Hecht Harvey S, Zaric Maja, Jelnin Vladimir, Lubarsky Lev, Prakash Manish, Roubin Gary
Lenox Hill Heart & Vascular Institute, New York, New York, USA.
Am J Cardiol. 2008 Mar 15;101(6):820-4. doi: 10.1016/j.amjcard.2007.09.117. Epub 2008 Jan 18.
The purpose of this study was to evaluate the accuracy of detector computed tomographic angiographic qualitative and quantitative analyses for the detection of in-stent restenosis (ISR) Previous studies have used qualitative analyses exclusively and have excluded "unevaluable" stents. Multidetector computed tomographic angiography (MDCT) was performed before quantitative coronary angiography in 67 patients with 132 stents that were evaluated by 2 techniques: (1) qualitative, on the basis of degree of visual hypodensity, and (2) quantitative, comparing in-stent with prestent Hounsfield units. All stents were evaluated, irrespective of image quality. The incidence of ISR was 12.5%. The sensitivity (94%), specificity (74%), and positive predictive value (39%) of the qualitative evaluation were superior to the quantitative technique (82%, 54%, and 21%, respectively); negative predictive values were similar (99% vs 95%). Accuracies were equal in stents located in proximal and distal vessels. In conclusion, ISR can be evaluated qualitatively by 64-slice MDCT with excellent sensitivity and negative predictive accuracy without exclusion of unevaluable stents and with reasonable specificity but low positive predictive value. Quantitative analysis was less accurate.
本研究的目的是评估探测器计算机断层血管造影定性和定量分析检测支架内再狭窄（ISR）的准确性。以往的研究仅采用定性分析，且排除了“无法评估”的支架。对67例患者的132个支架在进行定量冠状动脉造影之前先进行了多探测器计算机断层血管造影（MDCT），采用两种技术进行评估：（1）定性分析，基于视觉低密度程度；（2）定量分析，比较支架内与支架置入前的亨氏单位。所有支架均进行了评估，无论图像质量如何。ISR的发生率为12.5%。定性评估的敏感性（94%）、特异性（74%）和阳性预测值（39%）优于定量技术（分别为82%、54%和21%）；阴性预测值相似（99%对95%）。位于近端和远端血管的支架的准确性相同。总之，64层MDCT可对ISR进行定性评估，具有出色的敏感性和阴性预测准确性，无需排除无法评估的支架，特异性合理但阳性预测值较低。定量分析的准确性较低。
