Schlosser T, Scheuermann T, Ulzheimer S, Mohrs O K, Kühling M, Albrecht P E, Voigtländer T, Barkhausen J, Schmermund A
Cardiovascular Center Bethanien (CCB), Frankfurt, Germany.
Acta Radiol. 2008 Feb;49(1):56-64. doi: 10.1080/02841850701678804.
Stent implantation is the predominant therapy for non-surgical myocardial revascularization in patients with coronary artery disease. However, despite substantial advances in multidetector computed tomography (MDCT) coronary imaging, a reliable detection of coronary in-stent restenosis is currently not possible.
To examine the ability of 64-detector-row CT to detect and to grade in-stent stenosis in coronary stents using a newly developed ex-vivo vessel phantom with a realistic CT density pattern, artificial stenosis, and a thorax phantom.
Four different stents (Liberté and Lunar ROX, Boston Scientific; Driver, Medtronic; Multi-Link Vision, Guidant) were examined. The stents were placed on a polymer tube with a diameter of 2.5, 3.0, 3.5, or 4.0 mm. Different degrees of stenosis (0%, 30%, 50%, 70-80%) were created inside the tube. For quantitative analysis, attenuation values were measured in the non-stenotic vessel outside the stent, in the non-stenotic vessel inside the stent, and in the stenotic area inside the stent. The grade of stenosis was visually assessed by two observers.
All stents led to artificial reduction of attenuation, the least degree of which was found in the Liberté stent (11.3+/-10.2 HU) and the Multi-Link Vision stent (17.6+/-17.9 HU; P = 0.25). Overall, the non-stenotic vessel was correctly diagnosed in 55.5%, the low-grade stenosis in 58.3%, the intermediate stenosis in 63.8%, and the high-grade stenosis in 80.5%. In the 3.0-, 3.5-, and 4.0-mm vessels, in none of the cases was a non-stenotic or low-grade stenotic vessel misdiagnosed as intermediate or high-grade stenosis. The average deviation from the real grade of stenosis was 0.40 for the Liberté stent, 0.46 for the Lunar ROX stent, 0.45 for the Driver stent, and 0.58 for the Multi-Link Vision stent.
Our ex-vivo data show that non-stenotic stents and low-grade in-stent stenosis can be reliably differentiated from intermediate and high-grade in-stent stenosis in vessels with a diameter of 3 to 4 mm. With regard to artifacts and the grading of stenoses, the Liberté stent was best suited for CT coronary angiography.
支架植入术是冠心病患者非手术心肌血运重建的主要治疗方法。然而，尽管多排螺旋计算机断层扫描（MDCT）冠状动脉成像取得了重大进展，但目前仍无法可靠地检测冠状动脉支架内再狭窄。
使用新开发的具有逼真CT密度模式、人工狭窄的离体血管模型和胸部模型，研究64排CT检测冠状动脉支架内狭窄并对其进行分级的能力。
检查了四种不同的支架（波士顿科学公司的Liberté和Lunar ROX；美敦力公司的Driver；Guidant公司的Multi-Link Vision）。将支架放置在直径为2.5、3.0、3.5或4.0mm的聚合物管上。在管内制造不同程度的狭窄（0%、30%、50%、70 - 80%）。为进行定量分析，在支架外的非狭窄血管、支架内的非狭窄血管以及支架内的狭窄区域测量衰减值。由两名观察者对狭窄程度进行视觉评估。
所有支架均导致衰减值人为降低，其中Liberté支架降低程度最小（11.3±10.2HU），Multi-Link Vision支架次之（17.6±17.9HU；P = 0.25）。总体而言，非狭窄血管的正确诊断率为55.5%，低度狭窄为58.3%，中度狭窄为63.8%，高度狭窄为80.5%。在直径为3.0、3.5和4.0mm的血管中，无一例非狭窄或低度狭窄血管被误诊为中度或高度狭窄。Liberté支架与实际狭窄程度的平均偏差为0.40，Lunar ROX支架为0.46，Driver支架为0.45，Multi-Link Vision支架为0.58。
我们的离体数据表明，在直径为3至4mm的血管中，非狭窄支架和低度支架内狭窄可与中度和高度支架内狭窄可靠区分。在伪影和狭窄分级方面，Liberté支架最适合CT冠状动脉造影。
