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01.12.2012 | Cardiac

Diagnostic performance of coronary CT angiography for stenosis detection according to calcium score: systematic review and meta-analysis

verfasst von: Martijn A. M. den Dekker, Kristof de Smet, Geertruida H. de Bock, Rene A. Tio, Matthijs Oudkerk, Rozemarijn Vliegenthart

Erschienen in: European Radiology | Ausgabe 12/2012

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Abstract

Objectives

A systematic review and meta-analysis to assess sensitivity and specificity of coronary CT angiography (CCTA) for significant stenosis at different degrees of coronary calcification.

Methods

A literature search was performed including studies describing test characteristics of CCTA for significant stenosis, performed with at least 16-MDCT and according to calcium score (CS). Invasive coronary angiography was the reference standard. Pooled sensitivity and specificity of CCTA by CS categories and CT equipment were calculated.

Results

Of 14,121 articles, 51 studies reported on the impact of calcium scoring on diagnostic performance of CCTA and could be included in the systematic review. Twenty-seven of these studies (5,203 participants) were suitable for meta-analysis. On a patient-basis, sensitivity of CCTA for significant stenosis was 95.8, 95.6, 97.6 and 99.0% for CS 0–100, 101–400, 401–1,000 and >1,000 respectively. Specificity was 91.2, 88.2, 50.6 and 84.0% respectively. Specificity of CCTA was significantly lower for CS 401–1,000 due to lack of patients without significant stenosis. Sensitivity and specificity of 16-MDCT were significantly lower compared to more modern CT systems.

Conclusions

Even in cases of severe coronary calcification, sensitivity and specificity of CCTA for significant stenosis are high. With 64-MDCT and newer CT systems, a CS cut-off for performing CCTA no longer seems indicated.

Key Points

• Decisions about performing coronary CT angiography (CCTA) sometimes depend on calcium scoring.

• CCTA is highly sensitive for coronary stenosis.

• With 16-MDCT, however, heavy calcification reduces specificity for significant stenosis.

• For 64-MDCT (and above), CCTA has high specificity, even with severe coronary calcification.

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Donnino R, Jacobs JE, Doshi JV et al (2009) Dual-source versus single-source cardiac CT angiography: comparison of diagnostic image quality. AJR Am J Roentgenol 192:1051–1056PubMedCrossRef

Hausleiter J, Meyer T, Hadamitzky M et al (2007) Non-invasive coronary computed tomographic angiography for patients with suspected coronary artery disease: the coronary angiography by computed tomography with the use of a submillimeter resolution (CACTUS) trial. Eur Heart J 28:3034–3041PubMedCrossRef

Miller JM, Rochitte CE, Dewey M et al (2008) Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 359:2324–2336PubMedCrossRef

Manghat NE, Morgan-Hughes GJ, Broadley AJ et al (2006) 16-detector row computed tomographic coronary angiography in patients undergoing evaluation for aortic valve replacement: comparison with catheter angiography. Clin Radiol 61:749–757PubMedCrossRef

Zhang LJ, Wu SY, Wang J et al (2010) Diagnostic accuracy of dual-source CT coronary angiography: the effect of average heart rate, heart rate variability, and calcium score in a clinical perspective. Acta Radiol 51:727–740PubMedCrossRef

Gang S, Min L, Li L et al (2011) Evaluation of CT coronary artery angiography with 320-row detector CT in a high-risk population. Br J Radiol. doi:10.1259/bjr/90347290

Dey D, Lee CJ, Ohba M et al (2008) Image quality and artifacts in coronary CT angiography with dual-source CT: initial clinical experience. J Cardiovasc Comput Tomogr 2:105–114PubMedCrossRef

Heuschmid M, Kuettner A, Schroeder S et al (2005) ECG-gated 16-MDCT of the coronary arteries: assessment of image quality and accuracy in detecting stenoses. AJR Am J Roentgenol 184:1413–1419PubMed

Taylor AJ, Cerqueira M, Hodgson JM et al (2010) ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol 56:1864–1894PubMedCrossRef

10.

Russo V, Gostoli V, Lovato L et al (2007) Clinical value of multidetector CT coronary angiography as a preoperative screening test before non-coronary cardiac surgery. Heart 93:1591–1598PubMedCrossRef

11.

