Noninvasive quantitative evaluation of coronary artery stent patency using 64-row multidetector computed tomography
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.
aDepartment of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1000 West Carson Street, Box 400, Torrance, CA 90509, USA
bCardiovascular Medical Group, Beverly Hills, CA, USA
Corresponding author.
Conflict of interest: Dr. Budoff is on the GE Speaker Bureau. The remaining authors report no conflicts of interest.
ABSTRACT