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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

View larger version (56K): [in a new window]   Figure 1 Diagnosis of in-stent restenosis. A curved multiplanar reformatted (MPR) two-dimensional image of the long axis of the stent is shown (center). The proximal portion (upper) of the stent (A) shows lack of contrast enhancement in relation to the distal portion of the stent (B), demonstrating restenosis in the proximal portion of the stent (quantitative coronary angiography 78%, multidetector computed tomography grade 4). The center line is drawn along the long axis of the stent, and cross-sections taken perpendicular to the center line show lack of contrast in the proximal portion of the stent (A, right) and contrast enhancement in the distal portion of the stent (B, left).

View larger version (129K): [in a new window]   Figure 2 Two-dimensional reconstruction of three stents in curved multiplanar reformatted (MPR) format in long axis (below) and short axis perpendicular to the center line (above). (A) Stent fully patent, with homogeneous contrast enhancement throughout the long- and short-axis images (quantitative coronary angiography [QCA] 0%, multidectector computed tomography [MDCT] grade 1). (B) Partially restenosed stent showing lack of contrast enhancement in lower left portion of long-axis image and in crescent shaped portion of short-axis image taken from lower part of the stent (QCA 39%, MDCT grade 2). (C) An obstructed stent, showing lack of contrast enhancement throughout long- and short-axis images (QCA 100%, MDCT grade 4).

View larger version (29K): [in a new window]   Figure 3 Box and whisker plot (median value and quartiles) of angiographic in-segment coronary stenosis (measured by quantitative coronary angiography [QCA]) for each of the four grades of multidectector computed tomography (MDCT) narrowing (definitions in section "Reconstruction and analysis of MDCT scans"). Group 4 MDCT narrowing identified 80% of patients with 60% QCA restenosis, while restenosis was excluded in all but one outlier with MDCT grade 1 (stents not assessable by MDCT [n = 5, 4.5%] are not included in the figure).