Improved diagnostic accuracy with 16-row multi-slice computed tomography coronary angiography (original) (raw)
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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.
Acta medica Iranica, 2012
The use of noninvasive assessment tools such as multi-slice CT coronary angiography (MSCT-CA-CA) is recently considered mainly because it offers safety, patient convenience, and faster performance. The aim of the present study was to determine the ability of MSCT-CA-CA for the detection of significant stenoses in the coronary arteries, in comparison to conventional invasive coronary angiography (ICA). A total of 58 consecutive patients who were candidate for coronary angiography, with the diagnosis of acute coronary syndrome, from September 2006 to March 2006 were entered into the study. They underwent both coronary MSCT-CA-CA and ICA. The findings of each coronary segment were compared to MSCT-CA-CA in comparison with ICA. Based on artery analysis, sensitivity and specificity of MSCT-CA for the detection of involvement in RCA were 90.0% and 92.8%, in LAD were 71.8% and 92.9% and in LCX were 67.9% and 92.6%, respectively. On a per-segment basis, the sensitivity of MSCT-CA in the det...
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.
Journal of the American College of Cardiology, 2008
The purpose of this study was to evaluate the diagnostic accuracy of electrocardiographically gated 64-multidetector row coronary computed tomographic angiography (CCTA) in individuals without known coronary artery disease (CAD). Background CCTA is a promising method for detection and exclusion of obstructive coronary artery stenosis. To date, no prospective multicenter trial has evaluated the diagnostic accuracy of 64-multidetector row CCTA in populations with intermediate prevalence of CAD. Methods We prospectively evaluated subjects with chest pain at 16 sites who were clinically referred for invasive coronary angiography (ICA). CCTAs were scored by consensus of 3 independent blinded readers. The ICAs were evaluated for coronary stenosis based on quantitative coronary angiography (QCA). No subjects were excluded for baseline coronary artery calcium score or body mass index. Results A total of 230 subjects underwent both CCTA and ICA (59.1% male; mean age: 57 Ϯ 10 years). On a patientbased model, the sensitivity, specificity, and positive and negative predictive values to detect Ն50% or Ն70% stenosis were 95%, 83%, 64%, and 99%, respectively, and 94%, 83%, 48%, 99%, respectively. No differences in sensitivity and specificity were noted for nonobese compared with obese subjects or for heart rates Յ65 beats/ min compared with Ͼ65 beats/min, whereas calcium scores Ͼ400 reduced specificity significantly. Conclusions In this prospective multicenter trial of chest pain patients without known CAD, 64-multidetector row CCTA possesses high diagnostic accuracy for detection of obstructive coronary stenosis at both thresholds of 50% and 70% stenosis. Importantly, the 99% negative predictive value at the patient and vessel level establishes CCTA as an effective noninvasive alternative to ICA to rule out obstructive coronary artery stenosis. (A Study of Computed Tomography [CT] for Evaluation of Coronary Artery Blockages in Typical or Atypical Chest Pain; NCT00348569) (
The American Journal of Cardiology, 2013
We assessed the performance of a new-generation, 256-row computed tomography (CT) scanner for detection of obstructive coronary artery disease (CAD) compared to invasive quantitative coronary angiography. A total 121 consecutive symptomatic patients without known CAD referred for invasive coronary angiography (age 59 -12 years, 37% women) underwent clinically driven 256-row coronary computed tomographic angiography (CCTA) before the invasive procedure. Obstructive CAD (>50% diameter stenosis) was assessed visually on CCTA by 2 independent observers using the 18-segment society of cardiovascular CT model and on invasive angiograms using quantitative coronary angiography (the reference standard). Observers were unaware of the findings from the alternate modality. Nonassessable coronary computed tomographic angiographic segments were considered obstructive for the purpose of analysis. Quantitative coronary angiography demonstrated obstructive CAD in 145 segments in 82 of 121 patients (68%). Overall, 1,677 coronary segments were available for comparative analysis, of which 39 (2.3%) were nonassessable by CCTA, mostly because of heavy calcification. Patient-based and segmentbased analysis showed a sensitivity of 100% and 97% (95% confidence interval 95% to 100%) and specificity of 69% (95% confidence interval 55% to 84%) and 97% (confidence interval 96% to 98%), respectively. Four segments with obstructive CAD in 4 patients were not detected by CCTA. All 4 patients had additional coronary obstructions identified by CCTA. The predictive accuracy was 90% (range 85% to 95%) for patient based and 97% (96% to 98%) for segment based analysis. In conclusion, 256-row CCTA showed high sensitivity and high predictive accuracy for detection of obstructive CAD in patients without previously known disease. Although coronary calcification might still interfere with analysis, the rate of nonassessable segments was low. Ó 2013 Elsevier Inc. All rights reserved. (Am J Cardiol 2013;111:510e515)
Experimental and Clinical Cardiology, 2007
