Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Int J Cardiol. 2019 Jan 1;274:382-387. doi: 10.1016/j.ijcard.2018.09.010. Epub 2018 Sep 8.
To evaluate image quality, interpretability, diagnostic accuracy and radiation exposure of coronary CT angiography (CCTA) performed with a new scanner equipped with 0.23-mm spatial resolution, new generation iterative reconstruction, 0.28-second gantry rotation time and intra-cycle motion-correction algorithm in consecutive patients with coronary stents, including those with high heart rate (HR) and atrial fibrillation (AF).
We enrolled 100 consecutive patients (85 males, mean age 65 ± 10 years) with previous coronary stent implantation scheduled for clinically indicated non-emergent invasive coronary angiography (ICA). Image quality, coronary interpretability and diagnostic accuracy vs. ICA were evaluated and the effective dose (ED) was recorded.
Mean HR during the scan was 67 ± 13 bpm. Twenty-six patients had >65 bpm HR during scanning and 13 patients had AF. Overall, image quality was high (Likert = 3.2 ± 0.9). Stent interpretability was 95.8% (184/192 stents). Among 192 stented segments, CCTA correctly identified 22 out of 24 with >50% in-stent restenosis (ISR) (sensitivity 92%). In a stent-based analysis, specificity, positive and negative predictive values and diagnostic accuracy for ISR detection were 91%, 99%, 60% and 91%, respectively. In a patient-based analysis, CCTA diagnostic accuracy was 85%. Overall, mean ED of CCTA was 2.4 ± 1.2 mSv.
A whole-organ CT scanner was able to evaluate coronary stents with good diagnostic performance and low radiation exposure, also in presence of unfavorable HR and heart rhythm.
The present study is the first to evaluate the CCTA capability of detecting in-stent restenosis in consecutive patients, including those with high HR and AF, using a recent scanner generation that combines improved spatial and temporal resolution with wide coverage. Using the whole-organ high-definition CT scanner we obtained high quality images of coronary stents with good interpretability and diagnostic accuracy combined with low radiation exposure, even in patients with unfavorable HR or heart rhythm for CCTA evaluation.
评估配备 0.23 毫米空间分辨率、新一代迭代重建、0.28 秒机架旋转时间和循环内运动校正算法的新型扫描仪进行冠状动脉 CT 血管造影（CCTA）的图像质量、可解释性、诊断准确性和辐射暴露，用于连续冠状动脉支架植入患者，包括心率（HR）较高和心房颤动（AF）患者。
我们纳入了 100 例连续患者（85 例男性，平均年龄 65±10 岁），这些患者因先前的冠状动脉支架植入而接受临床指征的非紧急侵入性冠状动脉造影（ICA）。评估了图像质量、冠状动脉可解释性和与 ICA 的诊断准确性，并记录了有效剂量（ED）。
扫描期间的平均 HR 为 67±13 bpm。26 例患者在扫描期间 HR 超过 65 bpm，13 例患者患有 AF。总体而言，图像质量较高（Likert=3.2±0.9）。支架可解释性为 95.8%（184/192 个支架）。在 192 个支架段中，CCTA 正确识别出 24 个支架中有 22 个存在>50%的支架内再狭窄（ISR）（敏感性 92%）。在支架为基础的分析中，ISR 检测的特异性、阳性和阴性预测值和诊断准确性分别为 91%、99%、60%和 91%。在患者为基础的分析中，CCTA 的诊断准确性为 85%。总体而言，CCTA 的平均 ED 为 2.4±1.2 mSv。
全器官 CT 扫描仪能够以良好的诊断性能和低辐射暴露评估冠状动脉支架，即使在不利的 HR 和心律存在的情况下也是如此。
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