Assessment of in-stent restenosis using 64-MDCT: analysis of the CORE-64 Multicenter International Trial.
OBJECTIVE
Evaluations of stents by MDCT from studies performed at single centers have yielded variable results with a high proportion of unassessable stents. The purpose of this study was to evaluate the accuracy of 64-MDCT angiography (MDCTA) in identifying in-stent restenosis in a multicenter trial.


METHODS
The Coronary Evaluation Using Multidetector Spiral Computed Tomography Angiography Using 64 Detectors (CORE-64) Multicenter Trial and Registry evaluated the accuracy of 64-MDCTA in assessing 405 patients referred for coronary angiography. A total of 75 stents in 52 patients were assessed: 48 of 75 stents (64%) in 36 of 52 patients (69%) could be evaluated. The prevalence of in-stent restenosis by quantitative coronary angiography (QCA) in this subgroup was 23% (17/75). Eighty percent of the stents were <or=3.0 mm in diameter.


RESULTS
The overall sensitivity, specificity, positive predictive value, and negative predictive value to detect 50% in-stent stenosis visually using MDCT compared with QCA was 33.3%, 91.7%, 57.1%, and 80.5%, respectively, with an overall accuracy of 77.1% for the 48 assessable stents. The ability to evaluate stents on MDCTA varied by stent type: Thick-strut stents such as Bx Velocity were assessable in 50% of the cases; Cypher, 62.5% of the cases; and thinner-strut stents such as Taxus, 75% of the cases. We performed quantitative assessment of in-stent contrast attenuation in Hounsfield units and correlated that value with the quantitative percentage of stenosis by QCA. The correlation coefficient between the average attenuation decrease and >or=50% stenosis by QCA was 0.25 (p=0.073). Quantitative assessment failed to improve the accuracy of MDCT over qualitative assessment.


CONCLUSIONS
The results of our study showed that 64-MDCT has poor ability to detect in-stent restenosis in small-diameter stents. Evaluability and negative predictive value were better in large-diameter stents. Thus, 64-MDCT may be appropriate for stent assessment in only selected patients.
Wykrzykowska
Joanna J
JJ
Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Arbab-Zadeh
Armin
A
Godoy
Gustavo
G
Miller
Julie M
JM
Lin
Shezhang
S
Vavere
Andrea
A
Paul
Narinder
N
Niinuma
Hiroyuki
H
Hoe
John
J
Brinker
Jeffrey
J
Khosa
Faisal
F
Sarwar
Sheryar
S
Lima
Joao
J
Clouse
Melvin E
ME
D000368:Aged; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging*; D006801:Humans; D007479:Iopamidol; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D015607:Stents; D036542:Tomography, Spiral Computed / Q000379:methods*
D003287:Contrast Media; D007479:Iopamidol