Eldeeb Mohey E A, Mostafa Mohamed A, Nagiub Tarek A, Alshair Mohammed H E, Shehata Islam E
Department of Cardiovascular Medicine, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt.
Department of Cardiovascular Medicine, Kobry AlKobah Military Hospital, Military Medical Academy, Cairo, Egypt.
BMC Cardiovasc Disord. 2025 Aug 20;25(1):614. doi: 10.1186/s12872-025-04836-z.
Prior studies have assessed in-stent diameter restenosis (ISDR) in coronary arteries using 64-slice multidetector computed tomography coronary angiography (MDCT-CA) compared to invasive coronary angiography (ICA), which is the gold standard. This study aimed to compare the diagnostic accuracy of monoenergetic reconstruction using third-generation dual-source dual-energy CT (DSDECT) to that of ICA reconstruction via adjunctive intravascular ultrasonography (IVUS) for evaluating the ISDR.
A total of 95 patients with previously stented coronary arteries (involving 110 stents) underwent DSDECT followed by ICA and IVUS within a 24-h timeframe. The specificities, sensitivities, negative predictive values (NPVs), and positive predictive values (PPVs) of the DSDECT and ICA were compared for confirming or excluding the ISDR using in-stent area restenosis (ISAR) and a minimal luminal area (MLA) ≤ 4.0 mm on IVUS as the reference standard.
Compared with IVUS, the latest DSDECT demonstrated good sensitivity (100%), specificity (92.4%), and accuracy (96.1%) in detecting the ISDR. Our study highlights a limitation in assessability for stents with diameters < 3 mm, emphasizing the importance of careful patient selection. When employing an IVUS MLA of 4.0 mm as a reference for identifying the ISDR, no significant difference was observed between DSDECT and ICA in the identification of the ISDR. However, it is important to note that the use of absolute cut-offs, such as < 6.0 mm in the left main or < 4.0 mm, may not universally apply across varying ethnicities and between sexes. The interpretation of the minimal luminal area (MLA) should be considered in the context of individual patient characteristics, and caution is advised to avoid potential misleading conclusions based solely on absolute thresholds.
In summary, when assessing stent patency, the latest DSDECT exhibits similar performance to coronary angiography and IVUS. Moreover, it offers noninvasiveness, cost-effectiveness, and ease of operation, which are advantageous characteristics. However, it is essential to consider limitations in patient eligibility, including factors such as prior cardiac devices, arrhythmias, and any degree of chronic renal insufficiency, which may impact CT imaging analysis. The 100% negative predictive value (NPV) of third-generation DSDECT reliably excludes in-stent restenosis (ISDR), potentially obviating invasive angiography in stable patients with patent stents.
ZU-IRB#3915/13-8-2017 Registered 13 August 2017, email: IRB_123@medicine.zu.edu.eg.
既往研究已使用64层多排螺旋计算机断层扫描冠状动脉造影（MDCT-CA）与作为金标准的有创冠状动脉造影（ICA）相比较，评估冠状动脉内支架直径再狭窄（ISDR）情况。本研究旨在比较使用第三代双源双能量CT（DSDECT）的单能量重建与通过辅助血管内超声（IVUS）进行的ICA重建在评估ISDR方面的诊断准确性。
共有95例既往有冠状动脉支架置入史（涉及110个支架）的患者在24小时内先后接受了DSDECT检查，随后进行了ICA和IVUS检查。以血管内超声检查的支架内面积再狭窄（ISAR）和最小管腔面积（MLA）≤4.0 mm作为参考标准，比较DSDECT和ICA在确认或排除ISDR方面的特异性、敏感性、阴性预测值（NPV）和阳性预测值（PPV）。
与IVUS相比，最新的DSDECT在检测ISDR方面表现出良好的敏感性（100%）、特异性（92.4%）和准确性（96.1%）。我们的研究突出了直径<3 mm支架可评估性方面的局限性，强调了仔细选择患者的重要性。当采用IVUS的MLA为4.0 mm作为识别ISDR的参考标准时，DSDECT和ICA在识别ISDR方面未观察到显著差异。然而，需要注意的是，使用绝对临界值，如左主干<6.0 mm或<4.0 mm，可能并非普遍适用于不同种族和性别。最小管腔面积（MLA）的解读应结合个体患者特征来考虑，建议谨慎行事，避免仅基于绝对阈值得出潜在的误导性结论。
总之，在评估支架通畅性时，最新的DSDECT表现出与冠状动脉造影和IVUS相似的性能。此外，它具有非侵入性、成本效益高和操作简便等优点。然而，必须考虑患者入选方面的局限性，包括既往心脏装置、心律失常和任何程度的慢性肾功能不全等可能影响CT成像分析的因素。第三代DSDECT的100%阴性预测值（NPV）可靠地排除了支架内再狭窄（ISDR），对于支架通畅的稳定患者可能无需进行有创血管造影。
ZU-IRB#3915/13-8-2017，于2017年8月13日注册，电子邮件：IRB_123@medicine.zu.edu.eg。
