Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University Medical Center, Seodaemun-gu, Seoul, Korea.
J Thorac Imaging. 2010 Feb;25(1):57-63. doi: 10.1097/RTI.0b013e3181b5d813.
To determine factors affecting the ability of 64-multislice computed tomography (MSCT) to detect, assess, and accurately diagnose significant coronary arterial in-stent restenosis (ISR).
The institutional review board approved this study and waived informed consent. Sixty patients underwent CT coronary angiography using 64-MSCT, after implantation of coronary artery stents (n=91). We assessed diagnostic accuracy for ISR with CT in comparison with conventional coronary angiography as the gold standard, visually and with measurement of in-stent coronary lumen density. Possible factors that influenced the diagnostic performance of CT were evaluated, which included image quality (IQ), stent characteristics, and location.
Sixty-nine stents (75.8%) were assessable. Low IQ, location in the left circumflex coronary artery, and narrow stent diameter were associated with poor assessment (P<0.05). In stents that could be assessed, sensitivity, specificity, positive predictive value, and negative predictive value of 64-MSCT were 90.0%, 73.5%, 58.1%, and 94.7%, respectively, for significant ISR. The diagnostic accuracy in assessable stents showed a significant increase with better IQ, thinner strut thickness, and nondrug eluting stent. False-positive diagnoses of ISR by CT were explained by coronary lumen density measurements.
Evaluation of stents by 64-MSCT is not recommended in stents with diameters of < or = 2.75 mm or stents located at the left circumflex coronary artery. The diagnostic accuracy of 64-MSCT is affected by IQ and strut thickness in assessable stents. Significant ISR can be excluded with high reliability in selected patients.
确定影响 64 层多层螺旋 CT（MSCT）检测、评估和准确诊断冠状动脉支架内再狭窄（ISR）的因素。
本研究经机构审查委员会批准，豁免了知情同意。60 例患者（共 91 个支架）在植入冠状动脉支架后接受了 64 层 MSCT 冠状动脉血管造影。我们通过与传统冠状动脉造影（金标准）比较，评估 CT 诊断 ISR 的准确性，包括视觉评估和支架内冠状动脉管腔密度测量。评估了可能影响 CT 诊断性能的因素，包括图像质量（IQ）、支架特征和位置。
69 个支架（75.8%）可评估。低 IQ、左回旋支冠状动脉位置和较窄的支架直径与评估不佳相关（P<0.05）。在可评估的支架中，64 层 MSCT 对明显 ISR 的敏感性、特异性、阳性预测值和阴性预测值分别为 90.0%、73.5%、58.1%和 94.7%。在可评估支架中，IQ 更好、支架壁更薄和非药物洗脱支架的诊断准确性显著提高。CT 对 ISR 的假阳性诊断可通过冠状动脉管腔密度测量来解释。
对于直径≤2.75mm 的支架或位于左回旋支的支架，不建议使用 64 层 MSCT 进行支架评估。在可评估的支架中，IQ 和支架壁厚度会影响 64 层 MSCT 的诊断准确性。在选择的患者中，可高度可靠地排除明显 ISR。
