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J Am Coll Cardiol, 2006; 48:1896-1910, doi:10.1016/j.jacc.2006.08.028 (Published online 25 September 2006).
© 2006 by the American College of Cardiology Foundation
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EXPEDITED REVIEW

Diagnostic Performance of Multislice Spiral Computed Tomography of Coronary Arteries as Compared With Conventional Invasive Coronary Angiography

A Meta-Analysis

Michèle Hamon, MD*, Giuseppe G.L. Biondi-Zoccai, MD§, Patrizia Malagutti, MD||, Pierfrancesco Agostoni, MD, Rémy Morello, MD{ddagger}, Marco Valgimigli, MD{dagger} and Martial Hamon, MD{dagger},*

* Radiology
{dagger} Cardiology
{ddagger} Statistics of the University Hospital of Caen, Caen, Normandy, France
§ Hemodynamics and Cardiovascular Radiology Service, Policlinico San Donato, San Donato Milanese, Milan, Italy
|| Radiology Department, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands
Cardiovascular Institute Middelheim, AZ Middelheim, Antwerp, Belgium

Manuscript received July 5, 2006; revised manuscript received August 16, 2006, accepted August 26, 2006.

* Reprint requests and correspondence: Prof. Martial Hamon, Service des Maladies du Coeur et des Vaisseaux, Centre Hospitalier Universitaire de Caen, Avenue Côte de Nacre 14033 Caen, Normandy, France (Email: hamon-m{at}chu-caen.fr).

OBJECTIVES: This study was designed to define the current role of multislice spiral computed tomography (MSCT) for the diagnosis of coronary artery disease (CAD) using a meta-analytic process.

BACKGROUND: Multislice spiral computed tomography has recently been proposed as an alternative to conventional coronary angiography (CA) for the diagnosis of CAD.

METHODS: Using Medline, we identified 29 studies (2,024 patients) evaluating CAD by means of both MSCT (≥16 slices) and conventional CA before July 2006. After data extraction the analysis was performed according to a random-effects model.

RESULTS: The per-segment analysis pooled the results from 27 studies corresponding to a cumulative number of 22,798 segments. Among unassessable segments, 4.2% were excluded from the analysis and 6.4% were classified at the discretion of the investigators, underscoring the shortcomings of MSCT. With this major limitation, the per-segment sensitivity and specificity were 81% (95% confidence interval [CI] 72% to 89%) and 93% (95% CI 90% to 97%), respectively, with positive and negative likelihood ratios of 21.5 (95% CI 13.1 to 35.5) and 0.11 (95% CI 0.06 to 0.21), respectively, and positive and negative predictive values of 67.8% (95% CI 57.6% to 78.0%) and 96.5% (95% CI 94.7% to 98.3%), respectively. As expected, the per-patient analysis has shown an increased sensitivity of 96% (95% CI 94% to 98%) but a decreased specificity of 74% (95% CI 65% to 84%).

CONCLUSIONS: Multislice spiral computed tomography has shortcomings difficult to overcome in daily practice and, at the more clinically relevant per-patient analysis, continues to have moderate specificity in patients with high prevalence of CAD. Studies evaluating the diagnostic performance of the newest generation of MSCT, including patients with low to moderate CAD prevalence, will be critical in establishing the clinical role of this emerging technology as an alternative to CA.

Abbreviations and Acronyms
  AUC = area under the curve
  CA = coronary angiography
  FN = false negative
  FP = false positive
  MSCT = multislice computed tomography
  NPV = negative predictive value
  PPV = positive predictive value
  TN = true negative
  TP = true positive




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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]


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J Am Coll Cardiol ImgHome page
L. F. Tops, S. C. Krishnan, J. D. Schuijf, M. J. Schalij, and J. J. Bax
Noncoronary applications of cardiac multidetector row computed tomography.
J. Am. Coll. Cardiol. Img., January 1, 2008; 1(1): 94 - 106.
[Abstract] [Full Text] [PDF]


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QJMHome page
M. Dewey, B. Hamm, H-P. Dubel, and W. Rutsch
Multislice computed tomography coronary angiography for triaging patients with positive radionuclide myocardial perfusion imaging
QJM, January 1, 2008; 101(1): 65 - 67.
[Full Text] [PDF]


