Noninvasive quantitative evaluation of coronary artery stent patency using 64-row multidetector computed tomography

Abdelkarim, Murrad J.; Ahmadi, Naser; Gopal, Ambarish; Hamirani, Yasmin; Karlsberg, Ronald P.; Budoff, Matthew J.

doi:10.1016/j.jcct.2009.10.014

« Previous Next »Journal of Cardiovascular Computed Tomography
Volume 4, Issue 1 , Pages 29-37, January 2010

Noninvasive quantitative evaluation of coronary artery stent patency using 64-row multidetector computed tomography

Murrad J. Abdelkarim, MD
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1000 West Carson Street, Box 400, Torrance, CA 90509, USA
- Corresponding author.
Naser Ahmadi, MD
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1000 West Carson Street, Box 400, Torrance, CA 90509, USA
Ambarish Gopal, MD
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1000 West Carson Street, Box 400, Torrance, CA 90509, USA
Yasmin Hamirani, MD
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1000 West Carson Street, Box 400, Torrance, CA 90509, USA
Ronald P. Karlsberg, MD, FACP, FACC
- Cardiovascular Medical Group, Beverly Hills, CA, USA
Matthew J. Budoff, MD, FACC
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1000 West Carson Street, Box 400, Torrance, CA 90509, USA

Received 28 May 2009; accepted 23 October 2009. published online 30 November 2009.

Background

Many studies have used multidetector computed tomography (MDCT) angiography to evaluate coronary stents qualitatively but not quantitatively.

Objectives

This study sought to validate a method of quantitatively evaluating stent patency by using 64-row compared with invasive coronary angiography (ICA) and to evaluate the stent size threshold of MDCT in detecting stent patency.

Methods

Stented lesions (n=122) in 55 patients (age, 65±10 years; 90% men) who underwent both 64-row MDCT and ICA were studied. Density measurements in Hounsfield units (HUs) and stent diameters in millimeters were recorded in the stented segments, with the density of the ascending aorta (AO) taken as a reference. The ratio of the average of stent's proximal, middle, and distal densities to mean AO density was defined as the AS/AO HU. Threshold values for the detection of stent patency were examined by using receiver operator characteristic (ROC) curve analysis.

Results

One hundred six of 122 stents were interpretable. By ICA, 24 stents were found to have in-stent restenosis (22 interpretable and 2 noninterpretable with MDCT). The ROC curve showed that the optimal cutoff value of AS/AO HU to predict stent patency on MDCT was 0.81 with sensitivity of 90.9%, specificity of 95.2%, and the optimal stent diameter cutoff value was ≥2.5mm with a sensitivity of 91.8% and a specificity of 93.8%.

Conclusion

With 64-row MDCT, coronary stent patency can be evaluated quantitatively with high sensitivity and specificity and with adequate diagnostic accuracy in stents ≥2.5mm in diameter.

KeyWords: 64-row multidetector computed tomography (MDCT), Cardiac computed tomographic angiography (CTA), Computed tomography (CT) density, Coronary stent patency, In-stent restenosis (ISR)