Sang Hoon Chung MD, Presenter: Nothing to Disclose

Byoung Wook Choi MD, Abstract Co-Author: Nothing to Disclose

Young-Jin Kim, Abstract Co-Author: Nothing to Disclose

Kyu Ok Choe MD, Abstract Co-Author: Nothing to Disclose

Yangsoo Jang MD, Abstract Co-Author: Nothing to Disclose

Jin Hur, Abstract Co-Author: Nothing to Disclose

Namsik Chung, Abstract Co-Author: Nothing to Disclose

Tae Hoon Kim, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

Sixty-four multi-slice computed tomography (MSCT) has showed high accuracy more than 90% in detecting significant stenosis, however, evaluation of in-stent lumen with MSCT has been known to be limited by stent artifacts. We wanted to determine the accuracy of 64-MSCT for detecting significant coronary arterial in-stent restenosis (ISR) compared with conventional coronary angiography (CCA).

Sixty-three patients (45 males and 18 females, mean age 62) after implantation of coronary artery stents (n=93) underwent CT coronary angiography by using 64-MSCT (gantry rotation: 0.33s). Images were reconstructed using edge-enhancing sharp kernel. Significant ISR was defined as in-stent luminal narrowing more than 50% in diameter in CCA. Two experienced radiologists determined presence of significant ISR with CT in consensus. The image quality (IQ) of CT was scored in 1 to 4 (better in larger number). Sensitivity, specificity, and positive and negative predictive values were calculated using CCA as gold standard of reference.

Three stents were determined unassessable and excluded in calculating accuracy. CCA showed significant ISR in 19 stents. The sensitivity, specificity, and positive and negative predictive values of CT were 78.9% (15 of 19), 78.9% (56 of 71), 50.0% (15 of 30) and 93.3% (56 of 60) for significant ISR. Only 11 (16.9%) of 65 stents with better IQ (score 3 and 4) were incorrectly diagnosed while 8 (32.0%) of 25 stents with worse IQ (score 1 and 2) were misdiagnosed. The mean stent diameter was 3.19±0.47 mm. All stents with diameter greater than 3.5mm in diameter (n=9) were correctly diagnosed. In other stents with diameter equal to or less than 3.5mm, the mean diameter of correctly diagnosed stents (n=71) was not significantly different from falsely diagnosed stents (n=19) (3.20±0.55mm vs. 3.05±0.32mm, p>0.05).

Accuracy of 64-MSCT for evaluation of significant ISR of coronary stents is mainly affected by image quality and stent diameter. Significant ISR can be excluded with a relatively high reliability.

64-MSCT can exclude significant ISR of coronary stents with a relatively high reliability

Chung, S, Choi, B, Kim, Y, Choe, K, Jang, Y, Hur, J, Chung, N, Kim, T, et al, , et al, , Evaluation of Coronary Artery In-Stent Restenosis by 64-slice Computed Tomography.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5009724.html