Diagnostic Accuracy of 64-Slice Computed Tomography Coronary Angiography. A Prospective, Multicenter, Multivendor Study

Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Journal of the American College of Cardiology (Impact Factor: 16.5). 01/2009; 52(25):2135-44. DOI: 10.1016/j.jacc.2008.08.058
Source: PubMed


This study sought to determine the diagnostic accuracy of 64-slice computed tomographic coronary angiography (CTCA) to detect or rule out significant coronary artery disease (CAD).
CTCA is emerging as a noninvasive technique to detect coronary atherosclerosis.
We conducted a prospective, multicenter, multivendor study involving 360 symptomatic patients with acute and stable anginal syndromes who were between 50 and 70 years of age and were referred for diagnostic conventional coronary angiography (CCA) from September 2004 through June 2006. All patients underwent a nonenhanced calcium scan and a CTCA, which was compared with CCA. No patients or segments were excluded because of impaired image quality attributable to either coronary motion or calcifications. Patient-, vessel-, and segment-based sensitivities and specificities were calculated to detect or rule out significant CAD, defined as >or=50% lumen diameter reduction.
The prevalence among patients of having at least 1 significant stenosis was 68%. In a patient-based analysis, the sensitivity for detecting patients with significant CAD was 99% (95% confidence interval [CI]: 98% to 100%), specificity was 64% (95% CI: 55% to 73%), positive predictive value was 86% (95% CI: 82% to 90%), and negative predictive value was 97% (95% CI: 94% to 100%). In a segment-based analysis, the sensitivity was 88% (95% CI: 85% to 91%), specificity was 90% (95% CI: 89% to 92%), positive predictive value was 47% (95% CI: 44% to 51%), and negative predictive value was 99% (95% CI: 98% to 99%).
Among patients in whom a decision had already been made to obtain CCA, 64-slice CTCA was reliable for ruling out significant CAD in patients with stable and unstable anginal syndromes. A positive 64-slice CTCA scan often overestimates the severity of atherosclerotic obstructions and requires further testing to guide patient management.

Download full-text


Available from: Benno Rensing
  • Source
    • "Coronary computed tomographic angiography (CCTA) has been widely used as a noninvasive modality for the measurement of CAD presence and severity [5–7] and risk stratification [8–10] among subjects with suspected CAD. Because of the high spatial and temporal resolution, CCTA provides anatomical information, coronary plaque burden, and coronary plaque morphology, which cannot be visualized by ICA. "
    [Show abstract] [Hide abstract]
    ABSTRACT: For a decade, coronary computed tomographic angiography (CCTA) has been used as a promising noninvasive modality for the assessment of coronary artery disease (CAD) as well as cardiovascular risks. CCTA can provide more information incorporating the presence, extent, and severity of CAD; coronary plaque burden; and characteristics that highly correlate with those on invasive coronary angiography. Moreover, recent techniques of CCTA allow assessing hemodynamic significance of CAD. CCTA may be potentially used as a substitute for other invasive or noninvasive modalities. This review summarizes risk stratification by anatomical and hemodynamic information of CAD, coronary plaque characteristics, and burden observed on CCTA.
    Full-text · Article · Sep 2014
  • Source
    • "Computed tomographic coronary angiography (CTA) has emerged as an accurate non-invasive diagnostic tool for CAD [4-8] and has been demonstrated to have prognostic value [9-11]. Whether or not CTA can be used cost-effectively in HF patients for diagnosis and to guide patient investigations and management is unknown. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The prevalence of heart failure (HF) is rising in industrialized and developing countries. Though invasive coronary angiography (ICA) remains the gold standard for anatomical assessment of coronary artery disease in HF patients, alternatives are being sought. Computed tomographic coronary angiography (CTA) has emerged as an accurate non-invasive diagnostic tool for coronary artery disease (CAD) and has been demonstrated to have prognostic value. Whether or not CTA can be used in HF patients is unknown. Acknowledging the aging population, the growing prevalence of HF and the increasing financial burden of healthcare, we need to identify non-invasive diagnostic tests that are available, safe, accurate and cost-effective. The proposed study aims to provide insight into the efficacy of CTA in HF patients. A multicenter randomized controlled trial will enroll 250 HF patients requiring coronary anatomical definition. Enrolled patients will be randomized to either CTA or ICA (n = 125 per group) as the first test to define coronary anatomy. The primary outcomes will be collected to determine downstream resource utilization. Secondary outcomes will include the composite clinical events and major adverse cardiac events. In addition, the accuracy of CTA for detecting coronary anatomy and obstruction will be assessed in patients who subsequently undergo both CTA and ICA. It is expected that CTA will be a more cost-effective strategy for diagnosis: yielding similar outcomes with fewer procedural risks and improved resource utilization.Trial registration: NCT01283659Team grant #CIF 99470.
    Full-text · Article · Dec 2013 · Trials
  • Source
    • "MDCTA has emerged as a robust technique for the assessment of coronary artery anatomy and disease with accuracy comparable to invasive coronary angiography [1] [2] [3] [4] [5]. Owing to a high negative predictive value, coronary MDCTA may be suitable as a primary screening tool for those symptomatic patients with low probability of coronary artery disease [1]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: To compare radiation dose and image quality using predefined narrow phase window versus complete phase window with dose modulation during R-R using 320-row MDCTA. Methods: 114 patients underwent coronary CTA study using 320-row MDCT scanner. 87 patients with mean age (61 + 13 years), mean BMI (29 + 6), and mean heart rate (HR) (58 + 7 bpm) were imaged at predefined 66-80% R-R interval and then reconstructed at 75% while 27 patients with mean age (63 + 16 years), mean BMI (28 + 5), and mean HR (57 + 7 bpm) were scanned throughout the complete R-R interval with tube current modulation. The effective dose (ED) was calculated from dose length product (DLP) and conversion k (0.014 mSv/mGy/cm). Image quality was assessed using a three-point ordinal scale (1 = excellent, 2 = good, and 3 = nondiagnostic). Results: Both groups were statistically similar to each other with reference of HR (P = 0.59), BMI (P = 0.17), and tube current mAs (P = 0.68). The median radiation dose was significantly higher in those scanned with complete R-R phase window versus narrow phase window (P < 0.0001). Independently of patient and scan parameters, increased phase window was associated with higher radiation dose (P < 0.001). Image quality was better among those scanned with narrow phase window versus complete phase window (P < 0.0001). Conclusion: Our study supports that good HR control and predefined narrow window acquisition result in lower radiation dose without compromising diagnostic image quality for coronary disease evaluation.
    Full-text · Article · Dec 2013 · The Scientific World Journal
Show more