European Radiology

, Volume 17, Issue 1, pp 87–96 | Cite as

Diagnostic accuracy of 16-slice multidetector-row CT for detection of in-stent restenosis vs detection of stenosis in nonstented coronary arteries

  • Joelle M. Kefer
  • Emmanuel Coche
  • Jean-Louis J. Vanoverschelde
  • Bernhard L. GerberEmail author


The purpose of this study was to assess the diagnostic accuracy of 16-slice multidetector-row computed tomography (MDCT) for detecting in-stent restenosis. Fifty patients with 69 previously implanted coronary stents underwent 16-slice MDCT before quantitative coronary angiography (QCA). Diagnostic accuracy of MDCT for detection of in-stent restenosis defined as >50% lumen diameter stenosis (DS) in stented and nonstented coronary segments >1.5-mm diameter was computed using QCA as reference. According to QCA, 18/69 (25%) stented segments had restenosis. In addition, 33/518 (6.4%) nonstented segments had >50% DS. In-stent restenosis was correctly identified on MDCT images in 12/18 stents, and absence of restenosis was correctly identified in 50/51 stents. Stenosis in native coronary arteries was correctly identified in 22/33 segments and correctly excluded in 482/485 segments. Thus, sensitivity (67% vs 67% p=1.0), specificity (98% vs 99%, p=0.96) and overall diagnostic accuracy (90% vs 97%, p=0.68) was similarly high for detecting in-stent restenosis as for detecting stenosis in nonstented coronary segments. MDCT has similarly high diagnostic accuracy for detecting in-stent restenosis as for detecting coronary artery disease in nonstented segments. This suggests that MDCT could be clinically useful for identification of restenosis in patients after coronary stenting.


