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"The ability to evaluate stents on MDCTA varied by stent type: Thick strut stents such as Bx Velocity were assessable in 50% of cases; Cypher, 62.5% of cases, and thinner strut stents such as Taxus, 75% of cases."
Assessment of In-Stent Restenosis Using 64-MDCT: Analysis of the CORE-64 Multicenter International Trial
Wykrzykowska JJ et al.
AJR 2010: 194; 85-92"However despite improvements in technology, we found that in the real world situations—that is, when most of the stents are <3.0 mm with concomitant calcifications and motion artifacts—MDCT assessment of in-stent restenosis remains problematic and the evaluability and accuracy is still too low to make this technique applicable to most patients with stents."
Assessment of In-Stent Restenosis Using 64-MDCT: Analysis of the CORE-64 Multicenter International Trial
Wykrzykowska JJ et al.
AJR 2010: 194; 85-92"The results of our study showed that 64-MDCT has poor ability to detect in-stent restenosis in small diameter stents. Evaluability and negative predictive value were better in large diameter stents, Thus 64-MDCT may be appropriate for stent assessment in only selected patients."
Assessment of In-Stent Restenosis Using 64-MDCT: Analysis of the CORE-64 Multicenter International Trial
Wykrzykowska JJ et al.
AJR 2010: 194; 85-92"Material and Methods: The 4 datasets were evaluated with 5 different software packages by 2 observors with experience in CT coronary angiography blinded from the real dimensions of the vessel phantoms. Each stenosis measurement was repeated 15 times."
Evaluation of Coronary Stents with 64-MDCT: In Vitro Comparison of Scanners From Four Vendors
Wolf F et al.
AJR 2009; 193:787-794"For longitudinal reformations, scanners from the four leading vendors do not differ in artificial luminal narrowing, but there are differences in artificial luminal attenuation and image noise. The quality of images of the in-stent lumen is better on longitudinal reformations and for stents with a diameter greater than 3 mm. Except for image noise, differences between axial and longitudinal reformations are vendor specific."
Evaluation of Coronary Stents with 64-MDCT: In Vitro Comparison of Scanners From Four Vendors
Wolf F et al.
AJR 2009; 193:787-794"Objective: The purpose of this study was to compare 64-MDCT scanners from four vendors in the in vitro evaluation of coronary artery stents."
Evaluation of Coronary Stents with 64-MDCT: In Vitro Comparison of Scanners From Four Vendors
Wolf F et al.
AJR 2009; 193:787-794"With 64 row MDCT coronary artery stent patency can be evaluated Quantitatively with high sensitivity and specificity and with adequate diagnostic accuracy in stents ≥2.5 mm in diameter."
Noninvasive quantitative evaluation of coronary artery stent patency using 64-row multidetector computed tomography
Abdelkarim MJ et al.
J Cardiovasc Comput Tomogr (2010) 4, 29-37"HDCT, with improved in-plane spatial resolution of 0.23 mm, results in improved measurements of stent diameter and area. Novel ASIR image reconstruction techniques incrementally improved assessment of stent diameter and area.."
High-definition multidetector computed tomography for evaluation of coronary artery stents: Comparison to standard definition 64-detector row computed tomography
Min JK et al
J Cardiovasc Comput Tomogr (2009) 3, 246-251"On the basis of this ex-vivo study HDCT provides superior detection of intrastent luminal area and diameter visualization, compared with SDCT. ASIR (applied statistical iterative reconstruction) image reconstruction techniques for HDCT scans enhance the in-stent assessment while decreasing image noise."
High-definition multidetector computed tomography for evaluation of coronary artery stents: Comparison to standard definition 64-detector row computed tomography
Min JK et al
J Cardiovasc Comput Tomogr (2009) 3, 246-251- "The results of our meta-analysis by using a random effects model demonstrate a high accuracy (96.9%) of noninvasive multisection CT for the assessment of coronary bypass graft (CABG) compared with coronary angiography, although 7.6% of scanned grafts were not assessible."
Diagnostic Performance of 16- and 64-Section Spiral CT for Coronary Artery bypass graft Assessment: Meta-Analysis
Hamon M et al.
Radiology 2008; 247:679-686
- "Sensitivity for detection of graft occlusion (99.3%) was better than for detection of substantial stenosis (94.4%)."
Diagnostic Performance of 16- and 64-Section Spiral CT for Coronary Artery bypass graft Assessment: Meta-Analysis
Hamon M et al.
Radiology 2008; 247:679-686
- "Multisection CT provided high accuracy (96.9%) for the evaluation of CABG obstruction in assessable conduits and might be used as a noninvasive tool for the evaluation of patients suspected of having graft dysfunction."
