Assessment of in-stent restenosis using 64-MDCT: Analysis of the CORE-64 multicenter international trial

Joanna J. Wykrzykowska, Armin Arbab-Zadeh, Gustavo Godoy, Julie M. Miller, Shezhang Lin, Andrea Vavere, Narinder Paul, Hiroyuki Niinuma, John Hoe, Jeffrey Brinker, Faisal Khosa, Sheryar Sarwar, Joao Lima, Melvin E. Clouse

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE. Evaluations of stents by MDCT from studies performed at single centers have yielded variable results with a high proportion of unassessable stents. The purpose of this study was to evaluate the accuracy of 64-MDCT angiography (MDCTA) in identifying in-stent restenosis in a multicenter trial. MATERIALS AND METHODS. The Coronary Evaluation Using Multidetector Spiral Computed Tomography Angiography Using 64 Detectors (CORE-64) Multicenter Trial and Registry evaluated the accuracy of 64-MDCTA in assessing 405 patients referred for coronary angiography. A total of 75 stents in 52 patients were assessed: 48 of 75 stents (64%) in 36 of 52 patients (69%) could be evaluated. The prevalence of in-stent restenosis by quantitative coronary angiography (QCA) in this subgroup was 23% (17/75). Eighty percent of the stents were ≤ 3.0 mm in diameter. RESULTS. The overall sensitivity, specificity, positive predictive value, and negative predictive value to detect 50% in-stent stenosis visually using MDCT compared with QCA was 33.3%, 91.7%, 57.1%, and 80.5%, respectively, with an overall accuracy of 77.1% for the 48 assessable stents. The ability to evaluate stents on MDCTA varied by stent type: Thick-strut stents such as Bx Velocity were assessable in 50% of the cases; Cypher, 62.5% of the cases; and thinner-strut stents such as Taxus, 75% of the cases. We performed quantitative assessment of in-stent contrast attenuation in Hounsfield units and correlated that value with the quantitative percentage of stenosis by QCA. The correlation coefficient between the average attenuation decrease and ≥ 50% stenosis by QCA was 0.25 (p = 0.073). Quantitative assessment failed to improve the accuracy of MDCT over qualitative assessment. CONCLUSION. The results of our study showed that 64-MDCT has poor ability to detect in-stent restenosis in small-diameter stents. Evaluability and negative predictive value were better in large-diameter stents. Thus, 64-MDCT may be appropriate for stent assessment in only selected patients.

Original languageEnglish (US)
Pages (from-to)85-92
Number of pages8
JournalAmerican Journal of Roentgenology
Volume194
Issue number1
DOIs
StatePublished - Jan 2010

Keywords

  • Angiography
  • CORE-64
  • Cardiac imaging
  • MDCT
  • Restenosis
  • Stents

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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