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European Radiology
Published in: European Radiology 7/2011

01-07-2011 | Computed Tomography

High diagnostic accuracy of prospective ECG-gating 64-slice computed tomography coronary angiography for the detection of in-stent restenosis

In-stent restenosis assessment by low-dose MDCT

Authors: Daniele Andreini, Gianluca Pontone, Antonio L. Bartorelli, Saima Mushtaq, Daniela Trabattoni, Erika Bertella, Sarah Cortinovis, Andrea Annoni, Alberto Formenti, Giovanni Ballerini, Piergiuseppe Agostoni, Cesare Fiorentini, Mauro Pepi

Published in: European Radiology | Issue 7/2011

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Abstract

Objectives

The accuracy of computed tomography (CT) for assessment of coronary stents is as yet unproven and radiation exposure has been a concern. The aim of our study is to compare radiation dose and diagnostic performance of CT with prospective ECG-triggering versus retrospective ECG-triggering for the detection of in-stent restenosis (ISR).

Methods

We enrolled 168 consecutive patients with suspected ISR, 83 studied using CT with prospective ECG-triggering (group 1) and 85 using retrospective ECG-triggering (group 2).

Results

Prevalence of ISR according to catheter angiography was 24% in both groups. The overall evaluability was similar (93% in group 1 vs 95% in group 2). Artefact sub-analysis showed a significantly lower number of blooming and higher number of slice misalignment in group 1 vs group 2. In the stent-based analysis using only evaluable stents, specificity, positive predictive value and accuracy were significantly higher in group 1 (100%, 100% and 99%, respectively) than in group 2 (97%, 91% and 95%, respectively, p < 0.05). Group 1 was exposed to a lower radiation dose compared with group 2 (4.3 ± 1.4 mSv vs 18.5 ± 5.5 mSv, p < 00.1).

Conclusions

CT with prospective ECG-triggering can improve diagnostic accuracy of non-invasive imaging of coronary stents with a significant reduction in radiation exposure
Literature
1.
Zellweger MJ, Weinbacher M, Zutter AW et al (2003) Long-term outcome of patients with silent versus symptomatic ischemia six months after percutaneous coronary intervention and stenting. J Am Coll Cardiol 42:33–40PubMedCrossRef
2.
Chabbert V, Carrie D, Bennaceur M et al (2007) Evaluation of in-stent restenosis in proximal coronary arteries with multidetector computed tomography (MDCT). Eur Radiol 17:1452–1463PubMedCrossRef
3.
4.
Rixe J, Achenbach S, Ropers D et al (2006) Assessment of coronary artery stent restenosis by 64-slice multi-detector computed tomography. Eur Heart J 27:2567–2572PubMedCrossRef
5.
Ehara M, Kawai M, Surmely JF et al (2007) Diagnostic accuracy of coronary in-stent restenosis using 64-slice computed tomography: comparison with invasive coronary angiography. J Am Coll Cardiol 49:951–959PubMedCrossRef
6.
Andreini D, Pontone G, Bartorelli AL et al (2009) Comparison of feasibility and diagnostic accuracy of 64-slice multidetector computed tomography coronary angiography versus invasive coronary angiography versus intravascular ultrasound for evaluation of in-stent restenosis. Am J Cardiol 103:1349–1358PubMedCrossRef
7.
Fei X, Du X, Li P, Liao J, Shen Y, Li K (2008) Effect of dose-reduced scan protocols on cardiac coronary image quality with 64-row MDCT: a cardiac phantom study. Eur J Radiol 67:85–91PubMedCrossRef
8.
Wang M, Qi HT, Wang XM, Wang T, Chen JH, Liu C (2009) Dose performance and image quality: dual source CT versus single source CT in cardiac CT angiography. Eur J Radiol 72:396–400PubMedCrossRef
9.
Maintz D, Burg MC, Seifarth H et al (2009) Update on multidetector coronary CT angiography of coronary stents: in vitro evaluation of 29 different stent types with dual-source CT. Eur Radiol 19:42–49PubMedCrossRef
10.
Mori S, Nishizawa K, Kondo C, Ohno M, Akahane K, Endo M (2008) Effective doses in subjects undergoing computed tomography cardiac imaging with the 256-multislice CT scanner. Eur J Radiol 65:442–448PubMedCrossRef
11.
Rybicki FJ, Otero HJ, Steigner ML et al (2008) Initial evaluation of coronary images from 320-detector row computed tomography. Int J Cardiovasc Imaging 24:535–546PubMedCrossRef
12.
Leschka S, Stolzmann P, Desbiolles L et al (2009) Diagnostic accuracy of high-pitch dual-source CT for the assessment of coronary stenoses: first experience. Eur Radiol 19:2896–2903PubMedCrossRef
13.
Stolzmann P, Scheffel H, Leschka S (2008) Influence of calcifications on diagnostic accuracy of coronary CT angiography using prospective ECG triggering. AJR Am J Roentgenol 191:1684–1689PubMedCrossRef
14.
Leschka S, Wildermuth S, Boehm T et al (2006) Noninvasive coronary angiography with 64-section CT: effect of average heart rate and heart rate variability on image quality. Radiology 241:378–385PubMedCrossRef
15.
Pontone G, Andreini D, Bartorelli AL et al (2009) Diagnostic accuracy of coronary computed tomography angiography: a comparison between prospective and retrospective electrocardiogram triggering. J Am Coll Cardiol 54:346–355PubMedCrossRef
16.
Husmann L, Valenta I, Gaemperli O et al (2008) Feasibility of low-dose coronary CT angiography: first experience with prospective ECG-gating. Eur Heart J 29:191–197PubMedCrossRef
17.
Hsieh J, Londt J, Vass M, Li J, Tang X, Okerlund D (2006) Step-and-shoot data acquisition and reconstruction for cardiac x-ray computed tomography. Med Phys 33:4236–4248PubMedCrossRef
18.
Poll LW, Cohnen M, Brachten S, Ewen K, Mödder U (2002) Dose reduction in multi-slice CT of the heart by use of ECG-controlled tube current modulation (“ECG pulsing”): phantom measurements. Rofo 174:1500–1505PubMed
19.
Einstein AJ, Moser KW, Thompson RC, Cerqueira MD, Henzlova MJ (2007) Radiation dose to patients from cardiac diagnostic imaging. Circulation 116:1290–1305PubMedCrossRef
20.
Christner JA, Kofler JM, McCollough CH (2010) Estimating effective dose for CT using dose-length product compared with using organ doses: consequences of adopting international commission on radiological protection publication 103 or dual-energy scanning. Am J Roentgenol 194:881–889CrossRef
21.
22.
Budoff MJ, Achenbach S, Blumenthal RS et al (2006) Assessment of coronary artery disease by cardiac computed tomography. A scientific statement from the American Heart Association committee on cardiovascular imaging and intervention, council on cardiovascular radiology and intervention, and committee on cardiac imaging, council on clinical cardiology. Circulation 114:1761–1791PubMedCrossRef
23.
Marcassa C, Bax JJ, Bengel F et al (2008) Clinical value, cost-effectiveness, and safety of myocardial perfusion scintigraphy: a position statement. Eur Heart J 29:557–563PubMedCrossRef
24.
Einstein AJ, Henzlova MJ, Rajagopalan S (2007) Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA 298:317–323PubMedCrossRef
25.
Min JK, Swaminathan RV, Vass M, Gallagher S, Weinsaft JW (2009) High-definition multidetector computed tomography for evaluation of coronary artery stents: comparison to standard-definition 64-detector row computed tomography. J Cardiovasc Comput Tomogr 3:246–251PubMedCrossRef
26.
Pugliese F, Weustink AC, Van Mieghem C et al (2008) Dual-source coronary computed tomography angiography for detecting in-stent restenosis. Heart 94:848–854PubMedCrossRef
27.
Abada HT, Larchez C, Daoud B, Sigal-Cinqualbre A, Paul JF (2006) MDCT of the coronary arteries: feasibility of low-dose CT with ECG-pulsed tube current modulation to reduce radiation dose. AJR Am J Roentgenol 186:387–390CrossRef
28.
Husmann L, Schepis T, Scheffel H et al (2008) Comparison of diagnostic accuracy of 64-slice computed tomography coronary angiography in patients with low, intermediate, and high cardiovascular risk. Acad Radiol 15:452–461PubMedCrossRef
Metadata
Title
High diagnostic accuracy of prospective ECG-gating 64-slice computed tomography coronary angiography for the detection of in-stent restenosis
In-stent restenosis assessment by low-dose MDCT
Authors
Daniele Andreini
Gianluca Pontone
Antonio L. Bartorelli
Saima Mushtaq
Daniela Trabattoni
Erika Bertella
Sarah Cortinovis
Andrea Annoni
Alberto Formenti
Giovanni Ballerini
Piergiuseppe Agostoni
Cesare Fiorentini
Mauro Pepi
Publication date
01-07-2011
Publisher
Springer-Verlag
Published in
European Radiology / Issue 7/2011
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-011-2085-7

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