Diagnostic accuracy of first generation dual-source computed tomography in the assessment of coronary artery disease: a meta-analysis from 24 studies

Abstract

The objective of this study is to evaluate the diagnostic accuracy of the first generation dual-source computed tomography (DSCT) in the diagnosis of coronary artery disease (CAD). We selected articles from four databases (Pubmed, Embase, the Cochrane central register of controlled trials (CENTRAL) and Chinese biomedical literature database. The strict study selection was made, and two reviewers independently extracted data back-to-back from included studies. Meta-Disc version 1.4 was used to obtain the pooled results. 24 studies were included in meta-analysis. A cut off point of ≥50% stenosis was used in all the studies to define significant coronary artery stenosis. In patient-based analysis (n = 801), pooled sensitivity was 0.980 [95% confidence interval (CI):0.970-0.990], specificity 0.870 (95% CI: 0.830-0.900), median positive predictive value (PPV) across studies 0.876 (range from 0.741 to 0.943) and negative predictive value (NPV) 0.964 (range from 0.900 to 1.000). In vessel-based analysis (n = 3,620) DSCT pooled sensitivity was 0.957 (95% CI: 0.943-0.969), specificity 0.930 (95% CI: 0.910-0.940), median PPV across studies 0.838 (range from 0.534 to 0.964) and NPV 0.973 (range from 0.885 to 0.996). In segment-based analysis (n = 6,177) DSCT pooled sensitivity was 0.915 (95% CI: 0.901-0.928), specificity 0.959 (95% CI: 0.956-0.963), median PPV 0.782 (range from 0.320 to 0.927) and NPV 0.985 (range from 0.929 to 0.999). In subgroups analysis, pooled sensitivity and specificity in segment based analysis were 93.1 and 92.3% when heart rate (HR) is beyond 70 bpm; when HR was below 70 bpm, the sensitivity was similar (93%), but specificity increased a little from 92.3 to 94%. When analysed based on segment with a cut-off calcium score of 400, the sensitivity was slightly higher in the subgroup with a score over 400 than in the subgroup with a score below 400 (94 vs. 91%), while the specificity was much lower in the subgroup with the high calcium score than the subgroup with the low calcium score (85 vs. 96%). For subgroups with heart rate beyond and below 65 bpm in patient-based analysis, sensitivities were 0.95 (95% CI: 0.86-0.99) and 0.98 (95% CI 0.91-1.00), respectively, while the specificities were 0.88 (95% CI 0.81-0.94) and 0.85 (95% CI 0.77-0.91), respectively. The area under the receiver operating characteristic curve (AUC) in the two subgroups were 0.9608 and 0.9786, respectively. DSCT is highly sensitive for patient-based analysis of CAD and has high specificity and NPV for segment-based analysis of CAD. First generation DSCT may have a role in the evaluation of patients with chest pain as a simple non-invasive examination because of its ability to diagnose or exclude significant CAD.

Coronary computed tomography angiography with prospective electrocardiography triggering: a systematic review of image quality and radiation dose

“…(32) Similarly, a metaanalysis of 24 studies showed that DSCT coronary angiography had high sensitivity and specificity for CAD, especially in patients with high heart rates. (34) Our results were consistent with these reports, as we too found that assessable segments in studies using DSCT coronary angiography were higher than those in studies using SSCT coronary angiography, although the difference was not statistically significant.…”

Role of strain values using automated function imaging on transthoracic echocardiography for the assessment of acute chest pain in emergency department

“…We defined significant CAD as C70 % stenosis in one or more vessels on CAG or CCTA. Although CAG is the reference standard test to define significant coronary artery stenosis, the high diagnostic accuracy of CCTA has been reported in many studies [25][26][27]. Among 69 patients who underwent coronary imaging tests in this study, 33 patients underwent CAG and 52 patients did CCTA.…”

Coronary CT Angiography in Coronary Artery Disease: from Diagnosis to Prevention

“…3,5-7, 29,30 These analyses indicate that CCTA has high diagnostic value in the detection and characterization of CAD due to presence of plaques (Figure 1). Currently, 320-slice CT represents the recently technological developments in imaging coronary artery disease with good results achieved.…”