Diagnostic Performance of 16- and 64-Section Spiral CT for Coronary Artery bypass graft Assessment: Meta-Analysis
Hamon M et al.
Radiology 2008; 247:679-686
- "Sixty four section multidetector CT coronary angiography is a promising method for the noninvasive diagnosis of in-stent restenosis and occlusion"
Coronary Stent Patency and in-Stent Restenosis: Determination with 64-Section Multidetector CT Coronary Angiography-Initial Experience
Oncel D et al.
Radiology 2007; 242:403-409
- "Sensitivity, specificity and positive and negative predictive values were 89%, 95%, 94%, and 90%, respectively, for the detection of in-stent restenosis and occlusion with 64 section multidetector CT."
Coronary Stent Patency and in-Stent Restenosis: Determination with 64-Section Multidetector CT Coronary Angiography-Initial Experience
Oncel D et al.
Radiology 2007; 242:403-409
- "Sixty four slice CT angiography can be used for accurate exclusion of greater than 50% graft stenosis, but detection of distal anastomotic stenosis is limited, and the degree of stenosis can be overestimated."
Diagnostic Performance of 64-Slice Computed Tomography in Evaluation of Coronary Artery Bypass Grafts
Feuchtner GM et al.
AJR 2007 189;574-580
- "Sixty four slice CT angiography can be used for accurate exclusion of greater than 50% graft stenosis, but detection of distal anastomotic stenosis is limited, and the degree of stenosis can be overestimated The advantages of CT, however, are that it is noninvasive,vein graft disease can be diagnosed at an early stage, and complementary evaluation of extracardiac anastomotic features provides useful information before coronary artery bypass grafting is redone."
Diagnostic Performance of 64-Slice Computed Tomography in Evaluation of Coronary Artery Bypass Grafts
Feuchtner GM et al.
AJR 2007 189;574-580
- "The advantages of CT, however, are that it is noninvasive,vein graft disease can be diagnosed at an early stage, and complementary evaluation of extracardiac anastomotic features provides useful information before coronary artery bypass grafting is redone."
Diagnostic Performance of 64-Slice Computed Tomography in Evaluation of Coronary Artery Bypass Grafts
Feuchtner GM et al.
AJR 2007 189;574-580
- "The overall accuracy of 64-slice CT in identification of greater than 50% graft stenosis and occlusion pooled together was high, a sensitivity of 85% and a specificity of 95%."
Diagnostic Performance of 64-Slice Computed Tomography in Evaluation of Coronary Artery Bypass Grafts
Feuchtner GM et al.
rAJR 2007 189;574-580
- Coronary Artery Bypass Grafts (CABG)
- 400,000 CABG done each year in the US
- Re-stenosis or occlusion of the grafts are the classic complication
- Progressive disease in non-bypassed vessels can also be the cause of symptoms
- MDCT of Coronary Stents
- You will need to reconstruct with a higher spatial resolution kernel than for routine coronary imaging
- On Sensation 64 this means going from 30f to 46f
- "Fifty-two consecutive asymptomatic patients with a total of 166 bypass grafts were investigated by 16-slice computed tomography (CT) 15 +/- 5 days before invasive coronary angiography. Overall, 165 grafts (99.4%) were assessable with multislice CT (MSCT). Coronary angiography showed that 111 grafts (67%) were patent and 54 (33%) were occluded. Of the patent grafts, 22 had high-grade stenosis. MSCT correctly classified 111 grafts as patent and 54 as occluded. Of the patent grafts, 16-slice CT correctly detected 21 bypass stenosis (95%). These results yielded 100% sensitivity and specificity of 16-slice CT for detecting bypass grafts occlusion and 96% sensitivity and 100% specificity for detecting high-grade stenosis in patent grafts."
Follow-up of coronary artery bypass graft patency by multislice computed tomography.
Chiurlia E
Am J Cardiol. 2005 May 1;95(9):1094-1097
- "Despite image-degrading effects caused by the metallic scaffold of the stent, recent experience with the current generation of 64 section scanners suggests improved assessability of the in-stent lumen with the capability to appreciate more subtle degrees of in-stent neointimal hyperplasia."
Multidetector CT for Visualization of Coronary Stents
Pugliese F et al.
RadioGraphics 2006; 26:887-904.
- - Re-stenosis occurs in 10% of the population
- Re-stenosis is defined as vessel lumen narrowing of more than 50% after angioplasty
- Metal struts cause a severe CT artifact known as blooming effect