Multidetector computed tomography angiography for assessment of in-stent restenosis: meta-analysis of diagnostic performance.
BACKGROUND
Multi-detector computed tomography angiography (MDCTA)of the coronary arteries after stenting has been evaluated in multiple studies.The purpose of this study was to perform a structured review and meta-analysis of the diagnostic performance of MDCTA for the detection of in-stent restenosis in the coronary arteries.


METHODS
A Pubmed and manual search of the literature on in-stent restenosis (ISR) detected on MDCTA compared with conventional coronary angiography (CA) was performed. Bivariate summary receiver operating curve (SROC) analysis, with calculation of summary estimates was done on a stent and patient basis. In addition, the influence of study characteristics on diagnostic performance and number of non-assessable segments (NAP) was investigated with logistic meta-regression.


RESULTS
Fourteen studies were included. On a stent basis, Pooled sensitivity and specificity were 0.82(0.72-0.89) and 0.91 (0.83-0.96). Pooled negative likelihood ratio and positive likelihood ratio were 0.20 (0.13-0.32) and 9.34 (4.68-18.62) respectively. The exclusion of non-assessable stents and the strut thickness of the stents had an influence on the diagnostic performance. The proportion of non-assessable stents was influenced by the number of detectors, stent diameter, strut thickness and the use of an edge-enhancing kernel.


CONCLUSIONS
The sensitivity of MDTCA for the detection of in-stent stenosis is insufficient to use this test to select patients for further invasive testing as with this strategy around 20% of the patients with in-stent stenosis would be missed. Further improvement of scanner technology is needed before it can be recommended as a triage instrument in practice. In addition, the number of non-assessable stents is also high.
Vanhoenacker
Piet K
PK
Department of Radiology and Imaging, OLV Ziekenhuis, Aalst, Belgium. piet@vanhoenacker.be
Decramer
Isabel
I
Bladt
Olivier
O
Sarno
Giovanna
G
Van Hul
Erik
E
Wijns
William
W
Dwamena
Ben A
BA
D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D015607:Stents / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*