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KMID : 0882420090760040434
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Korean Journal of Medicine
2009 Volume.76 No. 4 p.434 ~ p.442
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Assessing stent restenosis using 64-multidetector computed tomography coronary angiography
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Seo Myeong-Gi
Koh Jin-Sin
Park So-Ra
Kang Young-Ran
Kang Min-Kyung
Cho Jung-Hyun
Ahn Yeon-Jeong
Choi Bong-Ryong
Jeong Young-Hoon
Kwak Choong-Hwan
Choi Ho-Cheol
Jeon Kyung-Nyeo
Hwang Jin-Yong
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Abstract
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Background/Aims: Multidetector computed tomography (MDCT) is considered to be a noninvasive, alternative method for evaluating stent restenosis. However, the diagnostic accuracy of 16-channel MDCT for stent stenosis is reported to have severe limitations because of high-attenuation stent-related artifacts. 64-channel MDCT, which recently became available in clinical practice, has better spatial and temporal resolution than 16-channel MDCT. The diagnostic accuracy of 64-channel MDCT for stent restenosis (in-segment and in-stent) was assessed by comparing it with conventional coronary angiography.
Methods: In-segment and in-stent restenosis (≥50% in diameter) were evaluated in 96 stent segments in 68 patients [61±12 years, 51 (75%) male] using both 64-channel MDCT and conventional coronary angiography. The in-stent analysis was confined to the portion of the artery covered by the stent and the in-segment analysis included the stent and 5 mm proximal or distal to the stent edges.
Results: The 64-channel MDCT could evaluate stent restenosis in 93 of 96 (97%) stent segments. Quantitative conventional coronary angiography found in-segment restenosis (≥50% in diameter) in 16 of 68 (23%) patients and 16 of 96 (17%) segments. For the patients with interpretable stent segments, the sensitivity, specificity, positive predictive value, and negative predictive value of 64-channel MDCT for in-segment restenosis per patient were 63, 96, 83, and 89%, respectively; per segment they were 63, 97, 83, and 93%, respectively; and for in-stent restenosis per stent they were 82, 98, 82, and 98%, respectively.
Conclusions: The diagnostic accuracy of 64-channel MDCT for assessing stent restenosis had high specificity and negative predictive value in the clinical setting. The 64-channel MDCT may be a promising, less-invasive imaging tool for stent restenosis, especially for the purpose of excluding stent restenosis.
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KEYWORD
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Coronary restenosis, Computed tomography
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