EXPRESS PUBLICATIONS
Improved diagnostic accuracy with 16-row multi-slice computed tomography coronary angiography
Nico R. Mollet, MD*, ,
Filippo Cademartiri, MD,
Gabriel P. Krestin, MD,
Eugène P. McFadden, MB, FACC*,
Chourmouzios A. Arampatzis, MD*,
Patrick W. Serruys, MD, FACC* and
Pim J. de Feyter, MD, FACC*,,*
* Departments of Cardiology
Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
Manuscript received May 11, 2004;
revised manuscript received September 9, 2004,
accepted September 14, 2004.
* Reprint requests and correspondence: Dr. Pim J. de Feyter, Erasmus Medical Center, Thoraxcenter, room Bd-410, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
(Email: p.j.defeyter{at}erasmusmc.nl).
OBJECTIVES: We sought to compare the diagnostic value of multi-slice computed tomography (MSCT) coronary angiography (CA) to detect significant stenoses ( 50% lumen diameter reduction) with that of invasive CA.
BACKGROUND: The latest 16-row MSCT scanner has a faster rotation time (375 ms) and permits scanning with a higher X-ray tube current (500 to 600 mA) during MSCT CA when compared with previous scanners.
METHODS: We studied 51 patients (37 men, mean age 58.9 ± 10.0 years) with stable angina or atypical chest pain. Patients with pre-scan heart rates 70 beats/min received oral beta-blockade. The heart was scanned after intravenous injection of 100 ml contrast (iodine content, 400 mg/ml). Mean scan time was 18.9 ± 1.0 s. The MSCT scans were analyzed by two observers unaware of the results of invasive angiography, and all available coronary branches 2 mm were included.
RESULTS: Invasive CA demonstrated normal arteries in 16% (8 of 51), non-significant disease in 21% (11 of 51), single-vessel disease in 37% (19 of 51), and multi-vessel disease in 26% (13 of 51) of patients. There were 64 significant lesions. Sensitivity, specificity, and positive and negative predictive values for detection of significant lesions on a segment-based analysis were 95% (61 of 64, 95% confidence interval [CI] 86 to 99), 98% (537 of 546, 95% CI 96 to 99), 87% (61 of 70, 95% CI 76 to 98), and 99% (537 of 540, 95% CI 98 to 99), respectively. All patients with angiographically normal coronary arteries or significant lesions were correctly identified. Three of 11 patients with <50% lesions were incorrectly classified as having single-vessel disease.
CONCLUSIONS: The 16-row MSCT CA reliably detects significant coronary stenoses in patients with atypical chest pain or stable angina pectoris.
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Abbreviations and Acronyms
| | CA = coronary angiography | | CX = circumflex coronary artery | | LAD = left anterior descending coronary artery | | LM = left main coronary artery | | MSCT = multi-slice computed tomography | | RCA = right coronary artery | | QCA = quantitative coronary angiography |
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