Clinical Research
Computed Tomography Angiography
Diagnostic Accuracy of Coronary In-Stent Restenosis Using 64-Slice Computed Tomography: Comparison With Invasive Coronary Angiography

https://doi.org/10.1016/j.jacc.2006.10.065Get rights and content
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Objectives

This study sought to evaluate the diagnostic accuracy of coronary binary in-stent restenosis (ISR) with angiography using 64-slice multislice computed tomography coronary angiography (CTCA) compared with invasive coronary angiography (ICA).

Background

A noninvasive detection of ISR would result in an easier and safer way to conduct patient follow-up.

Methods

We performed CTCA in 81 patients after stent implantation, and 125 stented lesions were scanned. Two sets of images were reconstructed with different types of convolution kernels. On CTCA, neointimal proliferation was visually evaluated according to luminal contrast attenuation inside the stent. Lesions were graded as follows: grade 1, none or slight neointimal proliferation; grade 2, neointimal proliferation with no significant stenosis (<50%); grade 3, neointimal proliferation with moderate stenosis (≥50%); and grade 4, neointimal proliferation with severe stenosis (≥75%). Grades 3 and 4 were considered binary ISR. The diagnostic accuracy of CTCA compared with ICA was evaluated.

Results

By ICA, 24 ISRs were diagnosed. Sensitivity, specificity, positive predictive value, and negative predictive value were 92%, 81%, 54%, and 98% for the overall population, whereas values were 91%, 93%, 77%, and 98% when excluding unassessable segments (15 segments, 12%). For assessable segments, CTCA correctly diagnosed 20 of the 22 ISRs detected by ICA. Six lesions without ISR were overestimated as ISR by CTCA. As the grade of neointimal proliferation by CTCA increases, the median value of percent diameter stenosis increased linearly.

Conclusions

Binary ISR can be excluded with high probability by CTCA, with a moderate rate of false-positive results.

Abbreviations and Acronyms

CI
confidence interval
CT
computed tomography
CTCA
computed tomography coronary angiography
%DS
percent diameter stenosis
ICA
invasive coronary angiography
ISR
in-stent restenosis
MSCT
multislice computed tomography
NPV
negative predictive value
PPV
positive predictive value

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