title: In-stent area stenosis on 64-slice multi-detector computed tomography coronary angiography: optimal cutoff value for minimum lumen cross-sectional area of coronary stents compared with intravascular ultrasound.
abstract: We aimed to prospectively assess the optimal cutoff value for a minimum lumen cross-sectional area (CSA) on a 64-slice multidetector computed tomography (MDCT) compared with an intravascular ultrasound (IVUS). In 39 patients with 43 stents, the minimum lumen diameter, stent diameter, diameter stenosis, minimum lumen CSA, stent CSA, and area stenosis at the narrowest point were measured independently on 64-slice MDCT and IVUS images. For the assessment of diameter and CSA, 64-slice MDCT showed good correlations with IVUS (r = 0.82 for minimum lumen diameter, r = 0.66 for stent diameter, r = 0.79 for minimum lumen CSA, and r = 0.75 for stent CSA, respectively, P < 0.0001). For the assessment of diameter and area stenoses, a 64-slice MDCT showed good correlations with IVUS (r = 0.89 and 0.91, respectively, P < 0.0001). The overall sensitivity, specificity, positive predictive value, and negative predictive value to detect in-stent area restenosis (≥ 50 % area stenosis) of a 64-slice MDCT were 77, 100, 100, and 91 %, respectively. The cutoff value of a 64-slice MDCT, determined by receiver operator characteristic (ROC) analysis, was 5.0 mm(2) with 76.5 % sensitivity and 92.3 % specificity for significant in-stent area restenosis; the area under the ROC curve was 0.902 (P < 0.0001). A good correlation was found between a 64-slice MDCT and the IVUS, regarding the assessment of diameter and area stenoses of coronary stents in selected patients implanted with stents of more than 3 mm in diameter. Optimal cutoff value for the minimum lumen CSA of coronary stents on the 64-slice MDCT is 5 mm(2) to predict a CSA of 4 mm(2) on IVUS.
authors.affiliation: Department of Radiology, Yonsei University Wonju College of Medicine, Wonju Christian Hospital, Wonju, Republic of Korea.
authors.forename: Woocheol
authors.initials: W
authors.lastname: Kwon
authors.forename: Jiyoun
authors.initials: J
authors.lastname: Choi
authors.forename: Jang-Young
authors.initials: JY
authors.lastname: Kim
authors.forename: Seong-Yoon
authors.initials: SY
authors.lastname: Kim
authors.forename: Junghan
authors.initials: J
authors.lastname: Yoon
authors.forename: Kyoung-Hoon
authors.initials: KH
authors.lastname: Choe
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Lee
authors.forename: Sung Gyun
authors.initials: SG
authors.lastname: Ahn
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D012372:ROC Curve; D056910:Republic of Korea; D012680:Sensitivity and Specificity; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional