Coronary artery disease
Diagnostic Accuracy of 64-Slice Multislice Computed Tomography in the Noninvasive Evaluation of Significant Coronary Artery Disease

https://doi.org/10.1016/j.amjcard.2006.01.092Get rights and content

The purpose of the present study was to determine the diagnostic accuracy of current 64-slice multislice computed tomography (MSCT) in the detection of significant coronary artery disease, using conventional coronary angiography as the gold standard. In 61 patients scheduled for conventional coronary angiography, 64-slice MSCT was performed and evaluated for the presence of significant (≥50% luminal narrowing) stenoses. One patient had to be excluded because of a heart rate >90 beats/min during data acquisition. In the remaining 60 patients (46 men, 14 women; average age 60 ± 11 years), 854 segments were available for evaluation. Of these segments 842 (99%) were of sufficient image quality. Conventional coronary angiography identified 73 lesions, of which 62 were detected by MSCT. The corresponding sensitivity and specificity were 85% and 97%, respectively. On a patient-per-patient analysis, sensitivity, specificity, and positive and negative predictive values were 94%, 97%, 97%, and 93%, respectively. In conclusion, the present study confirms that 64-slice MSCT enables the accurate and noninvasive evaluation of significant coronary artery stenoses.

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Patients and study protocol

The study group consisted of 61 patients who were scheduled for conventional coronary angiography. In addition, MSCT coronary angiography was performed. Patients with contraindications to MSCT were excluded.5 Conventional catheter-based coronary angiography was performed before or after MSCT and served as the reference standard. All patients gave written informed consent to the study protocol, which was approved by the local ethics committee.

Data acquisition

MSCT was performed using a Toshiba Multi-Slice

Patient characteristics

In total, 61 consecutive patients (46 men, 15 women; average age 60 ± 11 years) were included. The average interval between MSCT and conventional angiography was 49 ± 61 days. In 1 patient, the heart rate increased to >90 beats/min during MSCT, rendering the complete data set uninterpretable. The characteristics of the remaining 60 patients are listed in Table 1. In total, CAD was suspected in 25 patients (42%), whereas it was known in 35 patients (58%). A total of 44 stented segments was

Discussion

On a segmental level, a diagnostic accuracy of 97% was observed. It is important that only 12 segments (1%) could not be evaluated for the presence or absence of significant lesions because of insufficient image quality. In addition, an excellent specificity of 98% was observed, with a somewhat lower sensitivity of 85%, on a segmental basis. Nonetheless, from a clinical point of view, data regarding the performance on a patient rather than a segmental basis are preferred, because the selection

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Dr. Schuijf was financially supported by Grant 2002B105 from The Netherlands Heart Foundation. Dr. Pundziute was financially supported by a Training Fellowship of the European Society of Cardiology and the Huygens Scholarship, The Hague, The Netherlands. Dr. Jukema was supported by Grant 2001D032 from the The Netherlands Heart Foundation, The Hague, The Netherlands.

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