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Combined imaging modalities improved diagnosis in patients with stents
Compared with CTA alone, combined CTA and myocardial CT perfusion enhances diagnosis of CAD and in-stent restenosis in patients with stents, according to findings published today by the Journal of the American College of Cardiology.
In the study, researchers from Germany looked at 91 consecutive patients with stents before quantitative coronary angiography. If a coronary stent or vessel was nondiagnostic after angiography, adenosine stress CT perfusion in the corresponding myocardial territory was performed.
There were significantly more patients nondiagnostic for stent assessment by CTA (22%; due to metal artifacts [75%] or motion [25%]) compared with CT perfusion (1%; P<.001). Diagnostic accuracy of CT angiography/CT perfusion for stents (87%; 95% CI, 78-93) was significantly higher than that of CT angiography alone (71%; 95% CI, 61-80), mainly because nondiagnostic examinations were significantly reduced (P<.001).
Diagnostic accuracy and nondiagnostic rate also were significantly improved by adding CT perfusion (P<.001) for CAD. There was a significantly lower effective radiation dose with both imaging methods (7.9 ± 2.8 mSv) than just angiography (9.5 ± 5.1 mSv; P=.005).
The area under the receiver-operating-characteristic curve for CT angiography/CT perfusion (0.82; 95% CI, 0.69-0.95) was superior to that for just angiography (0.69; 95% CI, 0.57-0.82) in identifying patients requiring stent revascularization.
Researchers wrote that the combined imaging had 87% accuracy for detection of in-stent restenosis and 86% accuracy for CAD on the patient level, the most relevant level that indicates robust diagnostic performance.
“The need for two contrast agent injections of about 60 mL and an effective radiation dose of about 7.9 mSv for CTA/CT perfusion argue against its routine clinical use,” they wrote. “Nevertheless, the radiation dose of CTA/CT perfusion was significantly smaller than that for conventional coronary angiography.”
Disclosure: Rief reports no relevant financial disclosures.
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