Diagnostic Accuracy of 320-Row Multidetector Computed Tomography Coronary Angiography to Noninvasively Assess In-Stent Restenosis

Graaf, Fleur R. de; Schuijf, Joanne D.; Velzen, J.E. van; Boogers, Mark J.; Kroft, Lucia J.M.; Roos, Albert de; Reiber, J. H. C.; Sieders, Allard; Spanó, Fabrizio; Jukema, J. Wouter; Schalij, Martin J.; Wall, Ernst E. van der; Bax, Jeroen J.

doi:10.1097/rli.0b013e3181dfa312

Cited by 91 publications

(42 citation statements)

References 36 publications

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“…Recently, two studies using the new CT generations like 256-slice and 320-slice [36][37][38][39] have been published. In these initial studies only few patients with high CACS ([1,000) were included.…”

Section: Discussionmentioning

confidence: 99%

Influence of coronary calcification on the diagnostic accuracy of 64-slice computed tomography coronary angiography: a systematic review and meta-analysis

Abdulla

Pedersen

Budoff

et al. 2011

Int J Cardiovasc Imaging

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To determine via meta-analysis the diagnostic accuracy of 64-slice computed tomography coronary angiography (CTA) for assessment of significant obstructive coronary artery stenosis at different coronary artery calcium score (CACS) levels. Data of 12,053 versus 5,890 segments, 906 versus 758 arteries and 1,120 versus 514 patients in low versus high CACS subgroups from 19 eligible studies were compared. The per-patient prevalence of coronary artery disease was 48% versus 68%, respectively. Subgroups were stratified by different CACS thresholds ranging from 100 to 400. Meta-analyses of per-patient data comparing overall low versus high CACS subgroups resulted in a sensitivity of 97.5 (95.5-99)% versus 97 (94.5-98.5)%, specificity of 85 (82-88)% versus 66.5 (58-74.5)%, diagnostic odds ratio of 153 (81-290) versus 40 (20-83), positive predictive value of 85 (82-87)% versus 86 (84-88)%, negative predictive value of 97.5 (95-99)% versus 91 (88-94)% and overall accuracy of 91% versus 89% with 95% confidence interval, respectively. The drop in specificity was significant (P = 0.035), while the sensitivity and overall accuracy were insignificantly changed (P > 0.05). Meta-analyses of independent subgroups at CACS levels ≤10 and ≤100 demonstrated high specificities of 90 (94-100)% and 88.5 (81-91.5)%, whereas at CACS levels ≥400 the specificity declined significantly to 42 (28-56)% but with consistently retained high sensitivity of 97.5 (94-99)%. The specificity of CTA decreases with increasing CACS, while the sensitivity remains high independent of that. The suggested CACS thresholds are arbitrary and do not necessarily warrant cancelling angiography. Diagnostic studies are needed to explore whether a specific CACS threshold may serve as a pre-angiographic gatekeeper to prevent likely equivocal angiographies.

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Section: Discussionmentioning

confidence: 99%

Influence of coronary calcification on the diagnostic accuracy of 64-slice computed tomography coronary angiography: a systematic review and meta-analysis

Abdulla

Pedersen

Budoff

et al. 2011

Int J Cardiovasc Imaging

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“…For example, thick-strut stents (>140 μm) are reported to have low sensitivity on MDCT as compared with thin-strut stents (<140 μm). [20][21][22][23] Another report suggested that tantalum, gold or gold-coated stents, and covered stent grafts had reduced visualization of the lumen compared with stainless steel or cobalt stents. 24 The present study included both 2.25-mm and 2.5-mm stents (a total of 105/33.2%), classified as small stents, but Cypher stent was used at a high rate (62.3%), these being made of stainless steel, but with a strut thickness of 140 μm which provides severe artifacts on evaluation of the in-stent lumen.…”

Section: Discussionmentioning

confidence: 99%

Assessment of In-Stent Restenosis Using High-Definition Computed Tomography With a New Gemstone Detector

Tsuda

Ishii

Ichimiya

et al. 2015

Circ J

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1542TSUDA T et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jpMoreover, stents with diameter <3 mm are reported to have lower assessability than those ≥3 mm. 16 As an alternative method, stress tests could be used for non-invasive detection of ISR, but unfortunately the diagnostic accuracy is not so high. Although invasive coronary angiography (ICA) is the most reliable method for assessing ISR, there are disadvantages due to the possible serious complications during the procedure, and high cost. Thus, CTCA is the preferred modality to detect ISR in patients undergoing previous coronary stent implantation because it can visualize the in-stent lumen, non-invasively. Discovery CT 750HD (GE Healthcare Technologies, WI, USA) is a high-definition CT (HDCT) machine with a new gemstone detector (GE Gemstone TM detector). Gemstone is a complex rare earth-based oxide that has a chemically replicated garnet crystal structure, and has a primary speed of only 30 ns (100-fold faster than existing detectors) and low afterglow (4 times lower), which is a key contributor to fast kVP switching acquisition through its scintillator and data ercutaneous coronary intervention with stent implantation reduces restenosis of culprit lesions compared with plain-old balloon angioplasty alone. 1,2 Moreover, drug-eluting stents (DES) have remarkably improved results by preventing excessive neo-intimal hyperplasia of coronary arteries, 3,4 so that they are now widely used for small vessels, long lesions, and those with bifurcations, for example. 5,6 But even in the DES era, lesion complexity or patient comorbidities are related to restenosis. 7 Recently, computed tomography coronary angiography (CTCA) has become established in the non-invasive assessment of coronary stents. Multi-slice computed tomography (MSCT) or multi-detector computed tomography (MDCT) with 64-slice technology has improved the spatial resolution with a sensitivity of 82-95% and a specificity of 82-98% for de novo lesions of the coronary artery. 8, 9 Reports so far have indicated that MSCT or MDCT have a sensitivity of 90-95%, and a specificity of 73-93% for detecting in-stent restenosis (ISR). 10-15 It is sometimes difficult, however, to assess in-stent lumens due to stent strut artifacts. Background: Until now, there have been few reports on the accuracy of in-stent restenosis (ISR) detection using high-definition computed tomography (HDCT). The purpose of this study was to assess ISR using HDCT with a new gemstone detector and to examine the diagnostic accuracy compared with invasive coronary angiography.

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“…The development of CT scanners and scanning protocols continues to evolve. The diagnostic accuracy of coronary CTA with 256 and 320 detector rows was reported in small (n ϭ 64 to 104) single-center studies by Chao et al (22) and de Graaf et al (23). In patient-based analyses, the sensitivity to detect Ն50% diameter stenoses identified on invasive coronary angiography was 99% to 100%; with a specificity of 50% to 88%.…”

Section: Diagnosis: Cadmentioning

confidence: 92%

The Year in Cardiac Imaging

Gibbons¹,

Araoz²,

Gerber³

2012

Journal of the American College of Cardiology

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Diagnostic Accuracy of 320-Row Multidetector Computed Tomography Coronary Angiography to Noninvasively Assess In-Stent Restenosis

Cited by 91 publications

References 36 publications

Influence of coronary calcification on the diagnostic accuracy of 64-slice computed tomography coronary angiography: a systematic review and meta-analysis

Influence of coronary calcification on the diagnostic accuracy of 64-slice computed tomography coronary angiography: a systematic review and meta-analysis

Assessment of In-Stent Restenosis Using High-Definition Computed Tomography With a New Gemstone Detector

The Year in Cardiac Imaging

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