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CLINICAL RESEARCH: COMPUTED TOMOGRAPHY ANGIOGRAPHY

Diagnostic Accuracy of Coronary In-Stent Restenosis Using 64-Slice Computed Tomography

Comparison With Invasive Coronary Angiography

Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.

Manuscript received June 26, 2006; revised manuscript received October 23, 2006, accepted October 30, 2006.

^_* Reprint requests and correspondence: Dr. Mariko Ehara, Toyohashi Heart Center, Department of Cardiology, 21-1, Gobutori Oyamacho, Toyohashi-City, Aichi 441-8530, Japan. (Email: momomar{at}muc.biglobe.ne.jp).

Objectives: This study sought to evaluate the diagnostic accuracy of coronary binary in-stent restenosis (ISR) with angiography using 64-slice multislice computed tomography coronary angiography (CTCA) compared with invasive coronary angiography (ICA).

Background: A noninvasive detection of ISR would result in an easier and safer way to conduct patient follow-up.

Methods: We performed CTCA in 81 patients after stent implantation, and 125 stented lesions were scanned. Two sets of images were reconstructed with different types of convolution kernels. On CTCA, neointimal proliferation was visually evaluated according to luminal contrast attenuation inside the stent. Lesions were graded as follows: grade 1, none or slight neointimal proliferation; grade 2, neointimal proliferation with no significant stenosis (<50%); grade 3, neointimal proliferation with moderate stenosis (50%); and grade 4, neointimal proliferation with severe stenosis (75%). Grades 3 and 4 were considered binary ISR. The diagnostic accuracy of CTCA compared with ICA was evaluated.

Results: By ICA, 24 ISRs were diagnosed. Sensitivity, specificity, positive predictive value, and negative predictive value were 92%, 81%, 54%, and 98% for the overall population, whereas values were 91%, 93%, 77%, and 98% when excluding unassessable segments (15 segments, 12%). For assessable segments, CTCA correctly diagnosed 20 of the 22 ISRs detected by ICA. Six lesions without ISR were overestimated as ISR by CTCA. As the grade of neointimal proliferation by CTCA increases, the median value of percent diameter stenosis increased linearly.

Conclusions: Binary ISR can be excluded with high probability by CTCA, with a moderate rate of false-positive results.

Abbreviations and Acronyms   CI = confidence interval   CT = computed tomography   CTCA = computed tomography coronary angiography   %DS = percent diameter stenosis   ICA = invasive coronary angiography   ISR = in-stent restenosis   MSCT = multislice computed tomography   NPV = negative predictive value   PPV = positive predictive value

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