冠状动脉支架内再狭窄：CT 冠状动脉成像评估。
Coronary in-stent restenosis: assessment with CT coronary angiography.
机构信息
Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy.
出版信息
Radiology. 2012 Nov;265(2):410-7. doi: 10.1148/radiol.12112363. Epub 2012 Sep 10.
PURPOSE
To compare accuracy and radiation exposure of a new computed tomographic (CT) scanner with improved spatial resolution (scanner A) with those of a CT scanner with standard spatial resolution (scanner B) for evaluation of coronary in-stent restenosis (ISR) by using invasive coronary angiography (ICA) and intravascular ultrasonography (US) as reference methods.
MATERIALS AND METHODS
Written informed consent was obtained and study protocol was approved by institutional ethics committee. A total of 180 consecutive patients (154 men [mean age ± standard deviation, 66 years±12; range, 51-79 years] and 36 women [mean age, 70 years±12; range, 55-83 years]) scheduled to undergo ICA for suspected ISR were enrolled. Ninety patients were studied with scanner A (group 1: 72 men [mean age, 65 years±11; range, 52-79], 18 women [mean age, 68 years±12; range, 55-83 years]) and 90 with scanner B (group 2: 74 men [mean age, 64 years±10; range, 51-77 years], 16 women [mean age, 68 years±11; range, 55-82 years). Examination with the two scanners was compared with ICA and intravascular US. Radiation dose exposure was estimated. To compare stent evaluability between the two groups, χ2 test was used.
RESULTS
Stent evaluability was higher in group 1 than in group 2 (99% vs 92%, P=.0021). A significantly lower rate of beam-hardening artifact was observed in group 1 (two cases) than group 2 (12 cases, P<.05). For stent-based analysis, sensitivity, specificity, and accuracy of multidetector CT for ISR identification were 96%, 95%, and 96% in group 1 and 90%, 91%, and 91% in group 2, respectively, without statistically significant differences. The correlation between percent ISR evaluated at multidetector CT versus intravascular US was higher in group 1 than in group 2 (r=0.89 vs r=0.58; P=.019). The correlations of diameter and area measurements at reference site and stent maximal lumen narrowing site between multidetector CT and intravascular US were higher in group 1 than in group 2. Radiation dose was low in both multidetector CT groups (1.9 mSv±0.2).
CONCLUSION
Scanner A, with improved spatial resolution, allowed reliable detection and quantification of coronary ISR with low radiation exposure.
目的
通过使用有创冠状动脉造影（ICA）和血管内超声（IVUS）作为参考方法，比较新型高空间分辨率计算机断层扫描（CT）扫描仪（扫描仪 A）和标准空间分辨率 CT 扫描仪（扫描仪 B）在评估冠状动脉支架内再狭窄（ISR）方面的准确性和辐射暴露。
材料和方法
书面知情同意书获得，并经机构伦理委员会批准。共纳入 180 例连续接受疑似 ISR 的 ICA 检查的患者（154 例男性[平均年龄±标准差，66 岁±12；范围，51-79 岁]和 36 例女性[平均年龄，70 岁±12；范围，55-83 岁]）。90 例患者接受扫描仪 A 检查（组 1：72 例男性[平均年龄，65 岁±11；范围，52-79 岁]，18 例女性[平均年龄，68 岁±12；范围，55-83 岁]），90 例接受扫描仪 B 检查（组 2：74 例男性[平均年龄，64 岁±10；范围，51-77 岁]，16 例女性[平均年龄，68 岁±11；范围，55-82 岁]）。比较两种扫描仪与 ICA 和 IVUS 的检查结果。估计辐射剂量暴露。为了比较两组的支架可评估性，采用 χ2 检验。
结果
组 1 的支架可评估性高于组 2（99%比 92%，P=.0021）。组 1 中观察到的束硬化伪影发生率明显低于组 2（2 例比 12 例，P<.05）。对于基于支架的分析，组 1 和组 2 中多排 CT 识别 ISR 的灵敏度、特异性和准确性分别为 96%、95%和 96%和 90%、91%和 91%，差异无统计学意义。组 1 中多排 CT 评估的 ISR 百分比与 IVUS 的相关性高于组 2（r=0.89 比 r=0.58；P=.019）。组 1 中参考部位和支架最大管腔狭窄部位的直径和面积测量值与 IVUS 的相关性高于组 2。两种多排 CT 组的辐射剂量均较低（1.9 mSv±0.2）。
结论
具有更高空间分辨率的扫描仪 A 可实现冠状动脉 ISR 的可靠检测和定量，同时辐射暴露较低。
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