BACKGROUNDRecent studies have demonstrated a high sensitivity (S) of 16-multidetector computed tomography (16-MDCT) for the detection of significant coronary artery stenoses. Whether these results are applicable to clinical practice is unclear. Therefore, the aim of the present study was to compare 16-MDCT angiography with conventional coronary angiography (CCA) for the detection of significant coronary artery stenoses in a consecutive series of patients.METHODA total of 93 consecutive patients (mean [± SD] age 59±9 years), in whom CCA was performed for stable angina pectoris, underwent 16-MDCT angiography (16×0.75 mm, table feed 6.5 mm/s, rotation time 0.42 s; Sensation 16, Siemens Medical Solutions, Germany) the day before performing CCA. Patients with diabetes mellitus, serum creatinine level higher than 132.6 μmol/L and/or acute coronary syndromes were excluded. Two observers blinded to CCA results evaluated MDCT angiograms according to standard criteria. Segment-based (13 segments per patient) and patient-based (at least one stenosis greater than 50% lumen diameter reduction) analyses were performed.RESULTSA total of 1209 segments were analyzed. Of these segments, 173 (14%) were excluded due to poor image quality or massive calcification. In 86 segments, CCA revealed significant coronary artery stenosis (greater than 50% diameter reduction). However, 16-MDCT detected only 47 of these, resulting in a S of 55% and a specificity (SP) of 97% (positive predictive value 64%; negative predictive value 96%). On a patient-based analysis, the S increased to 89%, whereas the SP still remained high (87%).CONCLUSIONIn this relatively large consecutive cohort, S for the detection of significant coronary artery stenoses was moderate on a segment-based analysis but increased on a patient-based analysis using 16-MDCT. In contrast, SP was high in both analyses, supporting the use of 16-MDCT for the exclusion of significant coronary artery stenoses. Further improvement of spatial and temporal resolution in MDCT technology may lead to a lower exclusion rate and higher S.
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...
Circulation: Cardiovascular Imaging, 2014
C omputed tomographic coronary angiography (CTCA) is a reliable, noninvasive imaging modality to visualize coronary artery disease with a high diagnostic accuracy compared with invasive coronary angiography (ICA). 1-3 In addition, CTCA can provide quantitative information of a coronary stenosis, similar to intravascular ultrasound (IVUS), cross-sectional information, and plaque burden. In daily practice, lesions with a diameter stenosis ≥50% on visual CTCA are generally considered for referral to ICA. However, similar to ICA, CTCA is an anatomic imaging technique; thus, it may result in both under-and overestimation of a lesion's severity and is often inaccurate in identifying functionally significant coronary lesions that cause ischemia. 4,5 Current guidelines suggest that treatment decisions based on the hemodynamic effect of a coronary lesion may improve clinical outcome. 6-8 Therefore, it would be relevant if quantitative parameters derived from CTCA could be optimized to predict the functional significance of a coronary stenosis. Background-Coronary lesions with a diameter narrowing ≥50% on visual computed tomographic coronary angiography (CTCA) are generally considered for referral to invasive coronary angiography. However, similar to invasive coronary angiography, visual CTCA is often inaccurate in detecting functionally significant coronary lesions. We sought to compare the diagnostic performance of quantitative CTCA with visual CTCA for the detection of functionally significant coronary lesions using fractional flow reserve (FFR) as the reference standard. Methods and Results-CTCA and FFR measurements were obtained in 99 symptomatic patients. In total, 144 coronary lesions detected on CTCA were visually graded for stenosis severity. Quantitative CTCA measurements included lesion length, minimal area diameter, % area stenosis, minimal lumen diameter, % diameter stenosis, and plaque burden [(vessel area−lumen area)/vessel area×100]. Optimal cutoff values of CTCA-derived parameters were determined, and their diagnostic accuracy for the detection of flow-limiting coronary lesions (FFR ≤0.80) was compared with visual CTCA. FFR was ≤0.80 in 54 of 144 (38%) coronary lesions. Optimal cutoff values to predict flow-limiting coronary lesion were 10 mm for lesion length, 1.8 mm 2 for minimal area diameter, 73% for % area stenosis, 1.5 mm for minimal lumen diameter, 48% for % diameter stenosis, and 76% for plaque burden. No significant difference in sensitivity was found between visual CTCA and quantitative CTCA parameters (P>0.05). The specificity of visual CTCA (42%; 95% confidence interval [CI], 31%-54%) was lower than that of minimal area diameter (68%; 95% CI, 57%-77%; P=0.001), % area stenosis (76%; 95% CI, 65%-84%; P<0.001), minimal lumen diameter (67%; 95% CI, 55%-76%; P=0.001), % diameter stenosis (72%; 95% CI, 62%-80%; P<0.001), and plaque burden (63%; 95% CI, 52%-73%; P=0.004). The specificity of lesion length was comparable with that of visual CTCA. Conclusions-Quantitative CTCA improves the prediction of functionally significant coronary lesions compared with visual CTCA assessment but remains insufficient. Functional assessment is still required in lesions of moderate stenosis to accurately detect impaired FFR.
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).