Diagnostic Accuracy of 320-Row Multidetector Computed Tomography Coronary Angiography to Noninvasively Assess In-Stent Restenosis

Objectives:Percutaneous coronary intervention with stent implantation is routinely performed to treat patients with obstructive coronary artery disease. However, thus far, noninvasive assessment of in-stent restenosis has been challenging. Recently, 320-row multidetector computed tomography coronary angiography (CTA) was introduced, allowing volumetric image acquisition of the heart in a single heart beat or gantry rotation. The aim of this study was to evaluate the diagnostic performance of 320-row CTA in the evaluation of significant in-stent restenosis. Invasive coronary angiography (ICA) served as the standard of reference, using a quantitative approach. Materials and Methods:The population consisted of patients with previous coronary stent implantation who were clinically referred for cardiac evaluation because of recurrent chest pain and who underwent both CTA and ICA. CTA studies were performed using a 320-row CTA scanner with 320 detector-rows, each 0.5 mm wide, and a gantry rotation time of 350 milliseconds. Tube voltage and current were adapted to body mass index and thoracic anatomy. The entire heart was imaged in a single heart beat, with a maximum of 16-cm craniocaudal coverage. During the scan, the ECG was registered simultaneously for prospective triggering of the data. First, CTA stent image quality was assessed using a 3-point grading scale: (1) good image quality, (2) moderate image quality, and (3) poor image quality. Subsequently, the presence of in-stent restenosis was determined on a stent and patient basis by a blinded observer. Significant in-stent restenosis was defined as ≥50% luminal narrowing in the stent lumen or the presence of significant stent edge stenosis. Overlapping stents were considered to represent a single stent. Results were compared with ICA using quantitative coronary angiography. In addition, CTA stent image quality and diagnostic accuracy were related to stent characteristics and heart rate during CTA image acquisition. Results:The population consisted of 53 patients (37 men, mean age: 65 ± 13 years) with a total of 89 stents available for evaluation. ICA identified 12 stents (13%) with significant in-stent restenosis. A total of 7 stents (8%) were of nondiagnostic CTA stent image quality, and were considered positive. Sensitivity, specificity, positive, and negative predictive values were 92%, 83%, 46%, and 98%, respectively on a stent basis. Five CTA studies (9%) were of nondiagnostic quality for the evaluation of in-stent restenosis and were considered positive. Sensitivity, specificity, positive, and negative predictive values were 100%, 81%, 58%, and 100%, respectively on a patient level. Stent diameter <3 mm as well as stent strut thickness ≥140 &mgr;m were associated with decreased CTA stent image quality and diagnostic accuracy. Heart rate during CTA acquisition and stent overlap were not associated with image degradation. Conclusions:The present results show that 320-row CTA allows accurate noninvasive assessment of significant in-stent restenosis. However, stents with a large diameter and thin struts allowed better in-stent visualization than stents with a small diameter or thick struts. Consequently, noninvasive assessment of in-stent restenosis using CTA may be an attractive and feasible alternative particularly in carefully selected patients.

[1]  J. Gudjónsdóttir,et al.  Diagnostic accuracy of 64-slice multidetector CT for detection of in-stent restenosis in an unselected, consecutive patient population. , 2010, European journal of radiology.

[2]  Jeroen J. Bax,et al.  Diagnostic accuracy of 320-row multidetector computed tomography coronary angiography in the non-invasive evaluation of significant coronary artery disease. , 2010, European heart journal.

[3]  Jeroen J. Bax,et al.  Assessment of global left ventricular function and volumes with 320-row multidetector computed tomography: A comparison with 2D-echocardiography , 2009, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[4]  M. Schneider-Kolsky,et al.  Image quality of coronary 320-MDCT in patients with atrial fibrillation: initial experience. , 2009, AJR. American journal of roentgenology.

[5]  B. Hamm,et al.  Noninvasive Coronary Angiography by 320-Row Computed Tomography With Lower Radiation Exposure and Maintained Diagnostic Accuracy: Comparison of Results With Cardiac Catheterization in a Head-to-Head Pilot Investigation , 2009, Circulation.

[6]  Filippo Cademartiri,et al.  Evaluation of coronary stents with 64-MDCT: in vitro comparison of scanners from four vendors. , 2009, AJR. American journal of roentgenology.

[7]  V. Treyer,et al.  First head-to-head comparison of effective radiation dose from low-dose 64-slice CT with prospective ECG-triggering versus invasive coronary angiography , 2009, Heart.

[8]  J. Min,et al.  High-definition multidetector computed tomography for evaluation of coronary artery stents: comparison to standard-definition 64-detector row computed tomography. , 2009, Journal of cardiovascular computed tomography.

[9]  Scott D Flamm,et al.  Meta-analysis of diagnostic efficacy of 64-slice computed tomography in the evaluation of coronary in-stent restenosis. , 2009, The American journal of cardiology.

[10]  S. Voros What are the potential advantages and disadvantages of volumetric CT scanning? , 2009, Journal of cardiovascular computed tomography.

