Diagnostic Accuracy of 320-Row Multidetector Computed Tomography Coronary Angiography to Noninvasively Assess In-Stent Restenosis
OBJECTIVES:Percutaneous coronary intervention with stent implantation is routinely performed to treat patients with obstructive coronary artery disease. However, thus far, noninvasive assessment of in-stent restenosis has been challenging. Recently, 320-row multidetector computed tomography coronary...
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| Veröffentlicht in: | Investigative radiology 2010-06, Vol.45 (6), p.331-340 |
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| creator | de Graaf, Fleur R Schuijf, Joanne D van Velzen, Joëlla E Boogers, Mark J Kroft, Lucia J de Roos, Albert Reiber, Johannes H. C Sieders, Allard Spanó, Fabrizio Jukema, J Wouter Schalij, Martin J van der Wall, Ernst E Bax, Jeroen J |
| description | OBJECTIVES:Percutaneous coronary intervention with stent implantation is routinely performed to treat patients with obstructive coronary artery disease. However, thus far, noninvasive assessment of in-stent restenosis has been challenging. Recently, 320-row multidetector computed tomography coronary angiography (CTA) was introduced, allowing volumetric image acquisition of the heart in a single heart beat or gantry rotation. The aim of this study was to evaluate the diagnostic performance of 320-row CTA in the evaluation of significant in-stent restenosis. Invasive coronary angiography (ICA) served as the standard of reference, using a quantitative approach.
MATERIALS AND METHODS:The population consisted of patients with previous coronary stent implantation who were clinically referred for cardiac evaluation because of recurrent chest pain and who underwent both CTA and ICA. CTA studies were performed using a 320-row CTA scanner with 320 detector-rows, each 0.5 mm wide, and a gantry rotation time of 350 milliseconds. Tube voltage and current were adapted to body mass index and thoracic anatomy. The entire heart was imaged in a single heart beat, with a maximum of 16-cm craniocaudal coverage. During the scan, the ECG was registered simultaneously for prospective triggering of the data. First, CTA stent image quality was assessed using a 3-point grading scale(1) good image quality, (2) moderate image quality, and (3) poor image quality. Subsequently, the presence of in-stent restenosis was determined on a stent and patient basis by a blinded observer. Significant in-stent restenosis was defined as ≥50% luminal narrowing in the stent lumen or the presence of significant stent edge stenosis. Overlapping stents were considered to represent a single stent. Results were compared with ICA using quantitative coronary angiography. In addition, CTA stent image quality and diagnostic accuracy were related to stent characteristics and heart rate during CTA image acquisition.
RESULTS:The population consisted of 53 patients (37 men, mean age65 ± 13 years) with a total of 89 stents available for evaluation. ICA identified 12 stents (13%) with significant in-stent restenosis. A total of 7 stents (8%) were of nondiagnostic CTA stent image quality, and were considered positive. Sensitivity, specificity, positive, and negative predictive values were 92%, 83%, 46%, and 98%, respectively on a stent basis. Five CTA studies (9%) were of nondiagnostic quality for the evaluation of |
| doi_str_mv | 10.1097/RLI.0b013e3181dfa312 |
| format | Article |
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MATERIALS AND METHODS:The population consisted of patients with previous coronary stent implantation who were clinically referred for cardiac evaluation because of recurrent chest pain and who underwent both CTA and ICA. CTA studies were performed using a 320-row CTA scanner with 320 detector-rows, each 0.5 mm wide, and a gantry rotation time of 350 milliseconds. Tube voltage and current were adapted to body mass index and thoracic anatomy. The entire heart was imaged in a single heart beat, with a maximum of 16-cm craniocaudal coverage. During the scan, the ECG was registered simultaneously for prospective triggering of the data. First, CTA stent image quality was assessed using a 3-point grading scale(1) good image quality, (2) moderate image quality, and (3) poor image quality. Subsequently, the presence of in-stent restenosis was determined on a stent and patient basis by a blinded observer. Significant in-stent restenosis was defined as ≥50% luminal narrowing in the stent lumen or the presence of significant stent edge stenosis. Overlapping stents were considered to represent a single stent. Results were compared with ICA using quantitative coronary angiography. In addition, CTA stent image quality and diagnostic accuracy were related to stent characteristics and heart rate during CTA image acquisition.
RESULTS:The population consisted of 53 patients (37 men, mean age65 ± 13 years) with a total of 89 stents available for evaluation. ICA identified 12 stents (13%) with significant in-stent restenosis. A total of 7 stents (8%) were of nondiagnostic CTA stent image quality, and were considered positive. Sensitivity, specificity, positive, and negative predictive values were 92%, 83%, 46%, and 98%, respectively on a stent basis. Five CTA studies (9%) were of nondiagnostic quality for the evaluation of in-stent restenosis and were considered positive. Sensitivity, specificity, positive, and negative predictive values were 100%, 81%, 58%, and 100%, respectively on a patient level. Stent diameter <3 mm as well as stent strut thickness ≥140 μm were associated with decreased CTA stent image quality and diagnostic accuracy. Heart rate during CTA acquisition and stent overlap were not associated with image degradation.
CONCLUSIONS:The present results show that 320-row CTA allows accurate noninvasive assessment of significant in-stent restenosis. However, stents with a large diameter and thin struts allowed better in-stent visualization than stents with a small diameter or thick struts. Consequently, noninvasive assessment of in-stent restenosis using CTA may be an attractive and feasible alternative particularly in carefully selected patients.</description><identifier>ISSN: 0020-9996</identifier><identifier>EISSN: 1536-0210</identifier><identifier>DOI: 10.1097/RLI.0b013e3181dfa312</identifier><identifier>PMID: 20404736</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Coronary Angiography - methods ; Coronary Restenosis - diagnostic imaging ; Coronary Restenosis - etiology ; Female ; Graft Occlusion, Vascular - diagnostic imaging ; Graft Occlusion, Vascular - etiology ; Humans ; Male ; Middle Aged ; Reproducibility of Results ; Sensitivity and Specificity ; Stents - adverse effects ; Tomography, X-Ray Computed - methods</subject><ispartof>Investigative radiology, 2010-06, Vol.45 (6), p.331-340</ispartof><rights>2010 Lippincott Williams & Wilkins, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4212-a2a55e53dd5ccb7005dd066bc0702a727e3b9422dc087fd60a32a7d5cee66fec3</citedby><cites>FETCH-LOGICAL-c4212-a2a55e53dd5ccb7005dd066bc0702a727e3b9422dc087fd60a32a7d5cee66fec3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20404736$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>de Graaf, Fleur R</creatorcontrib><creatorcontrib>Schuijf, Joanne D</creatorcontrib><creatorcontrib>van Velzen, Joëlla E</creatorcontrib><creatorcontrib>Boogers, Mark J</creatorcontrib><creatorcontrib>Kroft, Lucia J</creatorcontrib><creatorcontrib>de Roos, Albert</creatorcontrib><creatorcontrib>Reiber, Johannes H. C</creatorcontrib><creatorcontrib>Sieders, Allard</creatorcontrib><creatorcontrib>Spanó, Fabrizio</creatorcontrib><creatorcontrib>Jukema, J Wouter</creatorcontrib><creatorcontrib>Schalij, Martin J</creatorcontrib><creatorcontrib>van der Wall, Ernst E</creatorcontrib><creatorcontrib>Bax, Jeroen J</creatorcontrib><title>Diagnostic Accuracy of 320-Row Multidetector Computed Tomography Coronary Angiography to Noninvasively Assess In-Stent Restenosis</title><title>Investigative radiology</title><addtitle>Invest Radiol</addtitle><description>OBJECTIVES:Percutaneous coronary intervention with stent implantation is routinely performed to treat patients with obstructive coronary artery disease. However, thus far, noninvasive assessment of in-stent restenosis has been challenging. Recently, 320-row multidetector computed tomography coronary angiography (CTA) was introduced, allowing volumetric image acquisition of the heart in a single heart beat or gantry rotation. The aim of this study was to evaluate the diagnostic performance of 320-row CTA in the evaluation of significant in-stent restenosis. Invasive coronary angiography (ICA) served as the standard of reference, using a quantitative approach.
