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EDUCATION EXHIBIT |
1 From the Departments of Radiology (F.P., F.C., N.R.A.M., G.P.K.) and Cardiology (C.v.M., W.B.M., P.M., P.J.d.F.), Erasmus MC, Dr Molenwaterplein 40, 3015 GD Rotterdam, the Netherlands; and Department of Radiology, University of Genoa, Genoa, Italy (C.M.). Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received September 29, 2005; revision requested October 24 and received November 10; accepted December 15. All authors have no financial relationships to disclose. Address correspondence to F.P. (e-mail: francesca.pugliese{at}libero.it).
Whereas the clinical diagnosis of in-stent thrombosis is straightforward, that of in-stent restenosis remains a problem, because although many patients experience chest pain after coronary stent placement, that symptom is secondary to ischemia in only a few. The use of a noninvasive technique to identify such patients for early invasive intervention versus more conservative management is thus highly desirable. Multidetector computed tomography (CT) performed with 16-section scanners recently emerged as such a technique and has overtaken modalities such as electron-beam CT and magnetic resonance imaging as an alternative to conventional angiography for the assessment of in-stent restenosis. The improved hardware design of the current 64-section CT scanners allows even better delineation of stent struts and lumen. The more reliable criterion of direct lumen visualization thus may be substituted for the presence of distal runoff, which lacks specificity for a determination of in-stent patency because of the possibility of collateral pathways. However, the capability to accurately visualize the in-stent lumen depends partly on knowledge of the causes of artifacts and how they can be compensated for with postprocessing and proper image display settings. In addition, an understanding of the major stent placement techniques used in the treatment of lesions at arterial bifurcations is helpful.
© RSNA, 2006
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