Multidetector CT Stent Restenosis Coronary angioplasty 



coronary artery disease


diameter stenosis


multidetector-row computed tomography


minimal lumen diameter


magnetic resonance imaging


New York Heart Association


quantitative coronary angiography


reference vessel diameter


  1. 1.
    Serruys PW, de Jaegere P, Kiemeneij F, Macaya C, Rutsch W, Heyndrickx G, Emanuelsson H, Marco J, Legrand V, Materne P; Benestent Study Group (1994) A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med 331:489–495CrossRefPubMedGoogle Scholar
  2. 2.
    Fischman DL, Leon MB, Baim DS, Schatz RA, Savage MP, Penn I, Detre K, Veltri L, Ricci D, Nobuyoshi M; Stent Restenosis Study Investigators (1994) A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 331:496–501CrossRefPubMedGoogle Scholar
  3. 3.
    Serruys PW, Degertekin M, Tanabe K, Abizaid A, Sousa JE, Colombo A, Guagliumi G, Wijns W, Lindeboom WK, Ligthart J, de Feyter PJ, Morice MC (2002) Intravascular ultrasound findings in the multicenter, randomized, double-blind RAVEL (RAndomized study with the sirolimus-eluting VElocity balloon-expandable stent in the treatment of patients with de novo native coronary artery Lesions) trial. Circulation 106:798–803CrossRefPubMedGoogle Scholar
  4. 4.
    Serruys PW, Degertekin M, Tanabe K, Russell ME, Guagliumi G, Webb J, Hamburger J, Rutsch W, Kaiser C, Whitbourn R, Camenzind E, Meredith I, Reeves F, Nienaber C, Benit E, Disco C, Koglin J, Colombo A (2004) Vascular responses at proximal and distal edges of paclitaxel-eluting stents: serial intravascular ultrasound analysis from the TAXUS II trial. Circulation 190(5):627–633CrossRefGoogle Scholar
  5. 5.
    Scanlon PJ, Faxon DP, Audet AM, Carabello B, Dehmer GJ, Eagle KA, Legako RD, Leon DF, Murray JA, Nissen SE, Pepine CJ, Watson RM, Ritchie JL, Gibbons RJ, Cheitlin MD, Gardner TJ, Garson A Jr, Russell RO Jr, Ryan TJ, Smith SC Jr (1999) ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. J Circulation 99(17):2345–2357Google Scholar
  6. 6.
    Johnson LW, Krone R (1993) Cardiac catheterization 1991: a report of the Registry of the Society for Cardiac Angiography and Interventions (SCA&I). Cathet Cardiovasc Diagn 28(3):219–220PubMedGoogle Scholar
  7. 7.
    Wyman RM, Safian RD, Portway V, Skillman JJ, McKay RG, Baim DS (1988) Current complications of diagnostic and therapeutic cardiac catheterization. J Am Coll Cardiol 12(6):1400–1406PubMedGoogle Scholar
  8. 8.
    Achenbach S, Giesler T, Ropers D, Ulzheimer S, Derlien H, Schulte C, Wenkel E, Moshage W, Bautz W, Daniel WG, Kalender WA, Baum U (2001) Detection of coronary artery stenoses by contrast-enhanced, retrospectively electrocardiographically-gated, multislice spiral computed tomography. Circulation 29(103):2535–2538Google Scholar
  9. 9.
    Nieman K, Cademartiri F, Lemos PA, Raaijmakers R, Pattynama PM, de Feyter PJ (2002) Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography. Circulation 106(16):2051–2054CrossRefPubMedGoogle Scholar
  10. 10.
    Ropers D, Baum U, Pohle K, Anders K, Ulzheimer S, Ohnesorge B, Schlundt C, Bautz W, Daniel WG, Achenbach S (2003) Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction. Circulation 107(5):664–666CrossRefPubMedGoogle Scholar
  11. 11.
    Kefer J, Coche E, Pasquet A, Legros G, Grandin C, Vanbeers B, Vanoverschelde JL, Gerber BL (2005) Head-to-head comparison of three-dimensional navigator-gated magnetic resonance imaging and 16-slice computed tomography to detect coronary artery stenosis in patients. J Am Coll Cardiol 46(1):92–100CrossRefPubMedGoogle Scholar
  12. 12.
    Begemann PG, van Stevendaal U, Manzke R, Stork A, Weiss F, Nolte-Ernsting C, Grass M, Adam G (2005) Evaluation of spatial and temporal resolution for ECG-gated 16-row multidetector CT using a dynamic cardiac phantom. Eur Radiol 15:1015–1026PubMedCrossRefGoogle Scholar
  13. 13.
    No authors listed (1987) Guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of diagnostic and therapeutic cardiovascular procedures (subcommittee on coronary angiography). J Am Coll Cardiol 10(4):935–950PubMedCrossRefGoogle Scholar
  14. 14.
    Hong C, Chrysant GS, Woodard PK, Bae KT (2004) Coronary artery stent patency assessed with in-stent contrast enhancement measured at multi-detector row CT angiography: initial experience. Radiology 233(1):286–291PubMedCrossRefGoogle Scholar
  15. 15.
    Wintersperger BJ, Nikolaou K (2005) Basics of cardiac MDCT: techniques and contrast application. Eur Radiol 15(Suppl 2):B2–B9PubMedGoogle Scholar
  16. 16.
    Kuettner A, Kopp AF, Schroeder S, Rieger T, Brunn J, Meisner C, Heuschmid M, Trabold T, Burgstahler C, Martensen J, Schoebel W, Selbmann HK, Claussen CD (2004) Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with angiographically proven coronary artery disease. J Am Coll Cardiol 43(5):831–839CrossRefPubMedGoogle Scholar
  17. 17.
    Heuschmid M, Kuettner A, Schroeder S, Trabold T, Feyer A, Seemann MD, Kuzo R, Claussen CD, Kopp AF (2005) ECG-gated 16-MDCT of the coronary arteries: assessment of image quality and accuracy in detecting stenoses. AJR Am J Roentgenol 184(5):1413–1419PubMedGoogle Scholar
