EXPEDITED REVIEW
Diagnosis of Coronary In-Stent Restenosis With Multidetector Row Spiral Computed Tomography
Tamar Gaspar, MD*, ,
David A. Halon, MB, ChB, FACC ,,*,
Basil S. Lewis, MD, FRCP, FACC,,
Salim Adawi, MD,,
Jorge E. Schliamser, MD,,
Ronen Rubinshtein, MD,,
Moshe Y. Flugelman, MD, and
Nathan Peled, MD*,
* Department of Radiology, Lady Davis Carmel Medical Center, Haifa, Israel
Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel
Ruth and Bruce Rappaport School of Medicine, Technion—Israel Institute of Technology, Haifa, Israel
Manuscript received February 27, 2005;
revised manuscript received May 8, 2005,
accepted July 20, 2005.
* Reprint requests and correspondence: Dr. David A. Halon, Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa 34362, Israel (Email: halon{at}clalit.org.il).
OBJECTIVES: The purpose of this study was to assess the accuracy of a new generation spiral multidetector computed tomography (MDCT) scanner (Brilliance 40, Philips Medical Systems, Cleveland, Ohio) in the diagnosis of coronary in-stent restenosis (ISR).
BACKGROUND: Noninvasive imaging of ISR would be clinically useful, but artifacts caused by metallic stent struts have limited the role of early generation MDCT scanners.
METHODS: We examined 65 patients (age 63 ± 12 years, 48 [73.8%] men) with 111 implanted coronary stents who were referred for repeat invasive coronary angiography (ICA). Patients underwent 40-slice MDCT one to three days before scheduled ICA, using intravenous contrast enhancement. Images were reconstructed in multiple formats using retrospective electrocardiographic gating. Stents were viewed in their long and short axes and luminal contrast attenuation graded from MDCT grade 1 (minimal restenosis) to 4 (severe restenosis) by consensus of two observers.
RESULTS: In-stent restenosis ( 60% luminal narrowing by quantitative coronary angiography) was found on ICA in 18 (16.2%) of the stented segments and in 16 (24.6%) patients. The MDCT findings correlated with ICA restenosis, with restenosis in only 1 of 59 (1.6%) MDCT grade 1 segments, but in more than three-quarters (12 of 15, 80%) of MDCT grade 4 segments (sensitivity 72.2%, specificity 92.5%, positive predictive value [PPV] 65.0%, negative predictive value [NPV] 94.5% [five stents not assessable by MDCT considered as restenosis]). Using MDCT grades 3 or 4 combined for restenosis, sensitivity of MDCT was 88.9%, specificity 80.6%, PPV 47.1%, and NPV 97.4%.
CONCLUSIONS: In-stent restenosis can be diagnosed with moderate sensitivity using a new generation 40-slice MDCT scanner. The high NPV implies a significant role for MDCT in excluding ISR.
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Abbreviations and Acronyms
| | CI = confidence interval | | ICA = invasive coronary angiography | | ISR = in-stent restenosis | | MDCT = multidetector computed tomography | | NPV = negative predictive value | | PA = predictive accuracy | | PPV = positive predictive value | | QCA = quantitative coronary angiography | | SVG = saphenous vein bypass graft |
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