Multidetector Computed Tomography for the Diagnosis of Coronary Artery Disease: A Systematic Review

doi:10.1016/j.amjmed.2005.06.071

The American Journal of Medicine

Volume 119, Issue 3, March 2006, Pages 203-216

https://doi.org/10.1016/j.amjmed.2005.06.071 Get rights and content

Abstract

Purpose

The study’s purpose was to determine the sensitivity and specificity of contrast-enhanced multidetector computed tomography (CT) for the detection of coronary artery disease.

Subjects and methods

A search of the literature in all languages was performed incorporating both electronic and manual components. Manual reference checks of recent reviews and all original investigations supplemented the electronic searches.

Results

Average sensitivity for patient-based detection of significant (>50% or ≥50%) stenosis was 61 of 64 (95%) with 4-slice CT, 276 of 292 (95%) with 16-slice CT, and 47 of 47 (100%) with 64-slice CT. Average specificity was 84% for 4-slice CT, 84% for 16-slice CT, and 100% for 64-slice CT. The sensitivity for a significant stenosis in evaluable segments was 307 of 372 (83%) with 4-slice CT, 1023 of 1160 (88%) with 16-slice CT, and 165 of 176 (94%) with 64-slice CT. Average specificity was 93% or greater with all multidetector CT. Seventy-eight percent of segments were evaluable with 4-slice CT, 91% with 16-slice CT, and 100% with 64-slice CT. Stenoses in proximal and mid-segments were shown with a higher sensitivity than distal segments. Left main stenosis was identified with high sensitivity with all multidetector CT, but sensitivity in other vessels increased with an increasing number of detectors.

Conclusion

Multidetector CT has the potential to be used as a screening test in appropriate patients. Contrast-enhanced 16-slice CT seems to be reasonably sensitive and specific for the detection of significant coronary artery disease but has shortcomings. Preliminary data with 64-slice CT suggest that it is more sensitive and specific.

Section snippets

Methods

We used established methods for systematic review.6, 7, 8 A broad search of the literature in all languages was performed incorporating both electronic and manual components. The electronic search was performed using PubMed, which includes MEDLINE, OLDMEDLINE, OVID, and the Cochrane Library database. PubMed was searched from 1950 (well before multidetector CT was developed) to March 2005. Search terms were as follows: spiral CT/spiral computed tomography matched with coronary artery, coronary

Results

The number of patients in whom blinded and unblinded data were reported using 4-, 8-, 16-, and 64-slice CT, and the reasons for investigation are shown in Table 1.10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42 There were 617 patients who participated in blinded investigations with 4-slice CT,10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 50 patients who participated in blinded investigations with 8-slice CT,21, 22

Discussion

Pooled data indicate that 4-slice, 16-slice, and 64-slice CT are highly sensitive (95%–100%) for the patient-based detection of significant CAD. Specificity was lower (84%) with 4-slice and 16-slice CT, but 100% with a small sample of patients with 64-slice CT. For detection of significant stenosis in any segment, sensitivity increased from 83% with 4-slice CT to 88% with 16-slice CT and 94% with 64-slice CT. Sensitivity for significant stenosis in proximal and mid-segments was 90% or greater

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ReviewMultidetector Computed Tomography for the Diagnosis of Coronary Artery Disease: A Systematic Review

Abstract

Purpose

Subjects and methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Am J Cardiol

Lancet

Am J Cardiol

Clin Radiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Rev Esp Cardiol

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Clin Imaging

Radiol Clin North Am

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Am Heart J

Prog Cardiovasc Dis

Noninvasive coronary angiography-an acceptable alternative?

N Engl J Med

Cardiac-catheterization and cardiac-surgical facilitiesuse, trends, and future requirements

N Engl J Med

Coronary arteriography 1984-1987: a report of the Registry of the Society for Cardiac Angiography and Interventions. I. Results and complications

Cathet Cardiovasc Diagn

AHA Hospital Statistics, 2006 Edition

The STARD statement for reporting studies of diagnostic accuracyexplanation and elaboration

Ann Intern Med

Empirical evidence of design-related bias in studies of diagnostic tests

J Am Med Assoc

Systematic reviewssynthesis of best evidence for clinical decisions

Ann Intern Med

A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association

Circulation

Noninvasive assessment of coronary artery stenoses by multidetector-row spiral computed tomography; comparison with conventional angiography

Eur Rev Med Pharm Sci

Non-invasive intravenous coronary angiography using electron beam tomography and multislice computed tomography

Heart

Noninvasive assessment of coronary artery disease by multislice spiral computed tomography using a new retrospectively ECG-gated image reconstruction technique

Circ J

Detection of coronary artery stenoses with multislice helical CT angiography

J Comput Assist Tomogr

Visualization techniques in multislice CT-coronary angiography of the heart. Correlations of axial, multiplanar, three-dimensional and virtual endoscopic imaging with the invasive diagnosis

Rofo

Review
Multidetector Computed Tomography for the Diagnosis of Coronary Artery Disease: A Systematic Review