MATERIALS AND METHODS:The population consisted of patients with previous coronary stent implantation who were clinically referred for cardiac evaluation because of recurrent chest pain and who underwent both CTA and ICA. CTA studies were performed using a 320-row CTA scanner with 320 detector-rows, each 0.5 mm wide, and a gantry rotation time of 350 milliseconds. Tube voltage and current were adapted to body mass index and thoracic anatomy. The entire heart was imaged in a single heart beat, with a maximum of 16-cm craniocaudal coverage. During the scan, the ECG was registered simultaneously for prospective triggering of the data. First, CTA stent image quality was assessed using a 3-point grading scale(1) good image quality, (2) moderate image quality, and (3) poor image quality. Subsequently, the presence of in-stent restenosis was determined on a stent and patient basis by a blinded observer. Significant in-stent restenosis was defined as ≥50% luminal narrowing in the stent lumen or the presence of significant stent edge stenosis. Overlapping stents were considered to represent a single stent. Results were compared with ICA using quantitative coronary angiography. In addition, CTA stent image quality and diagnostic accuracy were related to stent characteristics and heart rate during CTA image acquisition.
RESULTS:The population consisted of 53 patients (37 men, mean age65 ± 13 years) with a total of 89 stents available for evaluation. ICA identified 12 stents (13%) with significant in-stent restenosis. A total of 7 stents (8%) were of nondiagnostic CTA stent image quality, and were considered positive. Sensitivity, specificity, positive, and negative predictive values were 92%, 83%, 46%, and 98%, respectively on a stent basis. Five CTA studies (9%) were of nondiagnostic quality for the evaluation of in-stent restenosis and were considered positive. Sensitivity, specificity, positive, and negative predictive values were 100%, 81%, 58%, and 100%, respectively on a patient level. Stent diameter <3 mm as well as stent strut thickness ≥140 μm were associated with decreased CTA stent image quality and diagnostic accuracy. Heart rate during CTA acquisition and stent overlap were not associated with image degradation.
CONCLUSIONS:The present results show that 320-row CTA allows accurate noninvasive assessment of significant in-stent restenosis. However, stents with a large diameter and thin struts allowed better in-stent visualization than stents with a small diameter or thick struts. Consequently, noninvasive assessment of in-stent restenosis using CTA may be an attractive and feasible alternative particularly in carefully selected patients.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Coronary Angiography - methods</subject><subject>Coronary Restenosis - diagnostic imaging</subject><subject>Coronary Restenosis - etiology</subject><subject>Female</subject><subject>Graft Occlusion, Vascular - diagnostic imaging</subject><subject>Graft Occlusion, Vascular - etiology</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Reproducibility of Results</subject><subject>Sensitivity and Specificity</subject><subject>Stents - adverse effects</subject><subject>Tomography, X-Ray Computed - methods</subject><issn>0020-9996</issn><issn>1536-0210</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE-P0zAQxS0EYsvCN0DIN05ZxnYSN8eq_KtUQCrLOXLsSWtI4uJxtuqRb45Rdzlw4DSaN783o3mMvRRwI6DRb3bbzQ10IBQqsRSuN0rIR2whKlUXIAU8ZgsACUXTNPUVe0b0HXKvQT1lVxJKKLWqF-zXW2_2U6DkLV9ZO0djzzz0XGXnLpz4p3lI3mFCm0Lk6zAe54SO34Yx7KM5Hs5Zi2Ey8cxX094_iCnwz2Hy050hf4dDHhIhEd9MxdeEU-I7pFwDeXrOnvRmIHxxX6_Zt_fvbtcfi-2XD5v1alvYUgpZGGmqCivlXGVtpwEq56CuOwsapNFSo-qaUkpnYal7V4NRWc4wYl33aNU1e33Ze4zh55zPt6Mni8NgJgwztVqpSlUCVCbLC2ljIIrYt8fox_xiK6D9k32bs2__zT7bXt0fmLsR3V_TQ9gZWF6AUxgSRvoxzCeM7QHNkA7_3_0bPUOVqg</recordid><startdate>201006</startdate><enddate>201006</enddate><creator>de