Diagnostic Accuracy of Noninvasive Coronary Angiography Using 64-Slice Spiral Computed Tomography (original) (raw)
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Accuracy of MSCT coronary angiography with 64-slice technology: first experience
European Heart Journal, 2005
Aims The aim of our study was to investigate the accuracy of 64-slice computed tomography (CT) for assessing haemodynamically significant stenoses of coronary arteries. Methods and results CT angiography was performed in 67 patients (50 male, 17 female; mean age 60.1 + 10.5 years) with suspected coronary artery disease and compared with invasive coronary angiography. All vessels !1.5 mm were considered for the assessment of significant coronary artery stenosis (diameter reduction .50%). Forty-seven patients were identified as having significant coronary stenoses on invasive angiography with 18% (176/1005) affected segments. None of the coronary segments needed to be excluded from analysis. CT correctly identified all 20 patients having no significant stenosis on invasive angiography. Overall sensitivity for classifying stenoses was 94%, specificity was 97%, positive predictive value was 87%, and negative predictive value was 99%. Conclusion Sixty-four-slice CT provides a high diagnostic accuracy in assessing coronary artery stenoses.
Improved diagnostic accuracy with 16-row multi-slice computed tomography coronary angiography
Journal of The American College of Cardiology, 2005
We sought to compare the diagnostic value of multi-slice computed tomography (MSCT) coronary angiography (CA) to detect significant stenoses (Ն50% lumen diameter reduction) with that of invasive CA. BACKGROUND The latest 16-row MSCT scanner has a faster rotation time (375 ms) and permits scanning with a higher X-ray tube current (500 to 600 mA) during MSCT CA when compared with previous scanners.
coronary angiography Improved diagnostic accuracy with 16-row multi-slice computed tomography
OBJECTIVES We sought to compare the diagnostic value of multi-slice computed tomography (MSCT) coronary angiography (CA) to detect significant stenoses (Ն50% lumen diameter reduction) with that of invasive CA. BACKGROUND The latest 16-row MSCT scanner has a faster rotation time (375 ms) and permits scanning with a higher X-ray tube current (500 to 600 mA) during MSCT CA when compared with previous scanners. METHODS We studied 51 patients (37 men, mean age 58.9 Ϯ 10.0 years) with stable angina or atypical chest pain. Patients with pre-scan heart rates Ն70 beats/min received oral beta-blockade. The heart was scanned after intravenous injection of 100 ml contrast (iodine content, 400 mg/ml). Mean scan time was 18.9 Ϯ 1.0 s. The MSCT scans were analyzed by two observers unaware of the results of invasive angiography, and all available coronary branches Ն2 mm were included. RESULTS Invasive CA demonstrated normal arteries in 16% (8 of 51), non-significant disease in 21% (11 of 51), single-vessel disease in 37% (19 of 51), and multi-vessel disease in 26% (13 of 51) of patients. There were 64 significant lesions. Sensitivity, specificity, and positive and negative predictive values for detection of significant lesions on a segment-based analysis were 95% (61 of 64, 95% confidence interval [CI] 86 to 99), 98% (537 of 546, 95% CI 96 to 99), 87% (61 of 70, 95% CI 76 to 98), and 99% (537 of 540, 95% CI 98 to 99), respectively. All patients with angiographically normal coronary arteries or significant lesions were correctly identified. Three of 11 patients with Ͻ50% lesions were incorrectly classified as having single-vessel disease. CONCLUSIONS The 16-row MSCT CA reliably detects significant coronary stenoses in patients with atypical chest pain or stable angina pectoris.
Archives of Cardiovascular Diseases, 2009
Multi-detector row computed tomography (MDCT) offers an alternative to diagnostic coronary angiography for visualizing coronary arteries. The major limitation of recently published studies, aside from being monocentric in nature and the low number of patients included, is the selection of patients. These studies do not provide any answers for patients who are seen daily in cardiology consultation. The purpose of our study was to determine the diagnostic accuracy of MDCT as compared with coronary angiography on a population of average patients who were not selected. Materials and methods. -Forty-eight patients with suspected coronary artery disease successively underwent 64-slice MDCT followed by coronary angiography with 24 to 48 hours. The diagnostic accuracy detection of significant coronary stenoses (greater than 50% stenoses in arteries greater than 1.5 mm in diameter) was determined and the two techniques were com-Conclusion. -L'utilisation du scanner multibarettes 64-coupe résulte en une excellente précision diagnostique et en une valeur prédictive négative élevée pour la détection des sténoses coronaires significatives lors de l'analyse par segments. L'analyse par patients réduit significativement la valeur du scanner, démontrant que les patients avec une haute probabilité d'atteinte coronaire ne bénéficient pas d'une telle approche non invasive.
