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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 BA - BMC Med Imaging (2008)

Bottom Line: Pooled negative likelihood ratio and positive likelihood ratio were 0.20 (0.13-0.32) and 9.34 (4.68-18.62) respectively.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiology and Imaging, OLV Ziekenhuis, Aalst, Belgium. piet@vanhoenacker.be

ABSTRACT

Background: 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.

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Related in: MedlinePlus

Conditional Probability plots per patient. LR+: positive likelihood ratio, LR-: negative likelihood ratio.
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Figure 9: Conditional Probability plots per patient. LR+: positive likelihood ratio, LR-: negative likelihood ratio.

Mentions: Random effects SROC curve and conditional probability plots are displayed in figure 6, 7, 8 and 9. The results of meta-regression are outlined in Table 6. Using a threshold of p < 0.05 for statistical significance, none of the evaluated covariables were significant predictors of sensitivity. The only significant predictor of specificity was the exclusion of non-assessable segments (p 0.003). A few selected covariables that were amenable to meaningful subgroup analysis are displayed with their stratum specific sensitivities and specificities in Table 7. Logistic metaregression on a per patient basis showed no predicting covariables. The pooled NAP was 0.11 (95%CI, 0,04–0,20, range 0.00–0.46). Meta-regression on NAP showed that it was influenced by the number of detectors, stent diameter, strut thickness and the use of an edge-enhancing kernel (Table 8).


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 BA - BMC Med Imaging (2008)

Conditional Probability plots per patient. LR+: positive likelihood ratio, LR-: negative likelihood ratio.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2533305&req=5

Figure 9: Conditional Probability plots per patient. LR+: positive likelihood ratio, LR-: negative likelihood ratio.
Mentions: Random effects SROC curve and conditional probability plots are displayed in figure 6, 7, 8 and 9. The results of meta-regression are outlined in Table 6. Using a threshold of p < 0.05 for statistical significance, none of the evaluated covariables were significant predictors of sensitivity. The only significant predictor of specificity was the exclusion of non-assessable segments (p 0.003). A few selected covariables that were amenable to meaningful subgroup analysis are displayed with their stratum specific sensitivities and specificities in Table 7. Logistic metaregression on a per patient basis showed no predicting covariables. The pooled NAP was 0.11 (95%CI, 0,04–0,20, range 0.00–0.46). Meta-regression on NAP showed that it was influenced by the number of detectors, stent diameter, strut thickness and the use of an edge-enhancing kernel (Table 8).

Bottom Line: Pooled negative likelihood ratio and positive likelihood ratio were 0.20 (0.13-0.32) and 9.34 (4.68-18.62) respectively.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiology and Imaging, OLV Ziekenhuis, Aalst, Belgium. piet@vanhoenacker.be

ABSTRACT

Background: 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.

Show MeSH
Related in: MedlinePlus