title: Diagnosis of coronary in-stent restenosis with multidetector row spiral computed tomography.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Radiology, Lady Davis Carmel Medical Center, Haifa, Israel.
authors.forename: Tamar
authors.initials: T
authors.lastname: Gaspar
authors.forename: David A
authors.initials: DA
authors.lastname: Halon
authors.forename: Basil S
authors.initials: BS
authors.lastname: Lewis
authors.forename: Salim
authors.initials: S
authors.lastname: Adawi
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Schliamser
authors.forename: Ronen
authors.initials: R
authors.lastname: Rubinshtein
authors.forename: Moshe Y
authors.initials: MY
authors.lastname: Flugelman
authors.forename: Nathan
authors.initials: N
authors.lastname: Peled
mesh_terms: D023903:Coronary Restenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015607:Stents; D036542:Tomography, Spiral Computed