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J Am Coll Cardiol, 2005; 46:552-557, doi:10.1016/j.jacc.2005.05.056 (Published online 5 July 2005).
© 2005 by the American College of Cardiology Foundation
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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.

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




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64-MDCT Coronary Angiography of Patients With Atrial Fibrillation: Influence of Heart Rate on Image Quality and Efficacy in Evaluation of Coronary Artery Disease
Am. J. Roentgenol., September 1, 2009; 193(3): 795 - 801.
[Abstract] [Full Text] [PDF]

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L. Husmann, B. A. Herzog, N. Burkhard, I. Valenta, I. A. Burger, O. Gaemperli, and P. A. Kaufmann
Low-Dose Coronary CT Angiography With Prospective ECG Triggering: Validation of a Contrast Material Protocol Adapted to Body Mass Index
Am. J. Roentgenol., September 1, 2009; 193(3): 802 - 806.
[Abstract] [Full Text] [PDF]

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J. J. Chen, M. A. Manning, A. A. Frazier, J. Jeudy, and C. S. White
CT Angiography of the Cardiac Valves: Normal, Diseased, and Postoperative Appearances
RadioGraphics, September 1, 2009; 29(5): 1393 - 1412.
[Abstract] [Full Text] [PDF]

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B. Bischoff, F. Hein, T. Meyer, M. Hadamitzky, S. Martinoff, A. Schomig, and J. Hausleiter
Impact of a Reduced Tube Voltage on CT Angiography and Radiation Dose: Results of the PROTECTION I Study
J. Am. Coll. Cardiol. Img., August 1, 2009; 2(8): 940 - 946.
[Abstract] [Full Text] [PDF]

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B. M. Wertman, V. Y. Cheng, S. Kar, H. Gransar, R. A. Berg, H. Naik, R. Makkar, J. D. Friedman, J. N. Schapira, and D. S. Berman
Characterization of Complex Coronary Artery Stenosis Morphology by Coronary Computed Tomographic Angiography
J. Am. Coll. Cardiol. Img., August 1, 2009; 2(8): 950 - 958.
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G. Bastarrika, C. Thilo, G. F. Headden, P. L. Zwerner, P. Costello, and U. J. Schoepf
Cardiac CT in the Assessment of Acute Chest Pain in the Emergency Department
Am. J. Roentgenol., August 1, 2009; 193(2): 397 - 409.
[Abstract] [Full Text] [PDF]

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R. W. Bauer, C. Thilo, S. A. Chiaramida, T. J. Vogl, P. Costello, and U. J. Schoepf
Noncalcified Atherosclerotic Plaque Burden at Coronary CT Angiography: A Better Predictor of Ischemia at Stress Myocardial Perfusion Imaging Than Calcium Score and Stenosis Severity
Am. J. Roentgenol., August 1, 2009; 193(2): 410 - 418.
[Abstract] [Full Text] [PDF]

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L HUSMANN, O GAEMPERLI, I VALENTA, T SCHEPIS, H SCHEFFEL, P STOLZMANN, S LESCHKA, L DESBIOLLES, B MARINCEK, H ALKADHI, et al.
Impact of vessel attenuation on quantitative coronary angiography with 64-slice CT
Br. J. Radiol., August 1, 2009; 82(980): 649 - 653.
[Abstract] [Full Text] [PDF]

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 RadiologyHome page
H. Gouya, O. Varenne, L. Trinquart, E. Touze, O. Vignaux, C. Spaulding, J.-L. Mas, and J.-L. Sablayrolles
Coronary Artery Stenosis in High-risk Patients: 64-Section CT and Coronary Angiography--Prospective Study and Analysis of Discordance
Radiology, August 1, 2009; 252(2): 377 - 385.
[Abstract] [Full Text] [PDF]

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J. M. May, W. P. Shuman, J. N. Strote, K. R. Branch, L. M. Mitsumori, D. W. Lockhart, and J. H. Caldwell
Low-Risk Patients With Chest Pain in the Emergency Department: Negative 64-MDCT Coronary Angiography May Reduce Length of Stay and Hospital Charges
Am. J. Roentgenol., July 1, 2009; 193(1): 150 - 154.
[Abstract] [Full Text] [PDF]

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N. Bettencourt, J. Rocha, M. Carvalho, D. Leite, A. M. Toschke, B. Melica, L. Santos, A. Rodrigues, M. Goncalves, P. Braga, et al.
Multislice Computed Tomography in the Exclusion of Coronary Artery Disease in Patients With Presurgical Valve Disease
Circ Cardiovasc Imaging, July 1, 2009; 2(4): 306 - 313.
[Abstract] [Full Text] [PDF]