  18. 18.
    Kuettner A, Beck T, Drosch T, Kettering K, Heuschmid M, Burgstahler C, Claussen CD, Kopp AF, Schroeder S (2005) Image quality and diagnostic accuracy of non-invasive coronary imaging with 16 detector slice spiral computed tomography with 188 ms temporal resolution. Heart 91:938–941CrossRefPubMedGoogle Scholar
  19. 19.
    Achenbach S, Ropers D, Pohle FK, Raaz D, von Erffa J, Yilmaz A, Muschiol G, Daniel WG (2005) Detection of coronary artery stenoses using multi-detector CT with 16×0.75 collimation and 375 ms rotation. Eur Heart J 26(19):1978–1986CrossRefPubMedGoogle Scholar
  20. 20.
    Leber AW, Knez A, von Ziegler F, Becker A, Nikolaou K, Paul S, Wintersperger B, Reiser M, Becker CR, Steinbeck G, Boekstegers P (2005) Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol 46(1):147–154PubMedCrossRefGoogle Scholar
  21. 21.
    Leschka S, Alkadhi H, Plass A, Desbiolles L, Grunenfelder J, Marincek B, Wildermuth S (2005) Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur Heart J 26(15):1482–1487PubMedCrossRefGoogle Scholar
  22. 22.
    Mollet NR, Cademartiri F, van Mieghem CA, Runza G, McFadden EP, Baks T, Serruys PW, Krestin GP, de Feyter PJ (2005) High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation 112(15):2318–2323CrossRefPubMedGoogle Scholar
  23. 23.
    Raff GL, Gallagher MJ, O’Neill WW, Goldstein JA (2005) Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46(3):552–557PubMedCrossRefGoogle Scholar
  24. 24.
    Mahnken AH, Buecker A, Wildberger JE, Ruebben A, Stanzel S, Vogt F, Gunther RW, Blindt R (2004) Coronary artery stents in multislice computed tomography: in vitro artifact evaluation. Invest Radiol 39(1):27–33PubMedCrossRefGoogle Scholar
  25. 25.
    Maintz D, Juergens KU, Wichter T, Grude M, Heindel W, Fischbach R (2003) Imaging of coronary artery stents using multislice computed tomography: in vitro evaluation. Eur Radiol 13:830–835PubMedGoogle Scholar
  26. 26.
    Maintz D, Seifarth H, Raupach R, Flohr T, Rink M, Sommer T, Ozgun M, Heindel W, Fischbach R (2005) 64-slice multidetector coronary CT angiography: in vitro evaluation of 68 different stents. Eur Radiol 15:1–9CrossRefGoogle Scholar
  27. 27.
    Maintz D, Seifarth H, Flohr T, Kramer S, Wichter T, Heindel W, Fischbach R (2003) Improved coronary artery stent visualization and in-stent stenosis detection using 16-slice computed-tomography and dedicated image reconstruction technique. Invest Radiol 38(12):790–795PubMedGoogle Scholar
  28. 28.
    Seifarth H, Raupach R, Schaller S, Fallenberg EM, Flohr T, Heindel W, Fischbach R, Maintz D (2005) Assessment of coronary artery stents using 16-slice MDCT angiography: evaluation of a dedicated reconstruction kernel and a noise reduction filter. Eur Radiol 15:721–726PubMedCrossRefGoogle Scholar
  29. 29.
    Kruger S, Mahnken AH, Sinha AM, Borghans A, Dedden K, Hoffmann R, Hanrath P (2003) Multislice spiral computed tomography for the detection of coronary stent restenosis and patency. Int J Cardiol 89(2–3):167–172PubMedGoogle Scholar
  30. 30.
    Maintz D, Grude M, Fallenberg EM, Heindel W, Fischbach R (2003) Assessment of coronary arterial stents by multislice-CT angiography. Acta Radiol 44(6):597–603PubMedCrossRefGoogle Scholar
  31. 31.
    Schuijf JD, Bax JJ, Jukema JW, Lamb HJ, Warda HM, Vliegen HW, de Roos A, van der Wall EE (2004) Feasibility of assessment of coronary stent patency using 16-slice computed tomography. Am J Cardiol 94(4):427–430PubMedCrossRefGoogle Scholar
  32. 32.
    Ohnuki K, Yoshida S, Ohta M, Mochizuki S, Nishioka M, Sakuma T, Fukuda K, Ishizaki M, Hirakawa E, Andou T (2006) New diagnostic technique in multi-slice computed tomography for in-stent restenosis: Pixel count method. Int J Cardiol 108(2):251–258CrossRefPubMedGoogle Scholar
  33. 33.
    Cademartiri F, Marano R, Runza G, Mollet N, Nieman K, Luccichenti G, Gualerzi M, Brambilla L, Coruzzi P, Galia M, Midiri M (2005) Non-invasive assessment of coronary artery stent patency with multislice CT: preliminary experience. Radiol Med (Torino) 190(5–6):500–507Google Scholar
  34. 34.
    Gilard M, Cornily JC, Pennec PY, Le Gal G, Nonent M, Mansourati J, Blanc JJ, Boschat J (2006) Assessment of coronary artery stents by 16-slice computed tomography. Heart 92(1):58–61CrossRefPubMedGoogle Scholar
  35. 35.
    Kaiser C, Brunner-La Rocca HP, Buser PT, Bonetti PO, Osswald S, Linka A, Bernheim A, Zutter A, Zellweger M, Grize L, Pfisterer ME (2005) Incremental cost-effectiveness of drug-eluting stents compared with a third-generation bare-metal stent in a real-world setting: randomised Basel Stent Kosten Effektivitats Trial (BASKET). Lancet 366(9489):921–929CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Joelle M. Kefer
    • 1
  • Emmanuel Coche
    • 2
  • Jean-Louis J. Vanoverschelde
    • 1
  • Bernhard L. Gerber
    • 1
    Email author
  1. 1.Department of CardiologyCliniques Universitaires St. Luc UCLBrusselsBelgium
  2. 2.Department of RadiologyCliniques Universitaires St. Luc UCLBrusselsBelgium

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