Graaf, Fleur R</creator><creator>Schuijf, Joanne D</creator><creator>van Velzen, Joëlla E</creator><creator>Boogers, Mark J</creator><creator>Kroft, Lucia J</creator><creator>de Roos, Albert</creator><creator>Reiber, Johannes H. C</creator><creator>Sieders, Allard</creator><creator>Spanó, Fabrizio</creator><creator>Jukema, J Wouter</creator><creator>Schalij, Martin J</creator><creator>van der Wall, Ernst E</creator><creator>Bax, Jeroen J</creator><general>Lippincott Williams & Wilkins, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201006</creationdate><title>Diagnostic Accuracy of 320-Row Multidetector Computed Tomography Coronary Angiography to Noninvasively Assess In-Stent Restenosis</title><author>de Graaf, Fleur R ; Schuijf, Joanne D ; van Velzen, Joëlla E ; Boogers, Mark J ; Kroft, Lucia J ; de Roos, Albert ; Reiber, Johannes H. C ; Sieders, Allard ; Spanó, Fabrizio ; Jukema, J Wouter ; Schalij, Martin J ; van der Wall, Ernst E ; Bax, Jeroen J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4212-a2a55e53dd5ccb7005dd066bc0702a727e3b9422dc087fd60a32a7d5cee66fec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Coronary Angiography - methods</topic><topic>Coronary Restenosis - diagnostic imaging</topic><topic>Coronary Restenosis - etiology</topic><topic>Female</topic><topic>Graft Occlusion, Vascular - diagnostic imaging</topic><topic>Graft Occlusion, Vascular - etiology</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Reproducibility of Results</topic><topic>Sensitivity and Specificity</topic><topic>Stents - adverse effects</topic><topic>Tomography, X-Ray Computed - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>de Graaf, Fleur R</creatorcontrib><creatorcontrib>Schuijf, Joanne D</creatorcontrib><creatorcontrib>van Velzen, Joëlla E</creatorcontrib><creatorcontrib>Boogers, Mark J</creatorcontrib><creatorcontrib>Kroft, Lucia J</creatorcontrib><creatorcontrib>de Roos, Albert</creatorcontrib><creatorcontrib>Reiber, Johannes H. C</creatorcontrib><creatorcontrib>Sieders, Allard</creatorcontrib><creatorcontrib>Spanó, Fabrizio</creatorcontrib><creatorcontrib>Jukema, J Wouter</creatorcontrib><creatorcontrib>Schalij, Martin J</creatorcontrib><creatorcontrib>van der Wall, Ernst E</creatorcontrib><creatorcontrib>Bax, Jeroen J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Investigative radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>de Graaf, Fleur R</au><au>Schuijf, Joanne D</au><au>van Velzen, Joëlla E</au><au>Boogers, Mark J</au><au>Kroft, Lucia J</au><au>de Roos, Albert</au><au>Reiber, Johannes H. C</au><au>Sieders, Allard</au><au>Spanó, Fabrizio</au><au>Jukema, J Wouter</au><au>Schalij, Martin J</au><au>van der Wall, Ernst E</au><au>Bax, Jeroen J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnostic Accuracy of 320-Row Multidetector Computed Tomography Coronary Angiography to Noninvasively Assess In-Stent Restenosis</atitle><jtitle>Investigative radiology</jtitle><addtitle>Invest Radiol</addtitle><date>2010-06</date><risdate>2010</risdate><volume>45</volume><issue>6</issue><spage>331</spage><epage>340</epage><pages>331-340</pages><issn>0020-9996</issn><eissn>1536-0210</eissn><abstract>OBJECTIVES:Percutaneous coronary intervention with stent implantation is routinely performed to treat patients with obstructive coronary artery disease. However, thus far, noninvasive assessment of in-stent restenosis has been challenging. Recently, 320-row multidetector computed tomography coronary angiography (CTA) was introduced, allowing volumetric image acquisition of the heart in a single heart beat or gantry rotation. The aim of this study was to evaluate the diagnostic performance of 320-row CTA in the evaluation of significant in-stent restenosis. Invasive coronary angiography (ICA) served as the standard of reference, using a quantitative approach.
