Diagnostic performance of multislice CT coronary angiography in the assessment of significant coronary artery disease (original) (raw)
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Bangladesh Medical Research Council Bulletin, 2014
Noninvasive CT coronary angiography is a promising coronary imaging technique. In spite of the unprecedented temporal and spatial resolution and the inability to perform therapeutic interventions in the same session multi-detector computed tomography (MDCT) has been considering a promising alternative, non invasive tool for coronary artery imaging due to its high sensitivity and specificity for the detection of significant coronary artery stenosis. To evaluate the diagnostic accuracy of 64-slice MDCT for assessing haemodynamically significant stenoses of the coronary arteries in comparison with the conventional standard cardiac angiography. Fifty patients scheduled for conventional coronary angiography at the department of Radiology and Imaging, United Hospital, Dhaka were enrolled between July 2007 and June 2008. All patients underwent both conventional and MDCT angiography within mean 10.70 days. Overall sensitivity of 64-slice MDCT for the detection of stenosis ?50%, stenosis >...
The Egyptian Journal of Radiology and Nuclear Medicine, 2014
Objective: To evaluate the effectiveness of the multislice CT coronary angiography, as a non-invasive imaging tool in assessment of coronary artery stenosis. Patients and methods: The study included 50 patients who were referred for MSCT coronary angiography followed by catheter coronary angiography. Patients with previous coronary bypass grafts and those with coronary stents were excluded. History of contrast allergy, renal impairment and severe chest conditions were exclusion criteria. The coronary angiographic CT studies were performed using a 320 CT scanner. The catheter coronary angiographic studies were performed via femoral arterial puncture. The results of CT angiography were compared with the gold standard catheter angiography. Results: The positive predictive value and negative predictive value of MSCT coronary angiography in detection of coronary artery stenosis were 94% and 100%, respectively. Conclusion: In conclusion, MSCT coronary angiography is a very helpful and rapid non-invasive coronary imaging modality that was able to detect and grade coronary artery stenosis better than other noninvasive examinations used to detect CAD, such as exercise stress testing. Due to its very high negative predictive value, it may eliminate the need for invasive coronary procedures in the presence of normal coronary imaging.
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...
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.
Value of the 64-rows multi-detector computed tomography in diagnose coronary disease
Value of the 64-rows multi-detector computed tomography in diagnose coronary disease Nguyen Khoi VIET, Hoang Van HOA, Nguyen Ngoc TRANG, Pham Minh THONG1 1. Dept of Radiology, Bach Mai Hospital, Ha Noi, Vietnam Summary: Accuracy of coronary imaging using the 64-row multi-detector computed tomography in diagnosis of coronary stenosis in the radiology departement in Bach Mai hospital. Method and result: During 2 years (10/2006-12/2008), A total of 2722 patients underwent coronary computed tomography( CTA). 207 patients also underwent contrast-enhanced conventional coronary angiography (CCA) in the Heart departement. CT angiography was performed in 207 patients (129 male, 79 female; mean age 60.49+11.7 years), mean heart rate 65,26+/-5,88 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. We use four main segments analysed. Of 828 segments, 748 segments was evaluated (90%). We excluded 80 segments with severe artifact, previous stent implantation, heavily calcified... Overall sensitivity for classifying stenoses was 89%, specificity was 96%, accuracy was 93%. Conclusion: 64-slice CT provides a high diagnostic accuracy in assessing coronary artery stenoses. Key words: computed tomography, MDCT, coronary artery disease, CTA, CCA.
Diagnostic Performance of Coronary Angiography by 64-Row CT
New England Journal of Medicine, 2008
CT coronary angiography can identify significant coronary stenoses in patients at high risk for heart disease, but it is falsely negative in 17% of patients. Background: Given the high prevalence of coronary artery disease (CAD), there continues to be great interest in minimally invasive ways to evaluate for coronary stenoses. Currently, CT coronary angiography is being used with increasing frequency, but its sensitivity and specificity are still unclear. Objective: To determine the accuracy of CT angiography as compared to conventional coronary angiography in patients at high risk for CAD. Design: Prospective, multicenter, international diagnostic study. Participants: To be eligible, patients had to be aged at least 40 years and be referred for coronary angiography for suspected symptomatic heart disease. Patients were not eligible if they had undergone cardiac surgery, had decreased renal function, or had elevated coronary calcium scoring (Agatston score >600). Methods: Each patient underwent coronary calcium scoring and CT coronary angiography (with 64-row scanners) before also undergoing cardiac catheterization. For CT images, 2 independent observers quantitated the degree of stenosis, and a reading was performed with an available software program. Similar segments of artery were identified and measured with conventional coronary angiography. Obstructive lesions were considered clinically important if >50%. Results: 291 patients were enrolled (median age, 59 years; 74% were male). Median time between CT study and conventional angiography was 10 hours. Overall, 56% of patients were found to have significant obstructive CAD. The sensitivity for CT angiography was 85% and specificity was 90%. For this population with a 56% prevalence, the positive-predictive value was 91% and the negative-predictive value was 83%. In a secondary analysis, CT angiography compared favorably with conventional angiography in predicting the need for coronary interventions. Only 2 patients had serious reactions to contrast dye, requiring hospitalization, and there were no cases of renal failure reported. Conclusions: CT coronary angiography can identify significant coronary stenoses in patients at high risk for heart disease. However, 17% of patients with a negative study were found to have significant obstruction on conventional angiography, making it unlikely that CT has adequate accuracy to replace conventional angiography. Reviewer's Comments: The accompanying editorial offers strong words on the judicious (or lack thereof) use of new technologies, offering concern over the quick adaption and use of unproven diagnostic tests. At this point, the most clearly defined role for CT angiography has been to quickly "rule out" significant disease in lower-risk patients presenting with chest symptoms (partly as a way to avoid need for hospitalization). Now we have further information on patients at higher risk. Clearly, the test has the capacity to identify many patients with CAD. However, it remains unclear to me that it has any use in this high-risk population. (Reviewer-Mark E. Pasanen, MD).