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Multidetector computed tomography angiography for assessment of in-stent restenosis: meta-analysis of diagnostic performance Vanhoenacker PK; Decramer I; Bladt O; Sarno G; Van Hul E; Wijns W; Dwamena BABMC Med Imaging 2008[Jul]; 8 (ä): 14BACKGROUND: 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. CONCLUSION: 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.|Blood Vessel Prosthesis/*statistics & numerical data[MESH]|Clinical Trials as Topic/statistics & numerical data[MESH]|Coronary Angiography/*statistics & numerical data[MESH]|Coronary Restenosis/*diagnostic imaging/*epidemiology[MESH]|Graft Occlusion, Vascular/*diagnostic imaging/*epidemiology[MESH]|Humans[MESH]|Incidence[MESH]|Stents/*statistics & numerical data[MESH]|Tomography, X-Ray Computed/*statistics & numerical data[MESH] |
