Abstract
In addition to assessment of native coronary artery disease, 64 slice multidetector computed tomography (MDCT) is recently shown to be a promising approach for non-invasive detection of in-stent restenosis (ISR). However, limited data is available for the diagnostic performance for current methods of MDCT analysis. In the present study, we sought to determine the diagnostic performance of commonly employed methods of visual assessment and commercially available Aquarius iNtuition software (TeraRecon, USA) for detection of ISR compared to gold standard of quantitative coronary angiography (QCA). MDCT was performed in eligible patients within 30 days of coronary angiography at 12-18 months after stenting of left main coronary artery for detection of ISR. Visual assessment by two independent observers and by Aquarius iNtuition software (TeraRecon, USA) was completed in a blinded manner for MDCT analysis and detection of ISR. Coronary angiography was analyzed by QCA using detection software (CAAS II, Pie Medical, Netherlands) for detection of ISR by an independent observer in a blinded manner. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, inter and intra observer variability was determined for the visual assessment and Aquarius iNtuition software. Forty two patients (31 men, 67±11 years) with 52 stents were included in the study. Three patients (4 stents) could not be analyzed by the software due to technical reasons. The mean stent diameter was 3.5±0.67 mm. Inter-observer agreement was moderate (κ=0.65). Intra-observer agreement was moderate to good (κ=0.65 and κ=1). The table shows the variable parameters of diagnostic performance for the two commonly used techniques of visual assessment and Aquarius iNtuition software for MDCT assessment of ISR. Tabled 1 In contrast to native coronary artery disease, both visual assessment and software analysis of MDCT offer poor sensitivity and variable specificity for detection of ISR. Technological advances with faster speed or novel techniques of MDCT analysis should be sought to improve the diagnostic performance of MDCT for detection of ISR.
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