320层螺旋CT冠状动脉血管造影对评估支架内再狭窄的诊断价值
[Diagnostic value of 320-slice computed tomography coronary angiography to assess in-stent restenosis].
作者信息
Wang Jian, Chen Xiao-min, Wang Sheng-huang, Ye Hong-hua, Cui Han-bin, Du Wei-ping, Zhou Hong-lin, Feng Ming-jun, Pan Yu-ning, Lin Shao-yi
机构信息
Department of Cardiology, Ningbo First Hospital Affiliated to Ningbo University, Ningbo 315000, China.
出版信息
Zhonghua Xin Xue Guan Bing Za Zhi. 2012 Jun;40(6):487-91.
OBJECTIVE
To evaluate the diagnostic accuracy of 320-slice CT coronary angiography (CTA) in the evaluation of in-stent restenosis (ISR, ≥50% luminal narrowing) in comparison with quantitative coronary angiography (CAG).
METHODS
A total of 69 patients with previous stent implantation who underwent both CTA and CAG were prospectively included. We assessed diagnostic valve for ISR with CTA in comparison with CAG.
RESULTS
A total of 110 stents were implanted in these patients.CAG identified 14 ISR. CTA correctly identified 13 ISR and misdiagnosed 5 ISR in stents without ISR. Besides, 6 stents could not be evaluated by CTA due to unsatisfied image quality. Accordingly, sensitivity, specificity, positive and negative predictive value of CTA for diagnosing ISR were 93%, 89%, 54% and 99%, respectively. The image quality of CTA was significantly better in larger stents (percentages of good and moderate stent image of ≥3.0 mm and <3.0 mm: 56% vs. 27%, 25% vs. 49%) and which was linked with better diagnostic coincidence rate (95% vs. 78%) for larger stents. The image quality of CTA was significantly better in stents with thinner stent strut thickness (percentages of poor CTA stent image quality of stent strut thickness<140 µm and ≥140 µm: 12% vs. 45%, P<0.01) and which was associated with better diagnostic coincidence rate for stents with thinner stent strut thickness (94% vs. 76%, P<0.05). The image quality of CTA was also significantly better in single stent (percentages of poor CTA stent image quality of single stent vs. overlap and dedicated stent: 17% vs. 36%, P<0.05). However, heart rate (≥65 beats/min vs. <65 beats/min) during CTA acquisition was not associated with image quality and the diagnostic coincidence rate (all P>0.05).
CONCLUSIONS
Our results indicate that 320-slice CTA allows accurate noninvasive assessment of significant in-stent restenosis in selected patients. Stents with a large diameter and thin struts are associated with better image quality and higher diagnostic accuracy.
目的
与定量冠状动脉造影（CAG）相比，评估320层CT冠状动脉造影（CTA）对支架内再狭窄（ISR，管腔狭窄≥50%）的诊断准确性。
方法
前瞻性纳入69例曾接受支架植入且同时接受CTA和CAG检查的患者。我们将CTA对ISR的诊断效能与CAG进行比较。
结果
这些患者共植入110枚支架。CAG识别出14例ISR。CTA正确识别出13例ISR，误诊了5例无ISR的支架。此外，由于图像质量不佳，6枚支架无法通过CTA评估。因此，CTA诊断ISR的敏感性、特异性、阳性预测值和阴性预测值分别为93%、89%、54%和99%。较大支架的CTA图像质量明显更好（直径≥3.0 mm和<3.0 mm的支架图像质量良好和中等的百分比：56%对27%，25%对49%），且较大支架的诊断符合率更高（95%对78%）。支架支柱厚度较薄的支架，其CTA图像质量明显更好（支架支柱厚度<140 µm和≥140 µm的CTA支架图像质量差的百分比：12%对45%，P<0.01），且支架支柱厚度较薄的支架诊断符合率更高（94%对76%，P<0.05）。单枚支架的CTA图像质量也明显更好（单枚支架与重叠和专用支架的CTA支架图像质量差的百分比：17%对36%，P<0.05）。然而，CTA采集期间的心率（≥65次/分钟与<65次/分钟）与图像质量和诊断符合率均无关（所有P>0.05）。
结论
我们的结果表明，320层CTA能够对部分患者的显著支架内再狭窄进行准确的无创评估。直径大且支柱薄的支架与更好的图像质量和更高的诊断准确性相关。
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