Panmethis M, Wangsuphachart S, Rerkpattanapipat P, Srimahachota S, Buddhari W, Kitsukjit W (2007) Detection of coronary stenoses in chronic stable angina by multi-detector CT coronary angiography. J Med Assoc Thai 90:1573–1580PubMed

12.

Korosoglou G, Mueller D, Lehrke S et al (2010) Quantitative assessment of stenosis severity and atherosclerotic plaque composition using 256-slice computed tomography. Eur Radiol 20:1841–1850PubMedCrossRef

13.

Morgan-Hughes GJ, Roobottom CA, Owens PE, Marshall AJ (2005) Highly accurate coronary angiography with submillimetre, 16 slice computed tomography. Heart 91:308–313PubMedCrossRef

14.

Maffei E, Martini C, Tedeschi C et al (2011) Diagnostic accuracy of 64-slice computed tomography coronary angiography in a large population of patients without revascularisation: registry data on the impact of calcium score. Radiol Med 116:1000–1013PubMedCrossRef

15.

Burgstahler C, Reimann A, Drosch T et al (2007) Cardiac dual-source computed tomography in patients with severe coronary calcifications and a high prevalence of coronary artery disease. J Cardiovasc Comput Tomogr 1:143–151PubMedCrossRef

16.

Cordeiro MA, Lardo AC, Brito MS et al (2006) CT angiography in highly calcified arteries: 2D manual vs. modified automated 3D approach to identify coronary stenoses. Int J Cardiovasc Imaging 22:507–516PubMedCrossRef

17.

Ghersin E, Litmanovich D, Dragu R et al (2006) 16-MDCT coronary angiography versus invasive coronary angiography in acute chest pain syndrome: a blinded prospective study. AJR Am J Roentgenol 186:177–184PubMedCrossRef

18.

Cademartiri F, Mollet NR, Lemos PA et al (2005) Impact of coronary calcium score on diagnostic accuracy for the detection of significant coronary stenosis with multislice computed tomography angiography. Am J Cardiol 95:1225–1227PubMedCrossRef

19.

Cademartiri F, Maffei E, Palumbo A et al (2010) Coronary calcium score and computed tomography coronary angiography in high-risk asymptomatic subjects: assessment of diagnostic accuracy and prevalence of non-obstructive coronary artery disease. Eur Radiol 20:846–854PubMedCrossRef

20.

Mollet NR, Cademartiri F, van Mieghem CA et al (2005) High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation 112:2318–2323PubMedCrossRef

21.

Sa MI, Nicol ED, Stirrup J et al (2011) Implications for single phase prospective CT coronary angiography for the diagnosis of significant coronary stenoses in clinical practice. Int J Cardiol 147:393–397PubMedCrossRef

22.

Stolzmann P, Scheffel H, Leschka S et al (2008) Influence of calcifications on diagnostic accuracy of coronary CT angiography using prospective ECG triggering. AJR Am J Roentgenol 191:1684–1689PubMedCrossRef

23.

Scheffel H, Alkadhi H, Plass A et al (2006) Accuracy of dual-source CT coronary angiography: first experience in a high pre-test probability population without heart rate control. Eur Radiol 16:2739–2747PubMedCrossRef

24.

Meijs MF, Meijboom WB, Prokop M et al (2009) Is there a role for CT coronary angiography in patients with symptomatic angina? Effect of coronary calcium score on identification of stenosis. Int J Cardiovasc Imaging 25:847–854PubMedCrossRef

25.

Diederichsen ACP, Petersen H, Jensen LO et al (2009) Diagnostic value of cardiac 64-slice computed tomography: importance of coronary calcium. Scand Cardiovasc J 43:337–344PubMedCrossRef

26.

Ulimoen GR, Gjonnaess E, Atar D, Dahl T, Stranden E, Sandbaek G (2008) Noninvasive coronary angiography with 64-channel multidetector computed tomography in patients with acute coronary syndrome. Acta Radiol 49:1140–1144PubMedCrossRef

27.

Alkadhi H, Scheffel H, Desbiolles L et al (2008) Dual-source computed tomography coronary angiography: influence of obesity, calcium load, and heart rate on diagnostic accuracy. Eur Heart J 29:766–776PubMedCrossRef

28.

Coles DR, Wilde P, Oberhoff M, Rogers CA, Karsch KR, Baumbach A (2007) Multislice computed tomography coronary angiography in patients admitted with a suspected acute coronary syndrome. Int J Cardiovasc Imaging 23:603–614PubMedCrossRef

29.

