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Published online before print September 21, 2007, 10.1148/radiol.2452061199
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(Radiology 2007;245:416-423.)
© RSNA, 2007

Cardiac Imaging

Evaluation of Patients with Previous Coronary Stent Implantation with 64-Section CT1

Joanne D. Schuijf, MSc, Gabija Pundziute, MD, J. Wouter Jukema, MD, Hildo J. Lamb, MD, Joan C. Tuinenburg, PhD, Barend L. van der Hoeven, MD, Albert de Roos, MD, Johannes H. C. Reiber, PhD, Ernst E. van der Wall, MD, Martin J. Schalij, MD, and Jeroen J. Bax, MD

1 From the Department of Cardiology (J.D.S., J.W.J., B.L.v.d.H., E.E.v.d.W., M.J.S., J.J.B.), Department of Radiology (J.D.S., H.J.L., A.d.R.), and Division of Image Processing, Department of Radiology (J.C.T., J.H.C.R.), Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands (J.D.S., J.W.J., E.E.v.d.W.); and Department of Cardiology, Kaunas University of Medicine, Kaunas, Lithuania (G.P.). Received July 12, 2006; revision requested September 15; revision received December 28; accepted January 30, 2007; final version accepted April 2. J.D.S. supported by grant 2002B105 from the Netherlands Heart Foundation. G.P. supported by the Training Fellowship of the European Society of Cardiology and the Huygens Scholarship, the Netherlands. J.W.J. is an established clinical investigator of the Netherlands Heart Foundation (grant 2001D032). Address correspondence to J.J.B. (e-mail: jbax{at}knoware.nl).

Purpose: To prospectively evaluate the diagnostic accuracy of 64-section computed tomography (CT) for the assessment of in-stent or peristent restenosis, with conventional coronary angiography as the reference standard.

Materials and Methods: The study was approved by the medical ethics committee, and informed consent was obtained in all 50 enrolled patients (40 men, 10 women; mean age, 60 years ± 11 [standard deviation]). In addition to conventional coronary angiography with quantitative coronary angiography, 64-section CT was performed. For each stent, assessability was determined and was related to stent characteristics and heart rate by using a {chi}2 test. On the interpretable images of stents and peristent lumina (5.00 mm proximal and distal to the stent), the presence of significant (≥50%) restenosis was determined. For this analysis, partially overlapping stents were considered to represent a single stent.

Results: Of 76 stents, 65 (86%) were determined to be assessable. Increased heart rate and overlapping positioning were associated with increased uninterpretability of the images of stents (P < .05), whereas location of the stent and thickness of the strut were not. In seven patients, stents were placed in an overlapping manner, resulting in 58 stents available for the evaluation of significant (≥50%) in-stent restenosis. All six significant (≥50%) in-stent restenoses were detected, and the absence of significant (≥50%) restenosis was correctly identified in the 52 remaining stents, resulting in sensitivity and specificity of 100%. Sensitivity and specificity for the detection of significant (≥50%) peristent stenosis were 100% and 98%, respectively.

Conclusion: In selected patients with previous stent implantation, 64-section CT can be used to evaluate in-stent restenosis with high accuracy. Accordingly, the technique may be useful for noninvasive exclusion of in-stent or peristent restenosis, thereby avoiding invasive imaging in a considerable number of patients.

© RSNA, 2007




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