Multidetector-row cardiac CT: diagnostic value of calcium scoring and CT coronary angiography in patients with symptomatic, but atypical, chest pain

Abstract

The aim of this study was to investigate the accuracy of multidetector-row cardiac CT (MDCT), calcium scoring (Ca-Sc), and MDCT coronary angiography (MD CTA) in the assessment of coronary atherosclerosis. Thirty-eight patients underwent invasive coronary angiography (CA) and MDCT (collimation 4x1 mm, pitch 1.5 mm, TI 500 ms, 120 kV, 300 mAs, and retrospective ECG-gating). Calcium scoring was calculated for the total coronary artery territory and for RCA, LCA, and LCX separately. The MD CTA served to assess the degree and the localization of stenoses. All findings were compared to invasive coronary angiography. Approximately 68.4% (390 of 570) of all coronary segments could be visualized by MDCT. Correlation coefficient for MD CTA and CA amounted to r=0.58, showing distinct differences for the individual segments. Proximal segments generally showed better correlation (range 0.81-0.77) than medial segments (range 0.91-0.20), distal segments (range 0.55-0.04), or side branches (range 0.76-0.00). Patients with hemodynamically relevant (>75%) stenoses were detected by MD CTA with 72.2% sensitivity (13 of 18) and 100% specificity (20 of 20). For Ca-Sc sensitivity ranged between 94.7% (17 of 18) and 66.7% (12 of 18), specificity between 20% (4 of 20) and 80% (16 of 20) respectively, depending on the prevailing cutoff value. Combination of both methods led to 83.3% sensitivity (15 of 18) and 100% specificity (20 of 20), reaching no level of significance as compared with Ca-Sc (p=0.73) or MD CTA (p=0.23) alone. Calcium scoring as a single method showed highest sensitivity in the detection of coronary atherosclerosis but at the expense of low specificity. In patients with no or moderate calcifications, combination with MD CTA helped to distinctly increase specificity and NPV.

Screening for coronary artery disease in respiratory patients: comparison of single- and dual-source CT in patients with a heart rate above 70 bpm

“…In this clinical setting, good sensitivity and specificity of ECG-gated single-source CT angiography have been reported for the simultaneous assessment of pulmonary embolism, coronary artery stenosis, and aortic dissection or aneurysm [32][33][34][35]. The higher temporal resolution of dualsource CT may further improve the diagnostic value of CT angiography in this subset of patients as they often present with high heart rates [16,32].…”

Coronary artery calcification score by multislice computed tomography predicts the outcome of dobutamine cardiovascular magnetic resonance imaging

“…Detection of coronary artery calcification (CAC) by means of multislice computed tomography (MSCT) is a sensitive and reproducible method for determining the presence of coronary atherosclerosis [8][9][10][11][12]. The amount of CAC detected with computed tomography is correlated with the severity and extent of angiographically detected significant CAD in patients suspected of having CAD and can be used as a tool for cardiac risk stratification [13][14][15].…”

Influence of a small field-of-view size on the detection of coronary artery calcifications with MSCT: in vitro and in vivo study

“…In clinical routine, a wide range of examination protocols with varying spatial resolution are used for coronary calcium scoring. While most studies use a slice thickness of 3 mm (z-axis resolution), the FOV size varies from 180×180 mm 2 to 430×430 mm 2 [8,[17][18][19][20][21], resulting in a broad bandwidth of spatial resolution in the x/y-plane. Some studies even used different FOV sizes in the same patient group [20,22].…”

“…All examinations were performed during a single breathhold of 18 Image reconstruction was performed at 60% of the RR interval with an effective slice thickness of 3 mm and a reconstruction increment of 2 mm. Corresponding to the in vitro examination, three axial image series with a heartsize-adapted FOV of 180×180 mm 2 and 220×220 mm 2 as well as a full-chest-size-adapted FOV of 380×380 mm 2 , were reconstructed in every patient using a 512 2 matrix.…”