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EXPRESS PUBLICATION

Diagnostic Accuracy of Noninvasive Coronary Angiography Using 64-Slice Spiral Computed Tomography

Cardiology Division, William Beaumont Hospital, Royal Oak, Michigan

Manuscript received April 6, 2005; revised manuscript received May 10, 2005, accepted May 17, 2005.

^_* Reprint requests and correspondence: Dr. Gilbert L. Raff, William Beaumont Hospital, Cardiology Division, 3601 West 13 Mile Road, Royal Oak, Michigan 48380 (Email: graff{at}beaumont.edu).

OBJECTIVES: The aim of our study was to evaluate the diagnostic accuracy of multislice computed tomography (MSCT) coronary angiography using a new 64-slice scanner.

BACKGROUND: The new 64-slice MSCT scanner has improved spatial resolution of 0.4 mm and a faster rotation time (330 ms) compared to prior MSCT scanners.

METHODS: We studied 70 consecutive patients undergoing elective invasive coronary angiography. Patients were excluded for atrial fibrillation, but not for high heart rate, coronary calcification, or obesity. All vessels were analyzed, including those <1.5 mm in diameter; MSCT lesions were analyzed quantitatively as well as by a qualitative scale and compared to quantitative coronary angiography (QCA). Results were also analyzed for significant coronary stenoses (over 50% luminal narrowing) by segment, by artery, and by patient.

RESULTS: All scans showed diagnostic image quality. Of 1,065 segments, 935 (88%) could be evaluated, and 773 of 935 (83%) could be assessed quantitatively by both MSCT and QCA. The Spearman correlation coefficient between MSCT and QCA was 0.76 (p < 0.0001). Bland-Altman analysis demonstrated a mean difference in percent stenosis of 1.3 ± 14.2%. A total of 26% of patients had calcium scores above 400 Agatston U, 25% had heart rates >70 beats/min, and 50% were obese. Specificity, sensitivity, and positive and negative predictive values for the presence of significant stenoses were: by segment (n = 935), 86%, 95%, 66%, and 98%, respectively; by artery (n = 279), 91%, 92%, 80%, and 97%, respectively; by patient (n = 70), 95%, 90%, 93%, and 93%, respectively.

CONCLUSIONS: Our results indicate high quantitative and qualitative diagnostic accuracy of 64-slice MSCT in comparison to QCA in a broad spectrum of patients.

Abbreviations and Acronyms   CT = computed tomography   ECG = electrocardiogram   MSCT = multislice computed tomography   QCA = quantitative coronary angiography

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				G. Pundziute, J. D. Schuijf, J. W. Jukema, I. Decramer, G. Sarno, P. K. Vanhoenacker, J. H.C. Reiber, M. J. Schalij, W. Wijns, and J. J. Bax Head-to-Head Comparison of Coronary Plaque Evaluation Between Multislice Computed Tomography and Intravascular Ultrasound Radiofrequency Data Analysis J. Am. Coll. Cardiol. Intv., April 1, 2008; 1(2): 176 - 182. [Abstract] [Full Text] [PDF]

				K. Nieman, M. D. Shapiro, M. Ferencik, C. H. Nomura, S. Abbara, U. Hoffmann, H. K. Gold, I.-K. Jang, T. J. Brady, and R. C. Cury Reperfused Myocardial Infarction: Contrast-enhanced 64-Section CT in Comparison to MR Imaging Radiology, April 1, 2008; 247(1): 49 - 56. [Abstract] [Full Text] [PDF]

				A. Sato, M. Hiroe, M. Tamura, H. Ohigashi, T. Nozato, H. Hikita, A. Takahashi, K. Aonuma, and M. Isobe Quantitative Measures of Coronary Stenosis Severity by 64-Slice CT Angiography and Relation to Physiologic Significance of Perfusion in Nonobese Patients: Comparison with Stress Myocardial Perfusion Imaging J. Nucl. Med., April 1, 2008; 49(4): 564 - 572. [Abstract] [Full Text] [PDF]