Diagnostic accuracy of 16-row multi-slice CT angiography in the evaluation of coronary segments
La radiologia medica
Purpose. To evaluate the diagnostic accuracy of 16-row multislice spiral computed tomography coranary angiography (16-MSCT-CA) for the non-invasive assessment of significant coronary artery stenosis. Materials and methods. We enrolled 40 patients (36 male, aged 59±11yrs) with suspected obstructive coronary artery disease and a heart rate <65 bpm during the scan. The 16-MSCT-CA (Sensation 16, Siemens, Forchheim, Germany) was performed with electrocardiographically-gated technique after the intravenous administration of 100 ml of iodinated contrast material followed by a saline bolus chaser. The scan parameters were: collimation 16×0.75 mm, rotation time 0.42 s, feed/rot. 3 mm (pitch 0.25), 120 kVp, 500 mAs. AB coronary segments 22 mm in diameter were evaluated by two independent observers for the presence of significant coronary artery stenosis (≥50%). Consensus reading was compared to quantitative coronary angiography. Result. The average heart rate was 55±6 bpm. Of the 428 segme...
Radiologia Medica, 2007
Purpose Our aim was to evaluate the diagnostic accuracy of 64-slice computed tomography coronary angiography (MSCT-CA) for detecting significant stenosis (≥50% lumen reduction) in a population of patients at low to intermediate risk. Materials and methods We studied 72 patients (38 men, 34 women, mean age 53.9±8.0 years) with atypical or typical chest pain and stratified in the low-to intermediate risk category. MSCT-CA (Sensation 64 Cardiac, Siemens, Germany) was performed after IV administration of 100 ml of iodinated contrast material (Iomeprol 400 mgI/ml, Bracco, Italy). Two observers, blinded to the results of conventional coronary angiography (CAG), assessed the MSCT-CA scans in consensus. Diagnostic accuracy for detecting significant stenosis was calculated. Results CAG demonstrated the absence of significant disease in 70.1% of patients (51/72). No patient was excluded from MSCT-CA. There were 37 significant lesions on 1,098 available coronary segments. Sensitivity, specificity and positive and negative predictive value of MSCT-CA for detecting significant coronary artery on a per-segment basis were 100%, 98.6%, 71.2% and 100%, respectively. All patients with at least one significant lesion were correctly identified by MSCT-CA. MSCT-CA scored 15 false positives on a per-segment base, which affected only marginally the per-p.atient performance (only one false positive). Conclusions We concluded that 64-slice CT-CA is a diagnostic modality with high sensitivity and negative predictive value in patients at low to intermediate risk. Obiettivo Valutare l’accuratezza diagnostica dell’angiografia coronarica non invasiva con tomografia computerizzata (AC-TC) a 64 strati nell’individuazione delle stenosi coronariche significative (riduzione del lume coronarico ≥ 50%) in una popolazione di pazienti a basso-intermedio rischio cardiovascolare. Materiali e metodi Sono stati studiati 72 pazienti (38 maschi, 34 donne, età media 53,9±8,0 anni) che presentavano dolore toracico atipico o angina pectoris stabile e che venivano stratificati nella categoria del rischio basso-intermedio. Per la scansione AC-TC sono stati iniettati endovena 100 ml di mezzo di contrasto (Iomeprolo 400 mgI/ml, Bracco, Italia). Due osservatori, in cieco rispetto alla coronarografia convenzionale CAG), hanno valutato in consenso le immagini dell’AC-TC. Sono stati quindi calcolati i valori di accuratezza diagnostica per la rilevazione di stenosi significative. Risultati L’angiografia coronarica invasiva ha dimostrato l’assenza di malattia o la presenza di malattia non critica nel 70,1% dei pazienti (51/72). Nessun paziente è stato escluso dalla popolazione studiata. Sono state individuate 37 lesioni significative su 1098 segmenti disponibili. Sensibilità, specificità, valore predittivo positivo e negativo dell’AC-TC nella determinazione delle stenosi significative utilizzando un’analisi per segmenti sono risultate, rispettivamente, del 100%, 98,6%, 71,2% e 100%. Tutti i pazienti con almeno una lesione significativa sono stati correttamente identificati anche nella valutazione con AC-TC. L’AC-TC ha generato 15 falsi postivi su base segmentale che però si riducono a un solo falso positivo nell’analisi per paziente. Conclusioni L’AC-TC a 64 strati rappresenta una metodica diagnostica ad elevata sensibilità e valore predittivo negativo nei pazienti con rischio basso o intermedio.