[11]  L. Husmann,et al.  Body physique and heart rate variability determine the occurrence of stair-step artefacts in 64-slice CT coronary angiography with prospective ECG-triggering , 2009, European Radiology.

[12]  V. Romano,et al.  Initial experience with a chest pain protocol using 320-slice volume MDCT , 2009, European Radiology.

[13]  J. Skinner,et al.  Outcomes following coronary stenting in the era of bare-metal vs the era of drug-eluting stents. , 2008, JAMA.

[14]  N. Kakani,et al.  Usefulness of 64-detector row computed tomography for evaluation of intracoronary stents in symptomatic patients with suspected in-stent restenosis. , 2008, The American journal of cardiology.

[15]  H. Otero,et al.  Initial evaluation of coronary images from 320-detector row computed tomography , 2008, The International Journal of Cardiovascular Imaging.

[16]  Tianxi Cai,et al.  Narrowing the phase window width in prospectively ECG-gated single heart beat 320-detector row coronary CT angiography , 2008, The International Journal of Cardiovascular Imaging.

[17]  C. Catalano,et al.  Non-invasive evaluation of coronary artery stent patency with retrospectively ECG-gated 64-slice CT angiography , 2008, European Radiology.

[18]  Jeroen J. Bax,et al.  Evaluation of patients with previous coronary stent implantation with 64-section CT. , 2007, Radiology.

[19]  P J de Feyter,et al.  Dual source coronary computed tomography angiography for detecting in-stent restenosis , 2007, Heart.

[20]  William Wijns,et al.  Diagnostic performance of multidetector CT angiography for assessment of coronary artery disease: meta-analysis. , 2007, Radiology.

[21]  Jeroen J. Bax,et al.  Usefulness of 64-slice multislice computed tomography coronary angiography to assess in-stent restenosis. , 2007, Journal of the American College of Cardiology.

[22]  H. Fujita,et al.  Diagnostic accuracy of coronary in-stent restenosis using 64-slice computed tomography: comparison with invasive coronary angiography. , 2007, Journal of the American College of Cardiology.

[23]  N Shandala,et al.  Scope of radiological protection control measures. , 2007, Annals of the ICRP.

[24]  J. Valentin,et al.  Managing patient dose in multi-detector computed tomography(MDCT). ICRP Publication 102. , 2007, Annals of the ICRP.

[25]  Zhonghua Sun,et al.  Diagnostic value of multislice computed tomography angiography in coronary artery disease: a meta-analysis. , 2006, European journal of radiology.

[26]  W. Bautz,et al.  Assessment of coronary artery stent restenosis by 64-slice multi-detector computed tomography. , 2006, European heart journal.

[27]  W. B. Meijboom,et al.  Multislice Spiral Computed Tomography for the Evaluation of Stent Patency After Left Main Coronary Artery Stenting: A Comparison With Conventional Coronary Angiography and Intravascular Ultrasound , 2006, Circulation.

[28]  W. B. Meijboom,et al.  Multidetector CT for visualization of coronary stents. , 2006, Radiographics : a review publication of the Radiological Society of North America, Inc.

[29]  P. Serruys,et al.  Sirolimus- vs paclitaxel-eluting stents in de novo coronary artery lesions: the REALITY trial: a randomized controlled trial. , 2006, JAMA.

[30]  J. Blanc,et al.  Assessment of coronary artery stents by 16 slice computed tomography , 2005, Heart.

[31]  K Murase,et al.  Comparison of patient doses in 256-slice CT and 16-slice CT scanners. , 2006, The British journal of radiology.

[32]  B. Gerber,et al.  Diagnostic accuracy of 16-slice multidetector-row CT for detection of in-stent restenosis vs detection of stenosis in nonstented coronary arteries , 2006, European Radiology.

[33]  B. Lewis,et al.  Diagnosis of coronary in-stent restenosis with multidetector row spiral computed tomography. , 2005, Journal of the American College of Cardiology.

[34]  P. Serruys,et al.  Thirty-day incidence and six-month clinical outcome of thrombotic stent occlusion after bare-metal, sirolimus, or paclitaxel stent implantation. , 2005, Journal of the American College of Cardiology.

[35]  Berend C. Stoel,et al.  Towards quantitative analysis of coronary CTA , 2005, The International Journal of Cardiovascular Imaging.

[36]  Nico Mollet,et al.  Intravenous contrast material administration at 16-detector row helical CT coronary angiography: test bolus versus bolus-tracking technique. , 2004, Radiology.

[37]  Jeroen J. Bax,et al.  Feasibility of assessment of coronary stent patency using 16-slice computed tomography. , 2004, The American journal of cardiology.

[38]  A. Mahnken,et al.  Multislice spiral computed tomography for the detection of coronary stent restenosis and patency. , 2003, International journal of cardiology.

[39]  W Rutsch,et al.  A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. , 1994, The New England journal of medicine.

[40]  R. Frye,et al.  A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. , 1975, Circulation.