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CLINICAL RESEARCH: CARDIAC IMAGING

Usefulness of 64-Slice Multislice Computed Tomography Coronary Angiography to Assess In-Stent Restenosis

Filippo Cademartiri, MD, PhD^_*,,1, Joanne D. Schuijf, MSc^,,1, Francesca Pugliese, MD^_*, Nico R. Mollet, MD, PhD^_*,, J. Wouter Jukema, MD, PhD^,, Erica Maffei, MD, Lucia J. Kroft, MD, PhD, Alessandro Palumbo, MD, Diego Ardissino, MD, Patrick W. Serruys, MD, PhD^_*, Gabriel P. Krestin, MD, PhD^_*, Ernst E. Van der Wall, MD, PhD^,, Pim J. de Feyter, MD, PhD^_* and Jeroen J. Bax, MD, PhD^,_*

^_* Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
Department of Radiology and Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
Department of Radiology and Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands.

Manuscript received September 19, 2006; revised manuscript received January 22, 2007, accepted February 5, 2007.

^_* Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands. (Email: jbax{at}knoware.nl).

Objectives: This study sought to evaluate the diagnostic accuracy of 64-slice multislice computed tomography (MSCT) coronary angiography in the follow-up of patients with previous coronary stent implantation.

Background: Recent investigations have shown increased image quality and diagnostic accuracy for noninvasive coronary angiography with 64-slice MSCT as compared with previous-generation MSCT scanners, but data on the evaluation of coronary stents are scarce.

Methods: In 182 patients (152 [84%] male, ages 58 ± 11 years) with previous stent (2.5 mm diameter) implantation (n = 192), 64-slice MSCT angiography using either a Sensation 64 (Siemens, Forchheim, Germany) or Aquilion 64 (Toshiba, Otawara, Japan) was performed. At each center, coronary stents were evaluated by 2 experienced observers and evaluated for the presence of significant (50%) in-stent restenosis. Quantitative coronary angiography served as the standard of reference.

Results: A total of 14 (7.3%) stented segments were excluded because of poor image quality. In the interpretable stents, 20 of the 178 (11.2%) evaluated stents were significantly diseased, of which 19 were correctly detected by 64-slice MSCT. Accordingly, sensitivity, specificity, and positive and negative predictive value to identify in-stent restenosis in interpretable stents were 95.0% (95% confidence interval [CI] 85% to 100%), 93.0% (95% CI 90% to 97%), 63.3% (95% CI 46% to 81%), and 99.3% (95% CI 98% to 100%), respectively.

Conclusions: In-stent restenosis can be evaluated with 64-slice MSCT with good diagnostic accuracy. In particular, a high negative predictive value of 99% was observed, indicating that 64-slice MSCT may be most valuable as a noninvasive method of excluding in-stent restenosis.

Abbreviations and Acronyms   CI = confidence interval   ECG = electrocardiogram   MSCT = multislice computed tomography

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