title: Diagnostic accuracy of coronary in-stent restenosis using 64-slice computed tomography: comparison with invasive coronary angiography.
abstract: OBJECTIVE
  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 (> or =50%); and grade 4, neointimal proliferation with severe stenosis (> or =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.
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, Toyohashi-City, Aichi, Japan. momomar@muc.biglobe.ne.jp
authors.forename: Mariko
authors.initials: M
authors.lastname: Ehara
authors.forename: Masato
authors.initials: M
authors.lastname: Kawai
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Surmely
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Matsubara
authors.forename: Mitsuyasu
authors.initials: M
authors.lastname: Terashima
authors.forename: Etsuo
authors.initials: E
authors.lastname: Tsuchikane
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ito
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Takeda
authors.forename: Kenya
authors.initials: K
authors.lastname: Nasu
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Tanaka
authors.forename: Akira
authors.initials: A
authors.lastname: Murata
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujita
authors.forename: Koyo
authors.initials: K
authors.lastname: Sato
authors.forename: Atsuko
authors.initials: A
authors.lastname: Kodama
authors.forename: Osamu
authors.initials: O
authors.lastname: Katoh
authors.forename: Takahiko
authors.initials: T
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000145:classification / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D015607:Stents; D014057:Tomography, X-Ray Computed