The Diagnostic Accuracy Of Dual-source CT Dual Energy Scan Pattern For In-stent Restenosis After PCI

Objective Explore the diagnostic accuracy of dual source CT dual energy scan pattern in macroscopic qualitative,nIC quantitative and qualitative combined with quantitative for in-stent restenosis after PCI.Methods Using the second generation Siemens dual-source CT to scan the 88 cases of coronary heart disease patients who was coronary artery stent implantation after follow-up from November of 2015 to December of 2016 in the first hospital of lanzhou university with dual energy pattern.There are 86 patients after coronary artery stent implantation,a total of 152 pieces of stents,eventually in this study.16 male and70 female,aged from 40 to 76,an average of 60.84±9.43 years old.Firstly,with five quantitative method to evaluate image quality,and to analyze its influencing factors.Using One-Way ANOVA to judge significant stenosis of stent lumen.By selective coronary angiography results as the gold standard,calculate the macroscopic qualitative analysis,quantitative analysis of the nIC and a combination for the diagnosis of coronary artery stent restenosis by sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,positive predictive value,negative predictive value,and diagnosis accuracy,respectively.Compared the above three methods for the evaluation of significant stenosis after coronary artery stent implantation with selective coronary angiography;And compare the macroscopic qualitative analysis,nIC quantitative analysis and the combination in the difference between accuracy indexes for the diagnosis of coronary artery stent restenosis;All statistical analysis were operated by SPSS 21.0 and MedCalc.P < 0.05 for the difference was statistically significant.Result1.Quality score range from 1 to 4 points,to an average of 1.86 + 0.78.2.Gold standard to assess 152 stents not seen in the narrow accounts for 49.34%(75/152),mild stenosis accounts for 19.08%(29/152),mild stenosis is 11.18%(17/152),moderate stenosis accounts for 4.60%(7/152),severe stenosis is 8.55%(13/152),totally occluded accounts for 7.24%(11/152).Significant stenosis(stenosisdegree is 50% or higher)is 31(20.39%).3.The qualitative analysis to the naked eye detection did not see the narrow stents103(67.76%),mild stenosis stents 13(8.55%),mild stenosis stents 11(7.24%),moderate stenosis stents 3(1.97%),severe stenosis stents 13(8.55%),occlusion stents9(5.92%),of which significantly narrow 25,accounts for 16.45%.The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,positive predictive value,negative predictive value and diagnostic accuracy of the diagnosis for ISR significant stenosis was 67.74%,96.69%,20.49,0.33,84%,92.13% and90.79%,respectively.There was no statistically significant difference with the SCA.4.nIC quantitative analysis of the detection of significant stenosis stents 27(17.76%),no significant stenosis stents is 125(82.24%).The diagnosis of coronary artery stents significant stenosis sensitivity,specific,positive likelihood ratio,negative likelihood ratio,positive predictive value,negative predictive value and accuracy of diagnosis were 58.06%,92.56%,7.81,0.45,66.67%,89.60% and 85.53%,respectively.There was no statistically significant difference with the SCA.5.Macroscopic qualitative combined with nIC quantitative analysis were detected significant stenosis stents 35(23.03%),no significant stenosis stents were 117(76.97%).The sensitivity of the diagnosis of ISR,specificity,positive likelihood ratio,negative likelihood ratio,positive predictive value,negative predictive value and diagnostic accuracy were 83.87%,92.56%,74.29%,95.73% and 90.79,11.28,0.17,respectively.And had no statistically significant difference from SCA.6.The differences of macroscopic qualitative,nIC quantitative and qualitative combined with quantitative analysis for the diagnosis restenosis after coronary stent implantation had no statistical significance between evaluation accuracy index.Conclusion1.Dual-source CT dual energy scan pattern can clearly show visually the anatomical location,the stent lumen filled,and be able to more accurately for indexing and classifying the stent restenosis,and clearing the cause of restenosis and involvement;2.Dual source CT dual energy scan pattern can get a clear map of iodine,by measuring the iodine in the stents,largely improve its diagnostic sensitivity of stent restenosis,but because of its high false positive result in specific degree decreased;3.Dual source CT dual energy scan pattern CT preliminary realized the quantitative analysis of stent restenosis,and laid a solid foundation for stent lumenplaques characteristic analysis and quantitative analysis of myocardial ischemia.