Vanhoenacker Piet K, Decramer Isabel, Bladt Olivier, Sarno Giovanna, Van Hul Erik, Wijns William, Dwamena Ben A
Department of Radiology and Imaging, OLV Ziekenhuis, Aalst, Belgium.
BMC Med Imaging. 2008 Jul 31;8:14. doi: 10.1186/1471-2342-8-14.
Multi-detector computed tomography angiography (MDCTA)of the coronary arteries after stenting has been evaluated in multiple studies.The purpose of this study was to perform a structured review and meta-analysis of the diagnostic performance of MDCTA for the detection of in-stent restenosis in the coronary arteries.
A Pubmed and manual search of the literature on in-stent restenosis (ISR) detected on MDCTA compared with conventional coronary angiography (CA) was performed. Bivariate summary receiver operating curve (SROC) analysis, with calculation of summary estimates was done on a stent and patient basis. In addition, the influence of study characteristics on diagnostic performance and number of non-assessable segments (NAP) was investigated with logistic meta-regression.
Fourteen studies were included. On a stent basis, Pooled sensitivity and specificity were 0.82(0.72-0.89) and 0.91 (0.83-0.96). Pooled negative likelihood ratio and positive likelihood ratio were 0.20 (0.13-0.32) and 9.34 (4.68-18.62) respectively. The exclusion of non-assessable stents and the strut thickness of the stents had an influence on the diagnostic performance. The proportion of non-assessable stents was influenced by the number of detectors, stent diameter, strut thickness and the use of an edge-enhancing kernel.
The sensitivity of MDTCA for the detection of in-stent stenosis is insufficient to use this test to select patients for further invasive testing as with this strategy around 20% of the patients with in-stent stenosis would be missed. Further improvement of scanner technology is needed before it can be recommended as a triage instrument in practice. In addition, the number of non-assessable stents is also high.
多项研究已对冠状动脉支架置入术后的多排螺旋CT血管造影（MDCTA）进行了评估。本研究的目的是对MDCTA检测冠状动脉支架内再狭窄的诊断性能进行结构化综述和荟萃分析。
对MDCTA检测到的支架内再狭窄（ISR）与传统冠状动脉造影（CA）相关的文献进行了PubMed检索和手动检索。在支架和患者层面进行双变量汇总接受者操作特征曲线（SROC）分析，并计算汇总估计值。此外，通过逻辑荟萃回归研究了研究特征对诊断性能和不可评估节段数（NAP）的影响。
纳入了14项研究。在支架层面，汇总敏感性和特异性分别为0.82（0.72 - 0.89）和0.91（0.83 - 0.96）。汇总阴性似然比和阳性似然比分别为0.20（0.13 - 0.32）和9.34（4.68 - 18.62）。排除不可评估的支架以及支架的支柱厚度对诊断性能有影响。不可评估支架的比例受探测器数量、支架直径、支柱厚度和边缘增强内核的使用影响。
MDTCA检测支架内狭窄的敏感性不足以用于选择患者进行进一步的侵入性检测，因为采用这种策略会遗漏约20%的支架内狭窄患者。在其能够被推荐作为实际的分诊工具之前，需要进一步改进扫描仪技术。此外，不可评估支架的数量也很多。
