CLINICAL RESEARCH: CARDIAC IMAGING
Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with angiographically proven coronary artery disease
Axel Kuettner, MD*,*,
Andreas F. Kopp, MD*,
Stephen Schroeder, MD ,
Thilo Rieger, MS*,
Juergen Brunn, MD ,
Christoph Meisner, MA ,
Martin Heuschmid, MD*,
Tobias Trabold, MD*,
Christof Burgstahler, MD,
Jens Martensen, MS*,
Wolfgang Schoebel, MD,
Hans-Konrad Selbmann, PhD and
Claus D. Claussen, MD*
* Department of Diagnostic Radiology, Tuebingen, Germany
Department of Internal Medicine, Division of Cardiology, Tuebingen, Germany
Institute for Medical Information Processing, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany
Department of Cardiology, Herz- und Gefäß-Klinik, Bad Neustadt, Germany
Manuscript received October 3, 2002;
revised manuscript received May 4, 2003,
accepted May 6, 2003.
* Reprint requests and correspondence: Dr. Axel Kuettner, Department of Diagnostic Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
axel.kuettner{at}med.unl-tubingen.de
OBJECTIVES: The aim of the present study was to evaluate the diagnostic accuracy in detecting high-grade coronary stenoses in patients with known coronary artery disease (CAD) using multidetector computed tomography (MDCT).
BACKGROUND: The MDCT systems with electrocardiographic (ECG)-gating permit visualization of the coronary arteries. However, severe calcifications and higher heart rates are known to degrade image quality and limit correct diagnosis.
METHODS: Sixty-six patients with proven CAD as assessed by conventional coronary angiography (CCA) were studied by MDCT (mean time 24 months postangiography). Total calcium score and all coronary arteries, including distal segments and side branches, were assessed with respect to evaluability, presence of high-grade coronary artery stenoses (>70%), and correct diagnosis. Results were compared to CCA.
RESULTS: A total of 105 lesions were detected by CCA. The MDCT correctly detected 39 lesions (sensitivity 37%, specificity 99%). The correct clinical diagnosis could be obtained in 24 patients (36%). Artifacts due to elevated heart rates or severe coronary artery calcification were the main cause of degraded image quality inhibiting correct diagnosis. In 21/66 patients (32%) all four major coronary vessel segments could be visualized. A threshold for maximum heart rate and a maximum calcification level were established (65 beats/min and an Agatston Score Equivalent of 335, respectively). A second analysis was made using these thresholds. Of all patients studied, 10/11 (91%) were correctly diagnosed when adhering to these thresholds.
CONCLUSIONS: When using MDCT as a noninvasive diagnostic modality to assess advanced CAD, it appears to be mandatory to preselect patients in order to achieve reliable results.
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Abbreviations and Acronyms
| | BMI | = body mass index | | CAD | = coronary artery disease | | CCA | = conventional coronary angiography | | EBCT | = electron beam computed tomography | | ECG | = electrocardiogram/electrocardiographic | | LAD | = left anterior descending | | LCx | = left circumflex | | MDCT | = multidetector computed tomography | | PTCA | = percutaneous transluminal coronary angioplasty | | RCA | = right coronary artery | | RCx | = right circumflex |
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