Cademartiri Filippo, Schuijf Joanne D, Pugliese Francesca, Mollet Nico R, Jukema J Wouter, Maffei Erica, Kroft Lucia J, Palumbo Alessandro, Ardissino Diego, Serruys Patrick W, Krestin Gabriel P, Van der Wall Ernst E, de Feyter Pim J, Bax Jeroen J
Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
J Am Coll Cardiol. 2007 Jun 5;49(22):2204-10. doi: 10.1016/j.jacc.2007.02.045. Epub 2007 May 23.
This study sought to evaluate the diagnostic accuracy of 64-slice multislice computed tomography (MSCT) coronary angiography in the follow-up of patients with previous coronary stent implantation.
Recent investigations have shown increased image quality and diagnostic accuracy for noninvasive coronary angiography with 64-slice MSCT as compared with previous-generation MSCT scanners, but data on the evaluation of coronary stents are scarce.
In 182 patients (152 [84%] male, ages 58 +/- 11 years) with previous stent (> or =2.5 mm diameter) implantation (n = 192), 64-slice MSCT angiography using either a Sensation 64 (Siemens, Forchheim, Germany) or Aquilion 64 (Toshiba, Otawara, Japan) was performed. At each center, coronary stents were evaluated by 2 experienced observers and evaluated for the presence of significant (> or =50%) in-stent restenosis. Quantitative coronary angiography served as the standard of reference.
A total of 14 (7.3%) stented segments were excluded because of poor image quality. In the interpretable stents, 20 of the 178 (11.2%) evaluated stents were significantly diseased, of which 19 were correctly detected by 64-slice MSCT. Accordingly, sensitivity, specificity, and positive and negative predictive value to identify in-stent restenosis in interpretable stents were 95.0% (95% confidence interval [CI] 85% to 100%), 93.0% (95% CI 90% to 97%), 63.3% (95% CI 46% to 81%), and 99.3% (95% CI 98% to 100%), respectively.
In-stent restenosis can be evaluated with 64-slice MSCT with good diagnostic accuracy. In particular, a high negative predictive value of 99% was observed, indicating that 64-slice MSCT may be most valuable as a noninvasive method of excluding in-stent restenosis.
本研究旨在评估64层多层螺旋计算机断层扫描（MSCT）冠状动脉造影对既往有冠状动脉支架植入术患者进行随访时的诊断准确性。
近期研究表明，与上一代MSCT扫描仪相比，64层MSCT的无创冠状动脉造影图像质量和诊断准确性有所提高，但关于冠状动脉支架评估的数据较少。
对182例（152例[84%]男性，年龄58±11岁）既往有支架（直径≥2.5 mm）植入史（n = 192）的患者进行64层MSCT血管造影，使用Sensation 64（德国西门子公司，福希海姆）或Aquilion 64（日本东芝公司，大田原）扫描仪。在每个中心，由2名经验丰富的观察者对冠状动脉支架进行评估，并评估是否存在显著（≥50%）的支架内再狭窄。定量冠状动脉造影作为参考标准。
共有14个（7.3%）支架节段因图像质量差而被排除。在可解释的支架中，178个评估支架中有20个（11.2%）存在显著病变，其中19个被64层MSCT正确检测到。因此，在可解释的支架中识别支架内再狭窄的敏感性、特异性、阳性预测值和阴性预测值分别为95.0%（95%置信区间[CI] 85%至100%）、93.0%（95% CI 90%至97%）、63.3%（95% CI 46%至81%）和99.3%（95% CI 98%至100%）。
64层MSCT对支架内再狭窄的评估具有良好的诊断准确性。特别是观察到高达99%的高阴性预测值，表明64层MSCT作为排除支架内再狭窄的无创方法可能最有价值。
