European Radiology

, Volume 21, Issue 7, pp 1430–1438 | Cite as

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
  • 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
Computed Tomography

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

Keywords

Computed tomography Coronary stents Radiation dose Invasive coronary angiography In-stent restenosis Coronary arteries 

References

  1. 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 42:33–40PubMedCrossRefGoogle Scholar
  2. 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 17:1452–1463PubMedCrossRefGoogle Scholar
  3. 3.
    Achenbach S (2006) Computed tomography coronary angiography. J Am Coll Cardiol 48:1919–1928PubMedCrossRefGoogle Scholar
  4. 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 27:2567–2572PubMedCrossRefGoogle Scholar
  5. 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 49:951–959PubMedCrossRefGoogle Scholar
  6. 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 103:1349–1358PubMedCrossRefGoogle Scholar
  7. 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 67:85–91PubMedCrossRefGoogle Scholar
  8. 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 72:396–400PubMedCrossRefGoogle Scholar
  9. 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 19:42–49PubMedCrossRefGoogle Scholar
  10. 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 65:442–448PubMedCrossRefGoogle Scholar
  11. 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 24:535–546PubMedCrossRefGoogle Scholar
  12. 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 19:2896–2903PubMedCrossRefGoogle Scholar
  13. 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 191:1684–1689PubMedCrossRefGoogle Scholar
  14. 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 241:378–385PubMedCrossRefGoogle Scholar
  15. 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 54:346–355PubMedCrossRefGoogle Scholar
  16. 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 29:191–197PubMedCrossRefGoogle Scholar
  17. 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 33:4236–4248PubMedCrossRefGoogle Scholar
  18. 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 174:1500–1505PubMedGoogle Scholar
  19. 19.
    Einstein AJ, Moser KW, Thompson RC, Cerqueira MD, Henzlova MJ (2007) Radiation dose to patients from cardiac diagnostic imaging. Circulation 116:1290–1305PubMedCrossRefGoogle Scholar
  20. 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 194:881–889CrossRefGoogle Scholar
  21. 21.
    Leung KC, Martin CJ (1996) Effective doses for coronary angiography. Br J Radiol 69:426–431PubMedCrossRefGoogle Scholar
  22. 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 114:1761–1791PubMedCrossRefGoogle Scholar
  23. 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 29:557–563PubMedCrossRefGoogle Scholar
  24. 24.
    Einstein AJ, Henzlova MJ, Rajagopalan S (2007) Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA 298:317–323PubMedCrossRefGoogle Scholar
  25. 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 3:246–251PubMedCrossRefGoogle Scholar
  26. 26.
    Pugliese F, Weustink AC, Van Mieghem C et al (2008) Dual-source coronary computed tomography angiography for detecting in-stent restenosis. Heart 94:848–854PubMedCrossRefGoogle Scholar
  27. 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 186:387–390CrossRefGoogle Scholar
  28. 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 15:452–461PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2011

Authors and Affiliations

  • Daniele Andreini
    • 1
  • Gianluca Pontone
    • 1
  • Antonio L. Bartorelli
    • 1
  • Saima Mushtaq
    • 1
  • Daniela Trabattoni
    • 1
  • Erika Bertella
    • 1
  • Sarah Cortinovis
    • 1
  • Andrea Annoni
    • 1
  • Alberto Formenti
    • 1
  • Giovanni Ballerini
    • 1
  • Piergiuseppe Agostoni
    • 1
    • 2
  • Cesare Fiorentini
    • 1
    • 2
  • Mauro Pepi
    • 1
  1. 1.Centro Cardiologico Monzino, IRCCSMilanItaly
  2. 2.Department of Cardiovascular SciencesUniversity of MilanMilanItaly

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