Diagnostic Accuracy of 64-Slice Computed Tomography for Detecting Angiographically Significant Coronary Artery Stenosis in an Unselected Consecutive Patient Population Comparison With Conventional Invasive Angiography

Abstract

oronary artery disease (CAD) and its thrombotic complications are the leading cause of morbidity and mortality in the industrialized countries. Over the past 30 years, invasive coronary angiography (ICAG) has been the gold standard method for the visualization and detection of coronary stenosis. Recently, efforts have been made to develop reliable noninvasive diagnostic methods that would allow a broader use, as well as decreasing the risks linked to an invasive examination.Multislice computed tomography (MSCT), which started with a 4-slice scanner in 1998, was the beginning of visualizing the coronary arteries noninvasively, 1-9 and with the development of 16-slice MSCT, this desire has been realized to some extent. To date, many investigators have evaluated the accuracy of MSCT for detecting significant coronary stenosis and in most of the published studies the sensitivity is approximately 80% and the specificity approximately 90%. [10][11][12][13][14][15][16][17][18][19] The results appear promising, but those studies did not consist of consecutive patients, including those with unsatisfactory images for interpretation. Besides, cases with severe calcification, high heart rates (>70 beats/min), or previous revascularization, were excluded from most of the studies.In daily practice, however, we often encounter patients with advanced CAD, having severely calcified arteries, or patients who are post percutaneous coronary intervention (PCI) using different treatment modalities such as stenting, plain old balloon dilatation, or debulking.The new 64-slice MSCT (64-MSCT), which provides a 0.4 mm isotropic resolution and less than 165 ms temporal resolution, has the potential to overcome image-degrading artifacts related to motion, pixel noise, calcification or coronary stents to some extent. 20,21 The aim of our study was to evaluate the diagnostic accuracy of 64-MSCT in various types of patients, including those with severely calcified arteries or post-PCI, as Background Multislice computed tomography (MSCT) is a promising noninvasive method of detecting coronary artery disease (CAD). However, most data have been obtained in selected series of patients. The purpose of the present study was to investigate the accuracy of 64-slice MSCT (64 MSCT) in daily practice, without any patient selection. Methods and ResultsUsing 64-slice MSCT coronary angiography (CTA), 69 consecutive patients, 39 (57%) of whom had previously undergone stent implantation, were evaluated. The mean heart rate during scan was 72 beats/min, scan time 13.6 s and the amount of contrast media 72 mL. The mean time span between invasive coronary angiography (ICAG) and CTA was 6 days. Significant stenosis was defined as a diameter reduction of >50%. Of 966 segments, 884 (92%) were assessable. Compared with ICAG, the sensitivity of CTA to diagnose significant stenosis was 90%, specificity 94%, positive predictive value (PPV) 89% and negative predictive value (NPV) 95%. With regard to 58 stented lesions, the sensitivity, specificity, PPV and NPV were 93...

Detection of Relevant Coronary Artery Disease Using Dual-Source Computed Tomography in a High Probability Patient Series Comparison With Invasive Angiography

“…4,19,35 However, in comparison with those studies, our data suggest a considerably increased diagnostic accuracy, which might be at least partially related to optimized image quality at elevated heart rates. Another limitation is that we did not enrol patients with coronary stents or atrial fibrillation, both clinically relevant conditions that should be the subject of further studies.…”

“…A low heart rate during scanning has therefore been an essential requirement to obtain a data set suitable for quantitative analysis, [32][33][34] which so far has required a consistent heart rate lowering protocol using oral or intravenous administration of β-blockers. [1][2][3][4]13,[35][36][37][38] Hence, the mean heart rate during scanning in studies using 64-slice MDCT is considerably below 65 bpm. 4,5 To overcome the occurrence of motion artefacts at higher heart rates, 2 technical approaches have been developed; multi-segment reconstruction algorithms combine data sets from 2 or even more cardiac cycles for reconstruction, achieving improved temporal resolution, but they disregard the inter-heartbeat variability of coronary artery position and require low table pitches.…”

Transitioning from 16-slice to 64-slice multidetector computed tomography for the assessment of coronary artery disease: Are we really making progress?

“…Currently, 15 studies have examined 64-slice technology for the evaluation of suspected CAD (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) (Figure 2). In these studies, 64-slice MDCT was able to assess 97% of all coronary artery segments visualized by both CCA and MDCT (Table 1), which is approximately 5% more than previous 16-slice technology.…”

“…Furthermore, when using patient-based analysis, defined as the presence of one or more significant coronary artery lesions in a study subject, sensitivity for 64-slice MDCT ranged between 88% to 100% in the 15 studies reviewed (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Additionally, in study populations with a low prevalence of CAD (32%), per-patient sensitivity remained very high (96%) (9).…”

Quantitative Gated Single-Photon Emission Computed Tomography With 99mTc Sestamibi Predicts Major Cardiac Events in Elderly Patients With Known or Suspected Coronary Artery Disease The QGS-Prognostic Value in the Elderly (Q-PROVE) Study

“…In addition, rapid advances in multislice computed tomography (CT) imaging have facilitated accurate noninvasive diagnosis of CAD, and some investigators propose that coronary CT should be the first-line test for patients suspected of having CAD. [29][30][31] However, the dense coronary calcification often observed in elderly patients aged ≥75 prevents coronary CT from adequately evaluating anatomy and results in reduced diagnostic accuracy. 31,32 Stress myocardial SPECT, on the other hand, shows good diagnostic accuracy, irrespective of age.…”