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S. Motoyama, M. Sarai, H. Harigaya, H. Anno, K. Inoue, T. Hara, H. Naruse, J. Ishii, H. Hishida, N. D. Wong, et al.
Computed Tomographic Angiography Characteristics of Atherosclerotic Plaques Subsequently Resulting in Acute Coronary Syndrome
J. Am. Coll. Cardiol., June 30, 2009; 54(1): 49 - 57.
[Abstract] [Full Text] [PDF]

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C. T. Sibley and D. A. Bluemke
Will 3.0-T Make Coronary Magnetic Resonance Angiography Competitive With Computed Tomography Angiography?
J. Am. Coll. Cardiol., June 30, 2009; 54(1): 77 - 78.
[Full Text] [PDF]

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J. Hur, Y. J. Kim, H.-J. Lee, J.-W. Ha, J. H. Heo, E.-Y. Choi, C.-Y. Shim, T. H. Kim, J. E. Nam, K. O. Choe, et al.
Cardiac Computed Tomographic Angiography for Detection of Cardiac Sources of Embolism in Stroke Patients
Stroke, June 1, 2009; 40(6): 2073 - 2078.
[Abstract] [Full Text] [PDF]

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 Circ Cardiovasc ImagingHome page
U. Hoffmann and F. Bamberg
Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?: CT Coronary Angiography Is the Most Accurate and Effective Noninvasive Imaging Tool for Evaluating Patients Presenting With Chest Pain to the Emergency Department
Circ Cardiovasc Imaging, May 1, 2009; 2(3): 251 - 263.
[Full Text] [PDF]

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 RadiologyHome page
F. Pugliese, M. G. M. Hunink, K. Gruszczynska, F. Alberghina, R. Malago, N. van Pelt, N. R. Mollet, F. Cademartiri, A. C. Weustink, W. B. Meijboom, et al.
Learning Curve for Coronary CT Angiography: What Constitutes Sufficient Training?1
Radiology, May 1, 2009; 251(2): 359 - 368.
[Abstract] [Full Text] [PDF]

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 Am. J. Roentgenol.Home page
P. T. Johnson, H. K. Pannu, and E. K. Fishman
IV Contrast Infusion for Coronary Artery CT Angiography: Literature Review and Results of a Nationwide Survey
Am. J. Roentgenol., May 1, 2009; 192(5): W214 - W221.
[Abstract] [Full Text] [PDF]

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K. M. Takakuwa, E. J. Halpern, E. L. Gingold, D. C. Levin, and F. S. Shofer
Radiation Dose in a "Triple Rule-Out" Coronary CT Angiography Protocol of Emergency Department Patients Using 64-MDCT: The Impact of ECG-Based Tube Current Modulation on Age, Sex, and Body Mass Index
Am. J. Roentgenol., April 1, 2009; 192(4): 866 - 872.
[Abstract] [Full Text] [PDF]

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R. Donnino, J. E. Jacobs, J. V. Doshi, E. M. Hecht, D. C. Kim, J. S. Babb, and M. B. Srichai
Dual-Source Versus Single-Source Cardiac CT Angiography: Comparison of Diagnostic Image Quality
Am. J. Roentgenol., April 1, 2009; 192(4): 1051 - 1056.
[Abstract] [Full Text] [PDF]

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M. R. JONES
The imaging of acute chest pain with multidetector computed tomography
Imaging, March 1, 2009; 21(1): 20 - 31.
[Abstract] [Full Text] [PDF]

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 Eur Heart JHome page
L. Husmann, B. A. Herzog, O. Gaemperli, F. Tatsugami, N. Burkhard, I. Valenta, P. Veit-Haibach, C. A. Wyss, U. Landmesser, and P. A. Kaufmann
Diagnostic accuracy of computed tomography coronary angiography and evaluation of stress-only single-photon emission computed tomography/computed tomography hybrid imaging: comparison of prospective electrocardiogram-triggering vs. retrospective gating
Eur. Heart J., March 1, 2009; 30(5): 600 - 607.
[Abstract] [Full Text] [PDF]

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F. Tatsugami, L. Husmann, B. A. Herzog, N. Burkhard, I. Valenta, O. Gaemperli, and P. A. Kaufmann
Evaluation of a Body Mass Index-Adapted Protocol for Low-Dose 64-MDCT Coronary Angiography with Prospective ECG Triggering
Am. J. Roentgenol., March 1, 2009; 192(3): 635 - 638.
[Abstract] [Full Text] [PDF]

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 Am. J. Roentgenol.Home page
J. R. Mayo and J. A. Leipsic
Radiation Dose in Cardiac CT
Am. J. Roentgenol., March 1, 2009; 192(3): 646 - 653.
[Abstract] [Full Text] [PDF]

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A. J. Einstein
Radiation Protection of Patients Undergoing Cardiac Computed Tomographic Angiography
JAMA, February 4, 2009; 301(5): 545 - 547.
[Full Text] [PDF]

