induced by automated processing and gain adjustments.Integrated backscatter IVUS (IB-IVUS) uses the fast Fourier transformation to analyse frequencies within the signal and provides colour-coded tissue maps of plaque components (lipid, fibrous, and calcified) enabling tissue characterization with a good correlation with histological and angioscopic findings.3 Some provocative preliminary studies have even suggested that IB-IVUS may allow the detection of changes in plaque characteristics induced by lipid-lowering drugs and could also help to predict future coronary events.2,4 Alternative modalities of tissue characterization, namely wavelet analysis of radiofrequency signals, have also been validated to … *Corresponding author. Email: falf{at}hotmail.com

Intravascular ultrasound tissue characterization. I like the rainbow but... what's behind the colours?