Ong TK, Chin SP, Liew CK et al (2006) Accuracy of 64-row multidetector computed tomography in detecting coronary artery disease in 134 symptomatic patients: influence of calcification. Am Heart J 151:1323.e1–1323.e6CrossRef

30.

Buffa V, De Cecco CN, Cossu L et al (2010) Preoperative coronary risk assessment with dual-source CT in patients undergoing noncoronary cardiac surgery. Radiol Med 115:1028–1037PubMedCrossRef

31.

Nazeri I, Shahabi P, Tehrai M, Sharif-Kashani B, Nazeri A (2010) Impact of calcification on diagnostic accuracy of 64-slice spiral computed tomography for detecting coronary artery disease: a single center experience. Arch Iran Med 13:373–383PubMed

32.

Bettencourt N, Rocha J, Carvalho M et al (2009) Multislice computed tomography in the exclusion of coronary artery disease in patients with presurgical valve disease. Circ Cardiovasc Imaging 2:306–313PubMedCrossRef

33.

Budoff MJ, Dowe D, Jollis JG et al (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (assessment by coronary computed tomographic angiography of individuals undergoing invasive coronary angiography) trial. J Am Coll Cardiol 52:1724–1732PubMedCrossRef

34.

Brodoefel H, Burgstahler C, Tsiflikas I et al (2008) Dual-source CT: effect of heart rate, heart rate variability, and calcification on image quality and diagnostic accuracy. Radiology 247:346–355PubMedCrossRef

35.

Brodoefel H, Reimann A, Burgstahler C et al (2008) Noninvasive coronary angiography using 64-slice spiral computed tomography in an unselected patient collective: effect of heart rate, heart rate variability and coronary calcifications on image quality and diagnostic accuracy. Eur J Radiol 66:134–141PubMedCrossRef

36.

Kuettner A, Trabold T, Schroeder S et al (2004) Noninvasive detection of coronary lesions using 16-detector multislice spiral computed tomography technology: initial clinical results. J Am Coll Cardiol 44:1230–1237PubMed

37.

Meng L, Cui L, Cheng Y et al (2009) Effect of heart rate and coronary calcification on the diagnostic accuracy of the dual-source CT coronary angiography in patients with suspected coronary artery disease. Korean J Radiol 10:347–354PubMedCrossRef

38.

Gutstein A, Wolak A, Lee C et al (2008) Predicting success of prospective and retrospective gating with dual-source coronary computed tomography angiography: development of selection criteria and initial experience. J Cardiovasc Comput Tomogr 2:81–90PubMedCrossRef

39.

Palumbo AA, Maffei E, Martini C et al (2009) Coronary calcium score as gatekeeper for 64-slice computed tomography coronary angiography in patients with chest pain: per-segment and per-patient analysis. Eur Radiol 19:2127–2135PubMedCrossRef

40.

Mitsutake R, Niimura H, Miura S et al (2006) Clinical significance of the coronary calcification score by multidetector row computed tomography for the evaluation of coronary stenosis in Japanese patients. Circ J 70:1122–1127PubMedCrossRef

41.

Goldstein JA, Gallagher MJ, O'Neill WW, Ross MA, O'Neil BJ, Raff GL (2007) A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol 49:863–871PubMedCrossRef

42.

van Werkhoven JM, de Boer SM, Schuijf JD et al (2010) Impact of clinical presentation and pretest likelihood on the relation between calcium score and computed tomographic coronary angiography. Am J Cardiol 106:1675–1679PubMedCrossRef

43.

Nieman K, Galema TW, Neefjes LA et al (2009) Comparison of the value of coronary calcium detection to computed tomographic angiography and exercise testing in patients with chest pain. Am J Cardiol 104:1499–1504PubMedCrossRef

44.

Jin GY, Jeong SK, Lee SR, Kwon KS, Han YM, Cho YI (2009) Screening strategies for the diagnosis of coronary artery stenosis in patients with cerebral infarction using dual-source spiral CT. J Neurol Sci 284:129–134PubMedCrossRef

45.

Husmann L, Herzog BA, Burger IA et al (2010) Usefulness of additional coronary calcium scoring in low-dose CT coronary angiography with prospective ECG-triggering impact on total effective radiation dose and diagnostic accuracy. Acad Radiol 17:201–206PubMedCrossRef

46.