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 J Am Coll Cardiol ImgHome page
J. A. Goldstein
Coronary plaque characterization by computed tomographic angiography: present promise and future hope.
J. Am. Coll. Cardiol. Img., February 1, 2009; 2(2): 161 - 163.
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B. J.W. Chow, A. Abraham, G. A. Wells, L. Chen, T. D. Ruddy, Y. Yam, N. Govas, P. D. Galbraith, C. Dennie, and R. S. Beanlands
Diagnostic Accuracy and Impact of Computed Tomographic Coronary Angiography on Utilization of Invasive Coronary Angiography
Circ Cardiovasc Imaging, January 1, 2009; 2(1): 16 - 23.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
W. B. Meijboom, M. F.L. Meijs, J. D. Schuijf, M. J. Cramer, N. R. Mollet, C. A.G. van Mieghem, K. Nieman, J. M. van Werkhoven, G. Pundziute, A. C. Weustink, et al.
Diagnostic Accuracy of 64-Slice Computed Tomography Coronary Angiography: A Prospective, Multicenter, Multivendor Study
J. Am. Coll. Cardiol., December 16, 2008; 52(25): 2135 - 2144.
[Abstract] [Full Text] [PDF]

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 Eur Heart JHome page
B. A. Herzog, L. Husmann, N. Burkhard, O. Gaemperli, I. Valenta, F. Tatsugami, C. A. Wyss, U. Landmesser, and P. A. Kaufmann
Accuracy of low-dose computed tomography coronary angiography using prospective electrocardiogram-triggering: first clinical experience
Eur. Heart J., December 2, 2008; 29(24): 3037 - 3042.
[Abstract] [Full Text] [PDF]

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 Am. J. Roentgenol.Home page
H. Matsumoto, T. Kondo, S. Watanabe, R. Kikumoto, T. Shimada, Y. Hiraoka, and K. Ueda
ECG-Edited Middiastolic Phase Reconstruction Improves Image Quality at 64-MDCT Coronary Angiography of Patients with Atrial Fibrillation
Am. J. Roentgenol., December 1, 2008; 191(6): 1659 - 1666.
[Abstract] [Full Text] [PDF]

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 Am. J. Roentgenol.Home page
A. B. Meijer, Y. L. O, J. Geleijns, and L. J. M. Kroft
Meta-Analysis of 40- and 64-MDCT Angiography for Assessing Coronary Artery Stenosis
Am. J. Roentgenol., December 1, 2008; 191(6): 1667 - 1675.
[Abstract] [Full Text] [PDF]

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 Am. J. Roentgenol.Home page
S. Zhang, D. C. Levin, E. J. Halpern, D. Fischman, M. Savage, and P. Walinsky
Accuracy of MDCT in Assessing the Degree of Stenosis Caused by Calcified Coronary Artery Plaques
Am. J. Roentgenol., December 1, 2008; 191(6): 1676 - 1683.
[Abstract] [Full Text] [PDF]

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 Am. J. Roentgenol.Home page
P. Stolzmann, H. Scheffel, S. Leschka, A. Plass, S. Baumuller, B. Marincek, and H. Alkadhi
Influence of Calcifications on Diagnostic Accuracy of Coronary CT Angiography Using Prospective ECG Triggering
Am. J. Roentgenol., December 1, 2008; 191(6): 1684 - 1689.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
M. J. Budoff, D. Dowe, J. G. Jollis, M. Gitter, J. Sutherland, E. Halamert, M. Scherer, R. Bellinger, A. Martin, R. Benton, et al.
Diagnostic Performance of 64-Multidetector Row Coronary Computed Tomographic Angiography for Evaluation of Coronary Artery Stenosis in Individuals Without Known Coronary Artery Disease: Results From the Prospective Multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) Trial
J. Am. Coll. Cardiol., November 18, 2008; 52(21): 1724 - 1732.
[Abstract] [Full Text] [PDF]

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G Mowatt, J A Cook, G S Hillis, S Walker, C Fraser, X Jia, and N Waugh
64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis
Heart, November 1, 2008; 94(11): 1386 - 1393.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
T. Maruyama, M. Takada, T. Hasuike, A. Yoshikawa, E. Namimatsu, and T. Yoshizumi
Radiation Dose Reduction and Coronary Assessability of Prospective Electrocardiogram-Gated Computed Tomography Coronary Angiography: Comparison With Retrospective Electrocardiogram-Gated Helical Scan
J. Am. Coll. Cardiol., October 28, 2008; 52(18): 1450 - 1455.
[Abstract] [Full Text] [PDF]

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 Eur Heart JHome page
P. Schoenhagen and E. M. Tuzcu
Identifying patterns of atherosclerotic disease manifestation with coronary computed tomography. Impact on clinical management and outcome?
Eur. Heart J., October 1, 2008; 29(19): 2323 - 2324.
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