NONINVASIVE CORONARY IMAGING
Noninvasive detection of coronary lesions using 16-detector multislice spiral computed tomography technology
Initial clinical results
Axel Kuettner, MD*,*,
Tobias Trabold, MD*,
Stephen Schroeder, MD ,
Anja Feyer, MS*,
Torsten Beck, MD,
Ariane Brueckner, MD*,
Martin Heuschmid, MD*,
Christof Burgstahler, MD,
Andreas F. Kopp, MD* and
Claus D. Claussen, MD*
* Department for Radiology, Diagnostic Radiology
Department for Internal Medicine, Division of Cardiology, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany
Manuscript received June 25, 2003;
revised manuscript received April 13, 2004,
accepted May 25, 2004.
* Reprint requests and correspondence: Dr. Axel Kuettner, Department of Diagnostic Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany (Email: axel.kuettner{at}med.uni-tubingen.de).
OBJECTIVES: The aim of our study was to evaluate the feasibility of detecting coronary artery lesions using a new computed tomography (CT) scanner with 16 detectors and faster gantry rotation.
BACKGROUND: Computed tomography angiography of the coronaries permits assessment of the coronaries; however, image quality is still impaired by motion artifacts and calcifications.
METHODS: Sixty patients scheduled for conventional coronary angiography (CCA) were additionally studied by multislice spiral computed tomography (MSCT).Calcium scores and a contrast-enhanced visualization of the coronaries were performed and analyzed regarding evaluability, presence of coronary artery lesions, and correct clinical diagnosis.
RESULTS: Calcium scoring was successful in all patients; 58 of 60 patients had a diagnostic contrast-enhanced scan. Mean calcium score was 506 ± 743 Agatston score equivalent (ASE); 13 of 58 (22%) patients had an ASE  1,000, 46 of 58 (78%) patients <1,000. In 763 coronary segments, CCA detected a total of 75 lesions 50%. The MSCT correctly assessed 54 of these. Twenty-one lesions were missed or incorrectly underestimated. Sensitivity was 72%, specificity 97%. When restricting analysis to patients with an ASE <1,000, 40 significant lesions 50% were seen on CCA, and MSCT correctly detected 39 lesions (sensitivity 98%, specificity 98%). Regardless of any threshold, the correct clinical diagnosis could be obtained in 58 of 60 (97%) of all patients.
CONCLUSIONS: In individuals with low-to-moderate amounts of coronary artery calcium, 16-detector CT coronary angiography has high sensitivity and specificity for the diagnosis of significant coronary artery stenosis.
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Abbreviations and Acronyms
| | CCA = conventional coronary angiography | | CT = computed tomography | | HR = heart rate | | LAD = left anterior descending coronary artery | | LCX = left circumflex coronary artery | | MSCT = multislice spiral computed tomography | | RCA = right coronary artery |
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