Objectives: A diagnostic technique to objectively determine coronary in-stent stenosis was developed with multi(16)-slice computed tomography(MSCT), and it was compared with coronary angiography(CAG) in clinical cases. Background: MSCT is expected to replace coronary angiography as a new non-invasive examination. Evaluation of highly calcified or in-stent lesions with CT is generally thought to be difficult. Methods: Twenty lesions among 16 consecutive patients that were implanted with coronary stents were examined with both MSCT and CAG at follow-up. The minor axis cross sections of the stents were reconstructed at intervals of 1.5 mm with multiplanar reformation(MPR). The pixel with a higher CT value than the lowest CT value in the standard cross section at the proximal site out of stent was counted to determine the presence/absence of a stenotic lesion. Results: Among 20 lesions, one case was not able to be evaluated with MSCT. MSCT correctly detected 3 of 4 cases with in- stent stenosis(sensitivity 75% ), and 14 of 16 cases with no in-stent stenosis(specificity 88% , negative predictive value 93% , positive predictive value 75% ). If analysis was made per-artery, sensitivity and specificity were 100% (3 of 3) and 87% (13 of 15), respectively, for detection of in-stent stenosis. Conclusions: This study was performed to examine a unique diagnostic technique: pixel count method, for coronary in-stent stenosis with MSCT. It showed that the coronary in-stent stenosis could be determined when stent struts were clearly imaged. Further examination is required with various stents, especially those with a diameter of 3.0 mm or smaller.
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