Dual source coronary computed tomography angiography for detecting in-stent restenosis

Objective: To evaluate the performance of dual source CT coronary angiography (DSCT-CA) in the detection of in-stent restenosis (⩾50% luminal narrowing) in symptomatic patients referred for conventional angiography (CA). Design/patients: 100 patients (78 males, age 62 (SD 10)) with chest pain were prospectively evaluated after coronary stenting. DSCT-CA was performed before CA. Setting: Many patients undergo coronary artery stenting; availability of a non-invasive modality to detect in-stent restenosis would be desirable. Results: Average heart rate (HR) was 67 (SD 12) (range 46–106) bpm. There were 178 stented lesions. The interval between stenting and inclusion in the study was 35 (SD 41) (range 3–140) months. 39/100 (39%) patients had angiographically proven restenosis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of DSCT-CA, calculated in all stents, were 94%, 92%, 77% and 98%, respectively. Diagnostic performance at HR <70 bpm (n = 69; mean 58 bpm) was similar to that at HR ⩾70 bpm (n = 31; mean 78 bpm); diagnostic performance in single stents (n = 95) was similar to that in overlapping stents and bifurcations (n = 83). In stents ⩾3.5 mm (n = 78), sensitivity, specificity, PPV, NPV were 100%; in 3 mm stents (n = 59), sensitivity and NPV were 100%, specificity 97%, PPV 91%; in stents ⩽2.75 mm (n = 41), sensitivity was 84%, specificity 64%, PPV 52%, NPV 90%. Nine stents ⩽2.75 mm were uninterpretable. Specificity of DSCT-CA in stents ⩾3.5 mm was significantly higher than in stents ⩽2.75 mm (OR  = 6.14; 99%CI: 1.52 to 9.79). Conclusion: DSCT-CA performs well in the detection of in-stent restenosis. Although DSCT-CA leads to frequent false positive findings in smaller stents (⩽2.75 mm), it reliably rules out in-stent restenosis irrespective of stent size.

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

[2]  K. Stierstorfer,et al.  First performance evaluation of a dual-source CT (DSCT) system , 2006, European Radiology.

[3]  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.

[4]  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.

[5]  M. Pfisterer,et al.  Long-term outcome of patients with silent versus symptomatic ischemia six months after percutaneous coronary intervention and stenting. , 2003, Journal of the American College of Cardiology.

[6]  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.

[7]  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.

[8]  Manesh R. Patel,et al.  ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. A report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group. , 2006, Journal of the American College of Radiology : JACR.

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

[10]  Johannes B Reitsma,et al.  The STARD initiative , 2003, The Lancet.

[11]  F. Sebening,et al.  [Coronary artery disease]. , 1980, Verhandlungen der Deutschen Gesellschaft fur Herz- und Kreislaufforschung.

[12]  James C Carr,et al.  ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Ra , 2006, Journal of the American College of Cardiology.

[13]  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.

[14]  T. Fujii,et al.  Noninvasive assessment of coronary stents in patients by 16-slice computed tomography. , 2006, International journal of cardiology.

[15]  R. Morin,et al.  Radiation dose in computed tomography of the heart. , 2003, Circulation.

[16]  S. Mochizuki,et al.  New diagnostic technique in multi-slice computed tomography for in-stent restenosis: pixel count method. , 2006, International journal of cardiology.

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

[18]  P J de Feyter,et al.  Quantitative coronary angiography (QCA) in interventional cardiology: clinical application of QCA measurements. , 1994, Progress in cardiovascular diseases.

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

[20]  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.

[21]  D. Rennie,et al.  Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative , 2003, BMJ : British Medical Journal.

[22]  W. Kalender,et al.  Assessment of calcium scoring performance in cardiac computed tomography , 2003, European Radiology.

[23]  D. Oncel,et al.  Coronary stent patency and in-stent restenosis: determination with 64-section multidetector CT coronary angiography--initial experience. , 2007, Radiology.

[24]  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.

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

[26]  A Hadgu,et al.  Sensitivity and specificity for correlated observations. , 1992, Statistics in medicine.

[27]  Filippo Cademartiri,et al.  Usefulness of multislice computed tomographic coronary angiography to assess in-stent restenosis. , 2005, The American journal of cardiology.

[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]  U. Hoffmann,et al.  Coronary multidetector computed tomography: a new standard for preoperative risk assessment? , 2006, Journal of the American College of Cardiology.

[30]  Samin K. Sharma,et al.  Simultaneous kissing stents (SKS) technique for treating bifurcation lesions in medium-to-large size coronary arteries. , 2004, The American journal of cardiology.