Rist Carsten, von Ziegler Franz, Nikolaou Konstantin, Kirchin Miles A, Wintersperger Bernd J, Johnson Thorsten R, Knez Andreas, Leber Alexander W, Reiser Maximilian F, Becker Christoph R
Department of Clinical Radiology, University Hospitals - Grosshadern Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany.
Acad Radiol. 2006 Dec;13(12):1465-73. doi: 10.1016/j.acra.2006.09.044.
Restenosis remains a major limitation of coronary catheter-based stent placement. Therefore, a reliable noninvasive diagnostic method for the evaluation of stented coronary arteries would be highly desirable. Our aim was to evaluate the diagnostic accuracy of high-resolution 64-slice computed tomography (64SCT) in a pilot study for the assessment of the lumen of coronary artery stents.
Twenty-five patients underwent 64SCT of the coronary arteries and quantitative x-ray coronary angiography (QCA) after coronary artery stent placement. 64SCT coronary angiography was performed with the following parameters: spatial resolution = 0.4 x 0.4 x 0.4 mm; temporal resolution = 83-165 milliseconds; contrast agent = 80 mL at a flow rate of 5 mL/second; retrospective electrocardiogram gating. The 64SCT scans were evaluated for image quality and for the presence of significant in-stent and peri-stent (proximal and distal) stenoses. Determinations were made of the sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values (PPV and NPV) of 64SCT for the detection or exclusion of stenoses.
A total of 46 stents were evaluated, of which 45 (98%) were of diagnostic image quality. Significant in-stent restenosis or occlusion was detected on QCA in 8/45 cases (>/=50% stenosis = 6; occlusion = 2). The sensitivity, specificity, accuracy, PPV, and NPV of 64SCT for the detection of significant in-stent disease was 75%, 92%, 89%, 67%, and 94%, respectively. Both occluded coronary artery stents were correctly identified. The sensitivity, specificity, and accuracy values of 64SCT for the detection of significant proximal peri-stent stenoses were 75%, 95%, and 93%, respectively, whereas the values for detection of significant distal peri-stent stenoses were 67%, 85%, and 84%, respectively.
The high spatial and temporal resolution of 64SCT may permit improved assessment of stent occlusion and peri-stent disease, although detection of in-stent stenosis remains difficult.
再狭窄仍是基于冠状动脉导管的支架置入术的主要限制因素。因此，非常需要一种可靠的非侵入性诊断方法来评估冠状动脉支架置入情况。我们的目的是在一项初步研究中评估高分辨率64层计算机断层扫描（64SCT）对冠状动脉支架管腔评估的诊断准确性。
25例患者在冠状动脉支架置入术后接受了冠状动脉64SCT检查和定量X线冠状动脉造影（QCA）。64SCT冠状动脉造影检查采用以下参数：空间分辨率=0.4×0.4×0.毫米；时间分辨率=83 - 165毫秒；造影剂=80毫升，流速为5毫升/秒；回顾性心电图门控。对64SCT扫描图像的质量以及支架内和支架周围（近端和远端）是否存在明显狭窄进行评估。确定64SCT检测或排除狭窄的敏感性、特异性、诊断准确性以及阳性和阴性预测值（PPV和NPV）。
共评估了46个支架，其中45个（98%）具有诊断图像质量。QCA检测到8/45例（≥50%狭窄=6例；闭塞=2例）存在明显的支架内再狭窄或闭塞。64SCT检测明显支架内病变的敏感性、特异性、准确性、PPV和NPV分别为75%、92%、89%、67%和94%。两个闭塞的冠状动脉支架均被正确识别。64SCT检测明显近端支架周围狭窄的敏感性、特异性和准确性值分别为75%、95%和93%，而检测明显远端支架周围狭窄的值分别为67%、85%和84%。
64SCT的高空间和时间分辨率可能有助于更好地评估支架闭塞和支架周围病变，尽管检测支架内狭窄仍然困难。
