Schuijf Joanne D, Pundziute Gabija, Jukema J Wouter, Lamb Hildo J, Tuinenburg Joan C, van der Hoeven Barend L, de Roos Albert, Reiber Johannes H C, van der Wall Ernst E, Schalij Martin J, Bax Jeroen J
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
Radiology. 2007 Nov;245(2):416-23. doi: 10.1148/radiol.2452061199. Epub 2007 Sep 21.
To prospectively evaluate the diagnostic accuracy of 64-section computed tomography (CT) for the assessment of in-stent or peristent restenosis, with conventional coronary angiography as the reference standard.
The study was approved by the medical ethics committee, and informed consent was obtained in all 50 enrolled patients (40 men, 10 women; mean age, 60 years +/- 11 [standard deviation]). In addition to conventional coronary angiography with quantitative coronary angiography, 64-section CT was performed. For each stent, assessability was determined and was related to stent characteristics and heart rate by using a chi(2) test. On the interpretable images of stents and peristent lumina (5.00 mm proximal and distal to the stent), the presence of significant (> or =50%) restenosis was determined. For this analysis, partially overlapping stents were considered to represent a single stent.
Of 76 stents, 65 (86%) were determined to be assessable. Increased heart rate and overlapping positioning were associated with increased uninterpretability of the images of stents (P < .05), whereas location of the stent and thickness of the strut were not. In seven patients, stents were placed in an overlapping manner, resulting in 58 stents available for the evaluation of significant (> or =50%) in-stent restenosis. All six significant (> or =50%) in-stent restenoses were detected, and the absence of significant (> or =50%) restenosis was correctly identified in the 52 remaining stents, resulting in sensitivity and specificity of 100%. Sensitivity and specificity for the detection of significant (> or =50%) peristent stenosis were 100% and 98%, respectively.
In selected patients with previous stent implantation, 64-section CT can be used to evaluate in-stent restenosis with high accuracy. Accordingly, the technique may be useful for noninvasive exclusion of in-stent or peristent restenosis, thereby avoiding invasive imaging in a considerable number of patients.
以传统冠状动脉造影为参考标准，前瞻性评估64层计算机断层扫描（CT）对支架内或持续性再狭窄评估的诊断准确性。
本研究经医学伦理委员会批准，纳入的50例患者（40例男性，10例女性；平均年龄60岁±11[标准差]）均签署了知情同意书。除了进行定量冠状动脉造影的传统冠状动脉造影外，还进行了64层CT检查。对于每个支架，通过卡方检验确定可评估性，并将其与支架特征和心率相关联。在支架和持续性管腔（支架近端和远端5.00 mm）的可解释图像上，确定是否存在显著（≥50%）再狭窄。对于该分析，部分重叠的支架被视为单个支架。
76个支架中，65个（86%）被确定为可评估。心率增加和重叠定位与支架图像的不可解释性增加相关（P<.05），而支架位置和支柱厚度则无关。7例患者的支架以重叠方式放置，从而有58个支架可用于评估显著（≥50%）的支架内再狭窄。所有6例显著（≥50%）的支架内再狭窄均被检测到，其余52个支架中无显著（≥50%）再狭窄也被正确识别，敏感性和特异性均为100%。检测显著（≥50%）持续性狭窄的敏感性和特异性分别为100%和98%。
在先前植入支架的特定患者中，64层CT可用于高精度评估支架内再狭窄。因此，该技术可能有助于无创排除支架内或持续性再狭窄，从而避免大量患者进行有创成像。
