Usefulness of 64-slice multislice computed tomography coronary angiography to assess in-stent restenosis.
OBJECTIVE
This study sought to evaluate the diagnostic accuracy of 64-slice multislice computed tomography (MSCT) coronary angiography in the follow-up of patients with previous coronary stent implantation.


BACKGROUND
Recent investigations have shown increased image quality and diagnostic accuracy for noninvasive coronary angiography with 64-slice MSCT as compared with previous-generation MSCT scanners, but data on the evaluation of coronary stents are scarce.


METHODS
In 182 patients (152 [84%] male, ages 58 +/- 11 years) with previous stent (> or =2.5 mm diameter) implantation (n = 192), 64-slice MSCT angiography using either a Sensation 64 (Siemens, Forchheim, Germany) or Aquilion 64 (Toshiba, Otawara, Japan) was performed. At each center, coronary stents were evaluated by 2 experienced observers and evaluated for the presence of significant (> or =50%) in-stent restenosis. Quantitative coronary angiography served as the standard of reference.


RESULTS
A total of 14 (7.3%) stented segments were excluded because of poor image quality. In the interpretable stents, 20 of the 178 (11.2%) evaluated stents were significantly diseased, of which 19 were correctly detected by 64-slice MSCT. Accordingly, sensitivity, specificity, and positive and negative predictive value to identify in-stent restenosis in interpretable stents were 95.0% (95% confidence interval [CI] 85% to 100%), 93.0% (95% CI 90% to 97%), 63.3% (95% CI 46% to 81%), and 99.3% (95% CI 98% to 100%), respectively.


CONCLUSIONS
In-stent restenosis can be evaluated with 64-slice MSCT with good diagnostic accuracy. In particular, a high negative predictive value of 99% was observed, indicating that 64-slice MSCT may be most valuable as a noninvasive method of excluding in-stent restenosis.
Cademartiri
Filippo
F
Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Schuijf
Joanne D
JD
Pugliese
Francesca
F
Mollet
Nico R
NR
Jukema
J Wouter
JW
Maffei
Erica
E
Kroft
Lucia J
LJ
Palumbo
Alessandro
A
Ardissino
Diego
D
Serruys
Patrick W
PW
Krestin
Gabriel P
GP
Van der Wall
Ernst E
EE
de Feyter
Pim J
PJ
Bax
Jeroen J
JJ
D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*; D036542:Tomography, Spiral Computed / Q000379:methods*