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Am. J. Roentgenol.Home page
I. Decramer, P. K. Vanhoenacker, G. Sarno, L. Van Hoe, O. Bladt, W. Wijns, and P. M. Parizel
Effects of Sublingual Nitroglycerin on Coronary Lumen Diameter and Number of Visualized Septal Branches on 64-MDCT Angiography
Am. J. Roentgenol., January 1, 2008; 190(1): 219 - 225.
[Abstract] [Full Text] [PDF]


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HeartHome page
G Pundziute, J D Schuijf, J W Jukema, J M van Werkhoven, E Boersma, A de Roos, E E van der Wall, and J J Bax
Gender influence on the diagnostic accuracy of 64-slice multislice computed tomography coronary angiography for detection of obstructive coronary artery disease
Heart, January 1, 2008; 94(1): 48 - 52.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
J. Abdulla, S. Z. Abildstrom, O. Gotzsche, E. Christensen, L. Kober, and C. Torp-Pedersen
64-multislice detector computed tomography coronary angiography as potential alternative to conventional coronary angiography: a systematic review and meta-analysis
Eur. Heart J., December 2, 2007; 28(24): 3042 - 3050.
[Abstract] [Full Text] [PDF]


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HeartHome page
S. K Seneviratne, F. Bamberg, and U. Hoffmann
CT angiography: front line for acute coronary syndromes now?
Heart, November 1, 2007; 93(11): 1325 - 1326.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
J. K. Min, L. J. Shaw, R. B. Devereux, P. M. Okin, J. W. Weinsaft, D. J. Russo, N. J. Lippolis, D. S. Berman, and T. Q. Callister
Prognostic Value of Multidetector Coronary Computed Tomographic Angiography for Prediction of All-Cause Mortality
J. Am. Coll. Cardiol., September 18, 2007; 50(12): 1161 - 1170.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
R. J. Gibbons, P. A. Araoz, and E. E. Williamson
The Year in Cardiac Imaging
J. Am. Coll. Cardiol., September 4, 2007; 50(10): 988 - 1003.
[Full Text] [PDF]


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J Am Coll CardiolHome page
A. C. Weustink, W. B. Meijboom, N. R. Mollet, M. Otsuka, F. Pugliese, C. van Mieghem, R. Malago, N. van Pelt, M. L. Dijkshoorn, F. Cademartiri, et al.
Reliable High-Speed Coronary Computed Tomography in Symptomatic Patients
J. Am. Coll. Cardiol., August 21, 2007; 50(8): 786 - 794.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
C. A.G. Van Mieghem, A. Thury, W. B. Meijboom, F. Cademartiri, N. R. Mollet, A. C. Weustink, G. Sianos, P. P.T. de Jaegere, P. W. Serruys, and P. de Feyter
Detection and characterization of coronary bifurcation lesions with 64-slice computed tomography coronary angiography
Eur. Heart J., August 2, 2007; 28(16): 1968 - 1976.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
T. C. Gerber, B. Kantor, and P. Chareonthaitawee
Coronary computed tomographic angiography and exercise electrocardiography: a great match or unequal partners?
Eur. Heart J., August 1, 2007; 28(15): 1787 - 1789.
[Full Text] [PDF]


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JAMAHome page
A. J. Einstein, M. J. Henzlova, and S. Rajagopalan
Estimating Risk of Cancer Associated With Radiation Exposure From 64-Slice Computed Tomography Coronary Angiography
JAMA, July 18, 2007; 298(3): 317 - 323.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
J. A.C. Lima and J. Hare
Visualizing the Coronaries in Patients Presenting With Heart Failure of Unknown Etiology
J. Am. Coll. Cardiol., May 22, 2007; 49(20): 2051 - 2052.
[Full Text] [PDF]


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CirculationHome page
M. Hamon, J. Riddell, and M. Hamon
Letter by Hamon et al Regarding Article, "Coronary Multidetector Computed Tomography in the Assessment of Patients With Acute Chest Pain"
Circulation, May 8, 2007; 115(18): e448 - e448.
[Full Text] [PDF]


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J Am Coll CardiolHome page
J. Sanz, P. R. Moreno, and V. Fuster
The Year in Atherothrombosis
J. Am. Coll. Cardiol., April 24, 2007; 49(16): 1740 - 1749.
[Full Text] [PDF]


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J Am Coll CardiolHome page
A. N. DeMaria, O. Ben-Yehuda, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, J. Narula, D. J. Sahn, et al.
Highlights of the Year in JACC 2006
J. Am. Coll. Cardiol., January 30, 2007; 49(4): 509 - 527.
[Full Text] [PDF]



 
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