Diagnostic Accuracy of Coronary In-Stent Restenosis Using 64-Slice Computed TomographyComparison With Invasive Coronary Angiography
Mariko Ehara, MD*,
Masato Kawai, RT,
Jean-François Surmely, MD,
Tetsuo Matsubara, MD,
Mitsuyasu Terashima, MD,
Etsuo Tsuchikane, MD,
Yoshihisa Kinoshita, MD,
Tatsuya Ito, MD,
Yoshihiro Takeda, MD,
Kenya Nasu, MD,
Nobuyoshi Tanaka, MD,
Akira Murata, MD,
Hiroshi Fujita, MD,
Koyo Sato, MD,
Atsuko Kodama, MD,
Osamu Katoh, MD and
Takahiko Suzuki, MD
Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
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Figure 1 Stent Images With 2 Different Convolution Kernels
A Cypher stent (3.5 x 13 mm) in the left main artery. (A) A multiplanar reformatted image, long-axis image generated with a smooth kernel (B30f), with 0.75-mm slice thickness (increment 0.4 mm). (B) A cross-sectional image generated with a smooth kernel. (C) A multiplanar reformatted image, long-axis image generated with a sharp kernel (B46f), with 0.6-mm slice thickness (increment 0.3 mm). (D) A cross-sectional image generated with a sharp kernel. A and B are suitable for delineating low-contrast objects such as coronary lumen or vessel wall, whereas C and D clearly visualize the high-density objects such as stent struts, but sometimes make much noise.
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Figure 2 Semiquantitative Classification of CTCA
The white lines on the figures show the sites of stents. A to D are Grade 1 (none or slight neointimal proliferation). (A) Two Cypher stents placed in the left main artery (3.5 x 18 mm) and the proximal left anterior descending artery (LAD) (3.5 x 23 mm). (B) A cross-section of the Cypher stent placed in the left main (LM) artery. (C) A cross-section of a Cypher stent placed in the LM. (D) Invasive coronary angiography (ICA) of the left coronary artery (LCA). E to G are Grade 2 (mild neointimal proliferation but no significant restenosis [<50% narrowing]). (E) A Cypher stent (3.5 x 23 mm) placed in the proximal LAD. (F) A cross-section. (G) An ICA of the LCA. H to J are Grade 3 (moderate neointimal proliferation with significant restenosis [ 50% narrowing]). (H) A Cypher stent (3.5 x 23 mm) placed in the proximal right coronary artery (RCA). (I) A cross-section. (J) An ICA of the RCA. K to M are Grade 4 (neointimal proliferation with severe stenosis or total occlusion [75% narrowing or occlusion]). (K) A Cypher stent (3 x 28 mm) placed in the proximal LAD. (L) A cross-section. (M) An ICA of the LCA. CTCA = computed tomographic coronary angiography.
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Figure 3 Correlation of Grades on CTCA With %DS
Graphic representation of grades on coronary angiography by computed tomography versus class on invasive coronary angiography is shown. The median value and quartiles are shown beside the plots. As the grade increases from 1 to 4, the median value of percent diameter stenosis (%DS) increases linearly. Abbreviations as in Figure 2.
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