title: Multi-detector row CT angiography in the assessment of coronary in-stent restenosis: a systematic review.
abstract: OBJECTIVE
  The aim of this study was to perform a systematic review of the diagnostic accuracy of multi-detector row computed tomography angiography (MDCT) for detection of coronary in-stent restenosis in patients treated with coronary stenting when compared to invasive catheter angiography.
  
  
  METHODS
  A search of PUBMED and MEDLINE databases for English literature was performed. Only studies with at least 10 patients comparing 16- or more detector rows MDCT angiography with invasive catheter angiography in the detection of coronary in-stent restenosis (more than 50% stenosis) were included for analysis. Sensitivity and specificity estimates pooled across studies were tested using a fixed effects model.
  
  
  RESULTS
  15 studies met selection criteria for inclusion in the analysis. There were eight studies performed with 16-detector row CT scanners, and five studies with 64-detector row scanners and one study with a 40-detector scanner. The remaining study was performed with a mixture of 16-and 64-detector row scanners. Prevalence of in-stent restenosis following coronary stenting was 18% (95% CI: 13, 24%). Pooled estimates of the sensitivity and specificity of overall MDCT angiography for the detection of coronary in-stent restenosis was 85% (95% CI: 78, 90%) and 97% (95% CI: 95, 98%), respectively. No significant difference was found between 16- and 64-detector row scanners regarding the sensitivity and specificity of MDCT for assessment of in-stent restenosis (p>0.05).
  
  
  CONCLUSIONS
  The results showed that MDCT angiography (with 16 or more detector rows) has moderate sensitivity and high specificity for the detection of coronary in-stent restenosis when compared to invasive catheter angiography. A high specificity value of MDCT may be most valuable as a non-invasive technique of excluding coronary stent restenosis or occlusion. The main factors affecting visualization are stent diameters and stent materials.
authors.affiliation: Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University of Technology, GPO Box, U1987, Perth 6845, Western Australia, Australia. z.sun@curtin.edu.au
authors.forename: Zhonghua
authors.initials: Z
authors.lastname: Sun
authors.forename: Robert
authors.initials: R
authors.lastname: Davidson
authors.forename: Cheng Hsun
authors.initials: CH
authors.lastname: Lin
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000209:etiology*; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015607:Stents / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed / Q000379:methods*