双源CT与冠状动脉造影评估冠状动脉支架内再狭窄

目的对比分析双源CT(dual-source CT,DSCT)与冠状动脉造影(coronary angiography,CAG)评估支架内再狭窄(in stent restenosis,ISR)的结果,探讨支架所在部位及支架大小对DSCT评估冠状动脉ISR的影响。方法 106例同期行DSCT及SCAG检查的支架术后的患者,以SCAG结果为标准,比较DSCT评估不同部位及大小支架ISR的敏感性、特异性及准确性。结果 173枚支架中有156枚支架DSCT显影良好。DSCT显示有ISR的支架33枚,CAG证实存在ISR的支架38枚,DSCT诊断ISR的敏感度和特异度分别为78.9%和97.5%,阳性预测值90.9%,阴性预测值93.5%,一致率为92.9%。DSCT对近心端支架再狭窄的检出率优于远心端支架;直径≥3.0 mm支架的ISR检出率优于直径<3.0 mm支架。结论支架内径大小及所在部位影响DSCT图像的显示。DSCT在评估ISR方面,可基本取代SCAG作为冠脉近端支架及大直径支架(支架直径≥3 mm)通畅情况的评估方式。

Dual-Source Computed Tomography and Coronary Angiography in Evaluation of In-Stent Restenosis

Objective To compare the results of dual-source CT(DSCT) and coronary angiography(CAG)in the diagnosis of in-stent restenosis(ISR),and discuss the influence of the positions and size of stents on the evaluation results of ISR by DSCT.Methods The 106 patients in the same period underwent DSCT and CAG were included in the study,analysis and comparison ISR of DSCT diagnostic sensitivity,specificity and accuracy to detect in-stent restenosis was evaluated referring to coronary angiography.ISR was defined as a lesion demonstrating stenosis greater than 50%.Results In all 173 stents,156 stents could be assessed by DSCT.33 stents could be detected ISR by DSCT,38 stents with ISR indicated by CAG.The sensitivity,specificity,positive and negative predictive value and accuracy to identify ISR was 78.9%,97.5%,90.9% and 93.5%,92.9%,respectively.DSCT coronary artery proximal in-stent restenosis detection rate were superior to the distal stent.The detection with DSCT in-stent restenosis of positive predictive value,specificity and sensitivity in diameter≥3.0 mm stents were better than the diameter of<3.0 mm stents.Conclusion The diameter and location of the stent plays a significant role in stent lumen.The DSCT in the diagnosis of in-stent restenosis for which diameter ≥3.0 mm or proximal stent is close to the CAG.