双源 CT 评估冠状动脉支架通畅性及支架内再狭窄的诊断准确性及其影响因素。

Diagnostic accuracy and its affecting factors of dual-source CT for assessment of coronary stents patency and in-stent restenosis.

机构信息

Department of Radiology, People's Liberation Army General Hospital, Beijing 100853, China.

出版信息

Chin Med J (Engl). 2012 Jun;125(11):1936-40.

Abstract

BACKGROUND

In-stent restenosis is a common complication after stent implantation. However, the assessment of stent lumen in computed tomography (CT) coronary angiography is limited by multiple factors. Our study aimed to evaluate the accuracy and the suspected affecting factors in diagnosing coronary in-stent restenosis by dual-source CT (DSCT) compared with coronary angiography.

METHODS

One hundred and fifteen stents in 50 patients were evaluated with DSCT before coronary angiography for the detection of coronary in-stent restenosis (≥ 50% luminal narrowing). Patency of each stent was analyzed by two independent expert radiologists blinded to the results of coronary angiography. The relationship between diagnostic accuracy and the suspected factors including age, body mass index (BMI), heart rate, variation of heart rate, radiation dose, image quality, location and stent characteristics (type, material, diameter, length and strut thickness) was assessed with both univariate and multivariate analysis. The fitting of a Logistic regression model was evaluated using a receiver operating characteristic (ROC) curve.

RESULTS

Mean stent diameter was (2.9 ± 0.4) mm. Sensitivity, specificity, positive and negative predictive values and accuracy of DSCT in detection of in-stent restenosis were 69.2%, 91.2%, 50.0%, 95.9%, and 88.7%, respectively. In a subgroup of stents with a diameter ≥ 3.0 mm, sensitivity, specificity, positive and negative predictive values and accuracy were 100.0%, 96.5%, 75.0%, 100.0%, and 96.8%, respectively. Stent diameter < 3.0 mm and poor image quality were associated with poor diagnostic accuracy (P < 0.05). The area under curve of ROC was 0.79.

CONCLUSION

DSCT can provide high accuracy for the assessment of in-stent restenosis in stents with a diameter = 3.0 mm, and can play an important role in ruling out in-stent restenosis.

摘要

背景

支架内再狭窄是支架植入术后的常见并发症。然而，在计算机断层扫描（CT）冠状动脉造影中，对支架管腔的评估受到多种因素的限制。我们的研究旨在通过双源 CT（DSCT）与冠状动脉造影比较，评估其对诊断冠状动脉支架内再狭窄（≥50%管腔狭窄）的准确性和可疑影响因素。

方法

50 例患者共 115 个支架，在冠状动脉造影前用 DSCT 评估冠状动脉支架内再狭窄（≥50%管腔狭窄）。两名独立的放射科专家在不了解冠状动脉造影结果的情况下对每个支架的通畅性进行分析。采用单因素和多因素分析评估诊断准确性与可疑因素（年龄、体重指数（BMI）、心率、心率变化、辐射剂量、图像质量、支架位置和支架特征（类型、材料、直径、长度和支架厚度））之间的关系。采用受试者工作特征（ROC）曲线评估 Logistic 回归模型的拟合情况。

结果

支架平均直径为（2.9±0.4）mm。DSCT 检测支架内再狭窄的灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为 69.2%、91.2%、50.0%、95.9%和 88.7%。在支架直径≥3.0mm的亚组中，灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为 100.0%、96.5%、75.0%、100.0%和 96.8%。支架直径<3.0mm和图像质量差与诊断准确性差相关（P<0.05）。ROC 曲线下面积为 0.79。