Multidetector computed tomography angiography for assessment of in-stent restenosis: meta-analysis of diagnostic performance
Multi-detector computed tomography angiography (MDCTA)of the coronary arteries after stenting has been evaluated in multiple studies. The purpose of this study was to perform a structured review and meta-analysis of the diagnostic performance of MDCTA for the detection of in-stent restenosis in the coronary arteries.
Methods: A Pubmed and manual search of the literature on in-stent restenosis (ISR) detected on MDCTA compared with conventional coronary angiography (CA) was performed.
Bivariate summary receiver operating curve (SROC) analysis, with calculation of summary estimates was done on a stent and patient basis. In addition, the influence of study characteristics on diagnostic performance and number of non-assessable segments (NAP) was investigated with logistic meta-regression.
Results: Fourteen studies were included. On a stent basis, Pooled sensitivity and specificity were 0.82(0.72-0.89) and 0.91 (0.83-0.96).
Pooled negative likelihood ratio and positive likelihood ratio were 0.20 (0.13-0.32) and 9.34 ( 4.68-18.62) respectively. The exclusion of non-assessable stents and the strut thickness of the stents had an influence on the diagnostic performance.
The proportion of non-assessable stents was influenced by the number of detectors, stent diameter, strut thickness and the use of an edge-enhancing kernel.
Conclusions: The sensitivity of MDTCA for the detection of in-stent stenosis is insufficient to use this test to select patients for further invasive testing as with this strategy around 20% of the patients with in-stent stenosis would be missed. Further improvement of scanner technology is needed before it can be recommended as a triage instrument in practice.
In addition, the number of non-assessable stents is also high.
Author: Piet K. Vanhoenacker, Isabel Decramer, Olivier Bladt, Giovanna Sarno, Erik Van Hul, William Wijns and Ben A. Dwamena
Credits/Source: BMC Medical Imaging 2008, 8:14
Published on: 2008-07-31
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
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