Abstract

JACC

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TCTAP A-058

The Diagnostic Precision of Monoenergetic Reconstructions Using Dual-Source Dual-Energy CT Compared to Invasive Coronary Angiography With Add on Intravascular Ultrasound to Evaluate In-stent Restenosis: Cross-Sectional Study

By Mohey Eldeen AbouElfetouh Eldeeb, Mohamed mostafa, Tarek Ahmed Naguib, Mohammed Hosam Eldein Alshair, Islam Elsayed Shehata

Presenter

Islam Elsayed Shehata

Authors

Mohey Eldeen AbouElfetouh Eldeeb1, Mohamed mostafa, Tarek Ahmed Naguib1, Mohammed Hosam Eldein Alshair1, Islam Elsayed Shehata1

Affiliation

Zagazig University, Egypt1
View Study Report
TCTAP A-058
Imaging: Non-Invasive

The Diagnostic Precision of Monoenergetic Reconstructions Using Dual-Source Dual-Energy CT Compared to Invasive Coronary Angiography With Add on Intravascular Ultrasound to Evaluate In-stent Restenosis: Cross-Sectional Study

Mohey Eldeen AbouElfetouh Eldeeb1, Mohamed mostafa, Tarek Ahmed Naguib1, Mohammed Hosam Eldein Alshair1, Islam Elsayed Shehata1

Zagazig University, Egypt1

Background

The conventional invasive coronary angiography (ICA) is an invasive method to detect in-stent restenosis (ISR). However, the financial cost and the expected complications of ICA made it important to look for another non-invasive modality for assessment of ISR. Also 64-slice multi-detector CT coronary angiography (MDCT-CA) unlike older version; can give information on morphology of coronary plaques and determine ISR clearly almost the way intravascular ultrasound (IVUS) can do.The advanced image-based monoenergetic reconstructions using third generation dual-source dual-energy CT provides more accurate visualization of the stent and so, detection of any ISR.So, we aimed to assess the diagnostic accuracy of monoenergetic reconstructions using third generation dual-source dual-energy CT compared to ICA with IVUS in detection of coronary ISR.

Methods

One hundred patients with previously stented coronaries (n=110 stents) underwent dual-source dual-energy CT followed by ICA and IVUS within 24 hours. Specificities, Sensitivities, negative predictive values (NPV) and positive predictive values (PPV) of dual-source dual-energy CT and ICA for confirming or excluding ISDR by measuring in-stent area restenosis (ISAR) andminimal luminal area (MLA) ≤4.0 mm2 of IVUS was taken as the standard reference standard.

Results

Newer generation dual-source dual-energy CT and IVUS had a good sensitivity, specificity and accuracy in detection of ISDR. However,the patients have to be carefully selected. Consistent with previous MDCT-CA studies, our study observed significant effect of stent diameter on assessability, with 3 mm being a cutoff point below which the percentage of assessable stents is extremely low. When using IVUS MLA of 4.0mm2 as a reference method for identification of ISDR, no significant difference was detected between dual-source dual-energy CT and ICA inidentification of ISDR.The higher NPV of dual-source dual-energy CT when compared with ICA and IVUS (100% and 100% respectively),therefore,dual-source dual-energy CT had an important role in exclusion of ISDR.

Conclusion

When evaluating the patency of stents, monoenergetic reconstructions using newer third generation dual-source dual-energy CT has the same performance as coronary angiography and IVUS and has the following advantages: non-invasiveness, low cost, and easy and convenient operation.

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