Multislice CT angiography in the assessment of coronary artery in-stent restenosis: A systematic review.
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Purpose: The aim of this study was to perform a systematic review of the diagnostic accuracy of multi-detector row computed tomography angiography (MDCT) for detection of coronary in-stent restenosis in patients treated with coronary stenting when compared to invasive catheter angiography.Materials and Methods: A search of PUBMED and MEDLINE databases for English literature was performed. Only studies with at least 10 patients comparing 16- or more detector rows MDCT angiography with invasive catheter angiography in the detection of coronary in-stent restenosis (more than 50% stenosis) were included for analysis. Sensitivity and specificity estimates pooled across studies were tested using a fixed effects model.Results: 15 studies met selection criteria for inclusion in the analysis. There were eight studies performed with 16-detector row CT scanners, and five studies with 64-detector row scanners and one study with a 40-detector scanner. The remaining study was performed with a mixture of 16-and 64-detector row scanners. Prevalence of in-stent restenosis following coronary stenting was 18% (95% CI: 13%, 24%). Pooled estimates of the sensitivity and specificity of overall MDCT angiography for the detection of coronary in-stent restenosis was 85% (95% CI: 78%, 90%) and 97% (95% CI: 95%, 98%), respectively. No significant difference was found between 16- and 64-detector row scanners regarding the sensitivity and specificity of MDCT for assessment of in-stent restenosis (p>0.05).Conclusion: The results showed that MDCT angiography (with 16 or more detector rows) has moderate sensitivity and high specificity for the detection of coronary in-stent restenosis when compared to invasive catheter angiography. A high specificity value of MDCT may be most valuable as a non-invasive technique of excluding coronary stent restenosis or occlusion. The main factors affecting visualization are stent diameters and stent materials.
Sun, Zhonghua and Davidson, Robert and Lin, Cheung HSun (2008) Multislice CT angiography in the assessment of coronary artery in-stent restenosis: A systematic review. Article in Press, Corrected Proof , European Journal of Radiology.
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