				I. Gottlieb and J. A.C. Lima Screening High-Risk Patients With Computed Tomography Angiography Circulation, March 11, 2008; 117(10): 1318 - 1332. [Full Text] [PDF]

				C. M. Kramer All High-Risk Patients Should Not Be Screened With Computed Tomographic Angiography Circulation, March 11, 2008; 117(10): 1333 - 1339. [Full Text] [PDF]

				V. Stangl, V. Witzel, G. Baumann, and K. Stangl Current diagnostic concepts to detect coronary artery disease in women Eur. Heart J., March 2, 2008; 29(6): 707 - 717. [Abstract] [Full Text] [PDF]

				H. Alkadhi, H. Scheffel, L. Desbiolles, O. Gaemperli, P. Stolzmann, A. Plass, G. W. Goerres, T. F. Luescher, M. Genoni, B. Marincek, et al. Dual-source computed tomography coronary angiography: influence of obesity, calcium load, and heart rate on diagnostic accuracy Eur. Heart J., March 2, 2008; 29(6): 766 - 776. [Abstract] [Full Text] [PDF]

				F. Cademartiri, E. Maffei, and N. R. Mollet Is dual-source CT coronary angiography ready for the real world? Eur. Heart J., March 2, 2008; 29(6): 701 - 703. [Full Text] [PDF]

				S. Prat-Gonzalez, J. Sanz, and M. J. Garcia Cardiac CT: Indications and Limitations J. Nucl. Med. Technol., March 1, 2008; 36(1): 18 - 24. [Abstract] [Full Text] [PDF]

				A J H A Scholte, J D Schuijf, A V Kharagjitsingh, J W Jukema, G Pundziute, E E van der Wall, and J J Bax Prevalence of coronary artery disease and plaque morphology assessed by multi-slice computed tomography coronary angiography and calcium scoring in asymptomatic patients with type 2 diabetes Heart, March 1, 2008; 94(3): 290 - 295. [Abstract] [Full Text] [PDF]

				J. P. Earls, E. L. Berman, B. A. Urban, C. A. Curry, J. L. Lane, R. S. Jennings, C. C. McCulloch, J. Hsieh, and J. H. Londt Prospectively Gated Transverse Coronary CT Angiography versus Retrospectively Gated Helical Technique: Improved Image Quality and Reduced Radiation Dose Radiology, March 1, 2008; 246(3): 742 - 753. [Abstract] [Full Text] [PDF]

				S. Leschka, P. Koepfli, L. Husmann, A. Plass, R. Vachenauer, O. Gaemperli, T. Schepis, M. Genoni, B. Marincek, F. R. Eberli, et al. Myocardial Bridging: Depiction Rate and Morphology at CT Coronary Angiography--Comparison with Conventional Coronary Angiography Radiology, March 1, 2008; 246(3): 754 - 762. [Abstract] [Full Text] [PDF]

				S. Schroeder, S. Achenbach, F. Bengel, C. Burgstahler, F. Cademartiri, P. de Feyter, R. George, P. Kaufmann, A. F. Kopp, J. Knuuti, et al. Cardiac computed tomography: indications, applications, limitations, and training requirements: Report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology Eur. Heart J., February 2, 2008; 29(4): 531 - 556. [Abstract] [Full Text] [PDF]

				J. Horiguchi, M. Kiguchi, C. Fujioka, Y. Shen, R. Arie, K. Sunasaka, and K. Ito Radiation Dose, Image Quality, Stenosis Measurement, and CT Densitometry Using ECG-Triggered Coronary 64-MDCT Angiography: A Phantom Study Am. J. Roentgenol., February 1, 2008; 190(2): 315 - 320. [Abstract] [Full Text] [PDF]

				F. Pugliese, N. R. Mollet, M. G. M. Hunink, F. Cademartiri, K. Nieman, R. T. van Domburg, W. B. Meijboom, C. Van Mieghem, A. C. Weustink, M. L. Dijkshoorn, et al. Diagnostic Performance of Coronary CT Angiography by Using Different Generations of Multisection Scanners: Single-Center Experience Radiology, February 1, 2008; 246(2): 384 - 393. [Abstract] [Full Text] [PDF]