EXPRESS PUBLICATION
Diagnostic Accuracy of Noninvasive Coronary Angiography Using 64-Slice Spiral Computed Tomography
Gilbert L. Raff, MD, FACC*,
Michael J. Gallagher, MD,
William W. O’Neill, MD, FACC and
James A. Goldstein, MD, FACC
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.
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Abbreviations and Acronyms
| | CT = computed tomography | | ECG = electrocardiogram | | MSCT = multislice computed tomography | | QCA = quantitative coronary angiography |
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