Diagnostic accuracy of 64-slice multislice computed tomographic coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease.
ABSTRACT Data on the diagnostic accuracy of multislice computed tomographic coronary angiography (CTA) have been mostly derived from patients with a high pretest likelihood of coronary artery disease. Systematic comparisons with invasive angiography in patients with an intermediate pretest likelihood are scarce. The purpose of the present study was to determine the diagnostic accuracy of CTA in patients without known coronary artery disease with an intermediate pretest likelihood. A total of 61 patients (61% men, average age 57 + or - 9 years) who had been referred for invasive coronary angiography underwent additional 64-slice CTA. A total of 920 segments were identified by invasive coronary angiography, of which 885 (96%) were interpretable on CTA. Invasive coronary angiography identified a significant stenosis (> or = 50% luminal narrowing) in 29 segments, of which 23 were detected on CTA. Thus, the sensitivity, specificity, positive predictive value, and negative predictive value was 79%, 98%, 61%, and 99%, respectively, for CTA. On a patient level, the sensitivity, specificity, positive predictive value, and negative predictive value was 100%, 89%, 76%, and 100%, respectively. CTA correctly ruled out the presence of significant stenosis in 40 (66%) of the 61 patients. In conclusion, the results from the present study have confirmed that CTA has excellent diagnostic accuracy in the target population of patients with an intermediate pretest likelihood. The high negative predictive value allowed us to rule out significant stenosis in a large proportion of patients. CTA can, therefore, be used as a highly effective gatekeeper for invasive coronary angiography.
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ABSTRACT: OBJECTIVES: To evaluate the methodological quality of diagnostic accuracy studies on coronary computed tomography (CT) angiography using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies included in systematic reviews) tool. METHODS: Each QUADAS item was individually defined to adapt it to the special requirements of studies on coronary CT angiography. Two independent investigators analysed 118 studies using 12 QUADAS items. Meta-regression and pooled analyses were performed to identify possible effects of methodological quality items on estimates of diagnostic accuracy. RESULTS: The overall methodological quality of coronary CT studies was merely moderate. They fulfilled a median of 7.5 out of 12 items. Only 9 of the 118 studies fulfilled more than 75 % of possible QUADAS items. One QUADAS item ("Uninterpretable Results") showed a significant influence (P = 0.02) on estimates of diagnostic accuracy with "no fulfilment" increasing specificity from 86 to 90 %. Furthermore, pooled analysis revealed that each QUADAS item that is not fulfilled has the potential to change estimates of diagnostic accuracy. CONCLUSIONS: The methodological quality of studies investigating the diagnostic accuracy of non-invasive coronary CT is only moderate and was found to affect the sensitivity and specificity. An improvement is highly desirable because good methodology is crucial for adequately assessing imaging technologies. KEY POINTS: • Good methodological quality is a basic requirement in diagnostic accuracy studies. • Most coronary CT angiography studies have only been of moderate design quality. • Weak methodological quality will affect the sensitivity and specificity. • No improvement in methodological quality was observed over time. • Authors should consider the QUADAS checklist when undertaking accuracy studies.European Radiology 01/2013; · 4.34 Impact Factor
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ABSTRACT: To determine whether a 3×2 table, using an intention to diagnose approach, is better than the "classic" 2×2 table at handling transparent reporting and non-evaluable results, when assessing the accuracy of a diagnostic test. Based on a systematic search for diagnostic accuracy studies of coronary computed tomography (CT) angiography, full texts of relevant studies were evaluated to determine whether they could calculate an alternative 3×2 table. To quantify an overall effect, we pooled diagnostic accuracy values according to a meta-analytical approach. Medline (via PubMed), Embase (via Ovid), and ISI Web of Science electronic databases. ELIGIBILITY CRITERIA : Prospective English or German language studies comparing coronary CT with conventional coronary angiography in all patients and providing sufficient data for a patient level analysis. 120 studies (10 287 patients) were eligible. Studies varied greatly in their approaches to handling non-evaluable findings. We found 26 studies (including 2298 patients) that allowed us to calculate both 2×2 tables and 3×2 tables. Using a bivariate random effects model, we compared the 2×2 table with the 3×2 table, and found significant differences for pooled sensitivity (98.2 (95% confidence interval 96.7 to 99.1) v 92.7 (88.5 to 95.3)), area under the curve (0.99 (0.98 to 1.00) v 0.93 (0.91 to 0.95)), positive likelihood ratio (9.1 (6.2 to 13.3) v 4.4 (3.3 to 6.0)), and negative likelihood ratio (0.02 (0.01 to 0.04) v 0.09 (0.06 to 0.15); (P<0.05)). Parameters for diagnostic performance significantly decrease if non-evaluable results are included by a 3×2 table for analysis (intention to diagnose approach). This approach provides a more realistic picture of the clinical potential of diagnostic tests.BMJ (online) 10/2012; 345:e6717. · 16.38 Impact Factor
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ABSTRACT: Purpose To determine the compliance of prospective diagnostic accuracy studies investigating computed tomographic (CT) coronary angiography with Standards for Reporting of Diagnostic Accuracy (STARD) guidelines. Materials and Methods Relevant studies were identified by means of a systematic literature search that included the MEDLINE, EMBASE, and Institute for Scientific Information Web of Science databases. Prospective studies that compared CT with conventional coronary angiography for the evaluation of the coronary arteries were included. STARD compliance was assessed by three independent investigators using 21 of the original 25 STARD checklist items. Items with the qualifier "if done" (items 13, 23, and 24) were excluded because they were not applicable to all studies. Owing to the inclusion criteria, all studies fulfilled item 9; therefore, this item was excluded as well. The correlation between the total score and multiple variables was tested with a linear regression model. Results One hundred thirty studies published in 44 scientific journals were included in the analysis. There was a significant correlation between the year of publication and STARD-adopting versus non-STARD-adopting journals, with the total STARD score based on a linear regression model. Studies published in STARD-adopting journals showed a significantly higher total STARD score than those published in nonadopting journals (15.4 ± 2.7 vs 14.1 ± 2.7; P = .018). Linear regression analysis yielded an increase in the total STARD score of 0.30 points (95% confidence interval: 0.03, 0.57; P = .031) per year. Adequate reporting of individual items varied between 17% (item 20b) and 97% (item 1). Conclusion The overall compliance with reporting guidelines of prospective diagnostic accuracy studies of CT coronary angiography is moderate to good, and STARD-adopting journals have greater STARD compliance than nonadopting journals. © RSNA, 2014 Online supplemental material is available for this article.Radiology 01/2014; · 6.21 Impact Factor