Diagnostic accuracy of 16-slice multidetector-row CT for detection of in-stent restenosis vs detection of stenosis in nonstented coronary arteries

The purpose of this study was to assess the diagnostic accuracy of 16-slice multidetector-row computed tomography (MDCT) for detecting in-stent restenosis. Fifty patients with 69 previously implanted coronary stents underwent 16-slice MDCT before quantitative coronary angiography (QCA). Diagnostic accuracy of MDCT for detection of in-stent restenosis defined as >50% lumen diameter stenosis (DS) in stented and nonstented coronary segments >1.5-mm diameter was computed using QCA as reference. According to QCA, 18/69 (25%) stented segments had restenosis. In addition, 33/518 (6.4%) nonstented segments had >50% DS. In-stent restenosis was correctly identified on MDCT images in 12/18 stents, and absence of restenosis was correctly identified in 50/51 stents. Stenosis in native coronary arteries was correctly identified in 22/33 segments and correctly excluded in 482/485 segments. Thus, sensitivity (67% vs 67% p=1.0), specificity (98% vs 99%, p=0.96) and overall diagnostic accuracy (90% vs 97%, p=0.68) was similarly high for detecting in-stent restenosis as for detecting stenosis in nonstented coronary segments. MDCT has similarly high diagnostic accuracy for detecting in-stent restenosis as for detecting coronary artery disease in nonstented segments. This suggests that MDCT could be clinically useful for identification of restenosis in patients after coronary stenting.

[1]  P. Serruys,et al.  Intravascular Ultrasound Findings in the Multicenter, Randomized, Double-Blind RAVEL (RAndomized study with the sirolimus-eluting VElocity balloon-expandable stent in the treatment of patients with de novo native coronary artery Lesions) Trial , 2002, Circulation.

[2]  R. Krone,et al.  Cardiac catheterization 1991: a report of the Registry of the Society for Cardiac Angiography and Interventions (SCA&I). , 1993, Catheterization and cardiovascular diagnosis.

[3]  Rüdiger Blindt,et al.  Coronary Artery Stents in Multislice Computed Tomography: In Vitro Artifact Evaluation , 2004, Investigative radiology.

[4]  W. Heindel,et al.  Assessment of coronary arterial stents by multislice-CT angiography. , 2003, Acta radiologica.

[5]  C. Claussen,et al.  Image quality and diagnostic accuracy of non-invasive coronary imaging with 16 detector slice spiral computed tomography with 188 ms temporal resolution , 2005, Heart.

[6]  Walter Heindel,et al.  Imaging of coronary artery stents using multislice computed tomography: in vitro evaluation , 2003, European Radiology.

[7]  P. Teirstein,et al.  A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. , 1994, The New England journal of medicine.

[8]  D. Baim,et al.  Current complications of diagnostic and therapeutic cardiac catheterization. , 1988, Journal of the American College of Cardiology.

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

[10]  S. Achenbach,et al.  Detection of coronary artery stenoses using multi-detector CT with 16 x 0.75 collimation and 375 ms rotation. , 2005, European heart journal.

[11]  W. Bautz,et al.  Detection of Coronary Artery Stenoses With Thin-Slice Multi-Detector Row Spiral Computed Tomography and Multiplanar Reconstruction , 2003, Circulation.

[12]  Cécile Grandin,et al.  Head-to-head comparison of three-dimensional navigator-gated magnetic resonance imaging and 16-slice computed tomography to detect coronary artery stenosis in patients. , 2005, Journal of the American College of Cardiology.

[13]  Werner Moshage,et al.  Detection of Coronary Artery Stenoses by Contrast-Enhanced, Retrospectively Electrocardiographically-Gated, Multislice Spiral Computed Tomography , 2001, Circulation.

[14]  C. Claussen,et al.  Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with angiographically proven coronary artery disease. , 2004, Journal of the American College of Cardiology.

[15]  P J Scanlon,et al.  ACC/AHA guidelines for coronary angiography: executive summary and recommendations. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and , 1999, Circulation.

[16]  C. Kuhl,et al.  MRI of the pelvis at 3 T: very high spatial resolution with sensitivity encoding and flip-angle sweep technique in clinically acceptable scan time , 2006, European Radiology.

[17]  Gabriel P. Krestin,et al.  High-Resolution Spiral Computed Tomography Coronary Angiography in Patients Referred for Diagnostic Conventional Coronary Angiography , 2005, Circulation.

[18]  D A Clark,et al.  Cardiac catheterization 1990: a report of the Registry of the Society for Cardiac Angiography and Interventions (SCA&I). , 1991, Catheterization and cardiovascular diagnosis.

[19]  Pedro A. Lemos,et al.  Reliable Noninvasive Coronary Angiography With Fast Submillimeter Multislice Spiral Computed Tomography , 2002, Circulation.

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

[21]  G. Raff,et al.  Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. , 2005, Journal of the American College of Cardiology.

[22]  M. Grass,et al.  Evaluation of spatial and temporal resolution for ECG-gated 16-row multidetector CT using a dynamic cardiac phantom , 2005, European Radiology.

[23]  B. Wintersperger,et al.  Basics of cardiac MDCT: techniques and contrast application , 2005, European radiology.

[24]  Thomas Flohr,et al.  Improved coronary artery stent visualization and in-stent stenosis detection using 16-slice computed-tomography and dedicated image reconstruction technique. , 2003, Investigative radiology.

[25]  大貫 勝美 New diagnostic technique in multi-slice computed tomography for in-stent restenosis : pixel count method , 2006 .

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

[27]  Rainer Raupach,et al.  Assessment of coronary artery stents using 16-slice MDCT angiography: evaluation of a dedicated reconstruction kernel and a noise reduction filter , 2005, European Radiology.

[28]  P. Buser,et al.  Incremental Cost-Effectiveness of Drug-Eluting Stents Compared With a Third-Generation Bare-Metal Stent in a Real-World Setting: Randomised Basel Stent Kosten Effektivitats Trial (BASKET) , 2005 .

[29]  David J. Feild Guidelines for coronary angiography: A report of the American College of Cardiology/American Heart Association task force on assessment of diagnostic and therapeutic cardiovascular procedures (Subcommittee on coronary angiography) , 1987 .

[30]  Konstantin Nikolaou,et al.  Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. , 2005, Journal of the American College of Cardiology.

[31]  Filippo Cademartiri,et al.  Non-invasive assessment of coronary artery stent patency with multislice CT: preliminary experience. , 2005, La Radiologia medica.

[32]  J. Murray,et al.  ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. , 1999, Journal of the American College of Cardiology.

[33]  Stephen Schroeder,et al.  ECG-gated 16-MDCT of the coronary arteries: assessment of image quality and accuracy in detecting stenoses. , 2005, AJR. American journal of roentgenology.

[34]  R. Whitbourn,et al.  Vascular Responses at Proximal and Distal Edges of Paclitaxel-Eluting Stents: Serial Intravascular Ultrasound Analysis From the TAXUS II Trial , 2004, Circulation.

[35]  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.

[36]  K. Bae,et al.  Coronary artery stent patency assessed with in-stent contrast enhancement measured at multi-detector row CT angiography: initial experience. , 2004, Radiology.

[37]  Simon Wildermuth,et al.  Accuracy of MSCT coronary angiography with 64-slice technology: first experience. , 2005 .

[38]  Rainer Raupach,et al.  64-slice multidetector coronary CT angiography: in vitro evaluation of 68 different stents , 2006, European Radiology.