Leschka S, Scheffel H, Desbiolles L et al (2008) Combining dual-source computed tomography coronary angiography and calcium scoring: added value for the assessment of coronary artery disease. Heart 94:1154–1161PubMedCrossRef

47.

Sousa PJ, Goncalves PA, Marques H et al (2010) Best calcium score cut-off to predict obstructive coronary artery disease in cardiac computed tomography. Eur Heart J 31:133–134

48.

Marano R, De Cobelli F, Floriani I et al (2009) Italian multicenter, prospective study to evaluate the negative predictive value of 16- and 64-slice MDCT imaging in patients scheduled for coronary angiography (NIMISCAD-non invasive multicenter Italian study for coronary artery disease). Eur Radiol 19:1114–1123PubMedCrossRef

49.

Zhao Y, Wei J, Hua Q, Wang J, He J, Li J (2008) Comparison of multi-slice CT coronary artery imaging with coronary angiography. J Clin Rehab Tissue Eng Res 12:8792–8796

50.

Meijboom WB, Mollet NR, Van Mieghem CA et al (2007) 64-slice CT coronary angiography in patients with non-ST elevation acute coronary syndrome. Heart 93:1386–1392PubMedCrossRef

51.

Dewey M, Vavere AL, Arbab-Zadeh A et al (2010) Patient characteristics as predictors of image quality and diagnostic accuracy of MDCT compared with conventional coronary angiography for detecting coronary artery stenoses: CORE-64 multicenter international trial. Am J Roentgenol 194:93–102CrossRef

52.

Oudkerk M, Stillman AE, Halliburton SS et al (2008) Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging. Int J Cardiovasc Imaging 24:645–671PubMedCrossRef

53.

Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283:2008–2012PubMedCrossRef

54.

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62:1006–1012PubMedCrossRef

55.

Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3:25PubMedCrossRef

56.

Menke J, Larsen J (2010) Meta-analysis: accuracy of contrast-enhanced magnetic resonance angiography for assessing steno-occlusions in peripheral arterial disease. Ann Intern Med 153:325–334PubMed

57.

Schwartz A (2007) Diagnostic test calculator. http://araw.mede.uic.edu/cgi-ebm/testcalc.pl

58.

Littenberg B, Moses LE (1993) Estimating diagnostic accuracy from multiple conflicting reports: a new meta-analytic method. Med Decis Making 13:313–321PubMedCrossRef

59.

Thompson SG (1994) Why sources of heterogeneity in meta-analysis should be investigated. BMJ 309:1351–1355PubMedCrossRef

60.

Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560PubMedCrossRef

61.

Lijmer JG, Bossuyt PM, Heisterkamp SH (2002) Exploring sources of heterogeneity in systematic reviews of diagnostic tests. Stat Med 21:1525–1537PubMedCrossRef

62.

Thompson SG, Higgins JP (2002) How should meta-regression analyses be undertaken and interpreted? Stat Med 21:1559–1573PubMedCrossRef

63.

Harbord RM, Whiting P (2009) Metandi: meta-analysis of diagnostic accuracy using hierarchical logistic regression. Stata J 9:211–229

64.

Otton J, Sammel N, Sesel K et al (2010) A high coronary calcium score does not preclude coronary evaluation by 320 detector-row cardiac CT. Heart Lung Circul 19:S160–S161CrossRef

65.

Abdulla J, Pedersen KS, Budoff M, Kofoed KF (2011) Influence of coronary calcification on the diagnostic accuracy of 64-slice computed tomography coronary angiography: a systematic review and meta-analysis. Int J Cardiovasc Imaging. doi:10.1007/s10554-011-9902-6

66.

Sangiorgi G, Rumberger JA, Severson A et al (1998) Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology. J Am Coll Cardiol 31:126–133PubMedCrossRef

Titel: Diagnostic performance of coronary CT angiography for stenosis detection according to calcium score: systematic review and meta-analysis
verfasst von: Martijn A. M. den Dekker
Kristof de Smet
Geertruida H. de Bock
Rene A. Tio
Matthijs Oudkerk
Rozemarijn Vliegenthart
Publikationsdatum: 01.12.2012
Verlag: Springer-Verlag
Erschienen in: European Radiology / Ausgabe 12/2012
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-012-2551-x

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Diagnostic performance of coronary CT angiography for stenosis detection according to calcium score: systematic review and meta-analysis