European Journal of Nuclear Medicine and Molecular Imaging, 2007
Purpose CT angiography (CTA) offers a valuable alternative for the diagnosis of CAD but its value in the detection of functionally relevant coronary stenoses remains uncertain. We prospectively compared the accuracy of 64-slice CTA with that of myocardial perfusion imaging (MPI) using 99m Tc-tetrofosmin-SPECT as the gold standard for the detection of functionally relevant coronary artery disease (CAD). Methods MPI and 64-slice CT were performed in 100 consecutive patients. CTA lesions were analysed quantitatively and area stenoses ≥50% and ≥75% were compared with the MPI findings. Results In 23 patients, MPI perfusion defects were found (12 reversible, 13 fixed). A total of 399 coronary arteries and 1,386 segments was analysed. Eighty-four segments (6.1%) in 23 coronary arteries (5.8%) of nine patients (9.0%) were excluded owing to insufficient image quality. In the remaining 1,302 segments, quantitative CTA revealed stenoses ≥50% in 57 of 376 coronary arteries (15.2%) and stenoses ≥75% in 32 (8.5%) coronary arteries. Using a cutoff at ≥75% area stenosis, CTA yielded the following sensitivity, specificity, negative (NPV) and positive predictive value (PPV), and accuracy for the detection of any (fixed and reversible) MPI defect: by patient, 75%, 90%, 93%, 68% and 87%, respectively; by artery, 76%, 95%, 99%, 50% and 94%, respectively. Conclusion Sixty-four-slice CTA is a reliable tool to rule out functionally relevant CAD in a non-selected population with an intermediate pretest likelihood of disease. However, an abnormal CTA is a poor predictor of ischaemia.
Diagnostic Accuracy of Noninvasive Coronary Angiography With 320Detector Row Computed Tomography
American Journal of Cardiology, 2010
Background-Multidetector computed tomographic angiography (MDCT) has been shown to allow detection of coronary artery bypass graft (CABG) occlusions and stenoses. However, the assessment of native coronary arteries in addition to CABG has thus far not been sufficiently validated. Methods and Results-Fifty patients with a total of 138 CABG (34 mammary grafts, 3 radial grafts, 101 venous grafts) were investigated by MDCT (0.6-mm collimation, 32 detector rows, 2 focal points, 330-ms rotation) 9 to 252 months (mean, 106 months) after surgery. CABG and all native coronary arteries with a diameter of Ͼ1.5 mm were evaluated for the presence of significant stenoses (Ն50% diameter reduction). Results were compared with quantitative coronary angiography. By MDCT, all CABG were evaluable and were correctly classified as occluded (nϭ38) or patent (nϭ100). Sensitivity for stenosis detection in patent grafts was 100% (16/16) with a specificity of 94% (79/84). For the per-segment evaluation of native coronary arteries and distal runoff vessels, sensitivity in evaluable segments (91%) was 86% (87/101) with a specificity of 76% (354/465). If evaluation was restricted to nongrafted arteries and distal runoff vessels, sensitivity was 86% (38/44) with a specificity of 90% (302/334). On a per-patient basis, classifying patients with at least 1 detected stenosis in a CABG, a distal runoff vessel, or a nongrafted artery or with at least 1 unevaluable segment as "positive," MDCT yielded a sensitivity of 97% (35/36) and specificity of 86% (12/14).