64-Slice Computed Tomography Coronary Angiography in Patients With High, Intermediate, or Low Pretest Probability of Significant Coronary Artery Disease
W. Bob Meijboom, MD*, ,
Carlos A.G. van Mieghem, MD*,,
Nico R. Mollet, MD, PhD*,,
Francesca Pugliese, MD*,,
Annick C. Weustink, MD*,,
Niels van Pelt, MD*,,
Filippo Cademartiri, MD, PhD,
Koen Nieman, MD, PhD*,
Eric Boersma, MSc, PhD*,
Peter de Jaegere, MD, PhD*,
Gabriel P. Krestin, MD, PhD and
Pim J. de Feyter, MD, PhD, FACC*,,*
* Department of Cardiology, Thoraxcenter, Rotterdam, the Netherlands
Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands.
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Figure 1 CTCA Image of the Right Coronary Artery
Volume-rendered computed tomography coronary angiography (CTCA) image (A) of the right coronary artery. A curved multiplanar reconstructed image (B) and a thick maximum-intensity projected image (C) disclose a significant coronary stenosis (arrows) in the midright coronary artery, which was corroborated by conventional coronary angiogram (D). Proximally and distally of the significant obstructed lesion, nonsignificant calcified plaques can be seen (C).
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Figure 2 Impact of CTCA on Various Estimated Pretest Probabilities of Significant CAD
1Estimated using Duke Clinical Score (including Diamond-Forrester criteria and prognostic clinical variables); 2based on conventional coronary angiography ( 1 significant coronary stenosis as determined by quantitative coronary angiography); 3calculated using Bayesian statistics (post-test odds = pretest odds x likelihood ratio). CAD = coronary artery disease; CTCA = computed tomography coronary angiography; Est = estimated; Obs = observed.
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Figure 3 Influence of CTCA on Probability of Obstructive CAD as a Function of Pretest Probability
Using the positive and negative likelihood ratios obtained from Table 2, we calculated the estimated post-test probabilities of CAD after positive and negative findings on CTCA from various estimated pre-test probabilities of CAD. Dashed lines = CTCA+; dotted lines = CTCA–. Abbreviations as in Figure 2.
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