MATERIALS AND METHODS:The population consisted of patients with previous coronary stent implantation who were clinically referred for cardiac evaluation because of recurrent chest pain and who underwent both CTA and ICA. CTA studies were performed using a 320-row CTA scanner with 320 detector-rows, each 0.5 mm wide, and a gantry rotation time of 350 milliseconds. Tube voltage and current were adapted to body mass index and thoracic anatomy. The entire heart was imaged in a single heart beat, with a maximum of 16-cm craniocaudal coverage. During the scan, the ECG was registered simultaneously for prospective triggering of the data. First, CTA stent image quality was assessed using a 3-point grading scale(1) good image quality, (2) moderate image quality, and (3) poor image quality. Subsequently, the presence of in-stent restenosis was determined on a stent and patient basis by a blinded observer. Significant in-stent restenosis was defined as ≥50% luminal narrowing in the stent lumen or the presence of significant stent edge stenosis. Overlapping stents were considered to represent a single stent. Results were compared with ICA using quantitative coronary angiography. In addition, CTA stent image quality and diagnostic accuracy were related to stent characteristics and heart rate during CTA image acquisition.
RESULTS:The population consisted of 53 patients (37 men, mean age65 ± 13 years) with a total of 89 stents available for evaluation. ICA identified 12 stents (13%) with significant in-stent restenosis. A total of 7 stents (8%) were of nondiagnostic CTA stent image quality, and were considered positive. Sensitivity, specificity, positive, and negative predictive values were 92%, 83%, 46%, and 98%, respectively on a stent basis. Five CTA studies (9%) were of nondiagnostic quality for the evaluation of in-stent restenosis and were considered positive. Sensitivity, specificity, positive, and negative predictive values were 100%, 81%, 58%, and 100%, respectively on a patient level. Stent diameter <3 mm as well as stent strut thickness ≥140 μm were associated with decreased CTA stent image quality and diagnostic accuracy. Heart rate during CTA acquisition and stent overlap were not associated with image degradation.
CONCLUSIONS:The present results show that 320-row CTA allows accurate noninvasive assessment of significant in-stent restenosis. However, stents with a large diameter and thin struts allowed better in-stent visualization than stents with a small diameter or thick struts. Consequently, noninvasive assessment of in-stent restenosis using CTA may be an attractive and feasible alternative particularly in carefully selected patients.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>20404736</pmid><doi>10.1097/RLI.0b013e3181dfa312</doi><tpages>10</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Coronary Angiography - methods Coronary Restenosis - diagnostic imaging Coronary Restenosis - etiology Female Graft Occlusion, Vascular - diagnostic imaging Graft Occlusion, Vascular - etiology Humans Male Middle Aged Reproducibility of Results Sensitivity and Specificity Stents - adverse effects Tomography, X-Ray Computed - methods |
| title | Diagnostic Accuracy of 320-Row Multidetector Computed Tomography Coronary Angiography to Noninvasively Assess In-Stent Restenosis |
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