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 ,
Marco Valgimigli, MD and
Martial Hamon, MD,*
* Radiology
Cardiology
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 |
|
This article has been cited by other articles:
|
|
|
|
 
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]
|
|
|
|
|
|
|
J. M. Miller, C. E. Rochitte, M. Dewey, A. Arbab-Zadeh, H. Niinuma, I. Gottlieb, N. Paul, M. E. Clouse, E. P. Shapiro, J. Hoe, et al.
Diagnostic Performance of Coronary Angiography by 64-Row CT
N. Engl. J. Med.,
November 27, 2008;
359(22):
2324 - 2336.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
J. K. Min and L. J. Shaw
Noninvasive Diagnostic and Prognostic Assessment of Individuals With Suspected Coronary Artery Disease: Coronary Computed Tomographic Angiography Perspective
Circ Cardiovasc Imaging,
November 1, 2008;
1(3):
270 - 281.
[Full Text]
[PDF]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
J. K. Min, N. Kang, L. J. Shaw, R. B. Devereux, M. Robinson, F. Lin, A. P. Legorreta, and A. Gilmore
Costs and Clinical Outcomes after Coronary Multidetector CT Angiography in Patients without Known Coronary Artery Disease: Comparison to Myocardial Perfusion SPECT
Radiology,
October 1, 2008;
249(1):
62 - 70.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Sarwar, J. Rieber, E. A. Q. Mooyaart, S. K. Seneviratne, S. L. Houser, F. Bamberg, O. C. Raffel, R. Gupta, M. K. Kalra, H. Pien, et al.
Calcified Plaque: Measurement of Area at Thin-Section Flat-Panel CT and 64-Section Multidetector CT and Comparison with Histopathologic Findings
Radiology,
October 1, 2008;
249(1):
301 - 306.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. J. Heffernan, J. D. Dodd, and D. E. Malone
Cardiac Multidetector CT: Technical and Diagnostic Evaluation with Evidence-based Practice Techniques
Radiology,
August 1, 2008;
248(2):
366 - 377.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. P. Shuman, K. R. Branch, J. M. May, L. M. Mitsumori, D. W. Lockhart, T. J. Dubinsky, B. H. Warren, and J. H. Caldwell
Prospective versus Retrospective ECG Gating for 64-Detector CT of the Coronary Arteries: Comparison of Image Quality and Patient Radiation Dose
Radiology,
August 1, 2008;
248(2):
431 - 437.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Cheng, A. Gutstein, A. Wolak, Y. Suzuki, D. Dey, H. Gransar, L. E.J. Thomson, S. W. Hayes, J. D. Friedman, and D. S. Berman
Moving Beyond Binary Grading of Coronary Arterial Stenoses on Coronary Computed Tomographic Angiography: Insights for the Imager and Referring Clinician
J. Am. Coll. Cardiol. Img.,
July 1, 2008;
1(4):
460 - 471.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W T Roberts, J J Bax, and L C Davies
Cardiac CT and CT coronary angiography: technology and application
Heart,
June 1, 2008;
94(6):
781 - 792.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Van Brabandt
Recommendations or mere prose?
Eur. Heart J.,
June 1, 2008;
29(11):
1473 - 1473.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Hamon, O. Lepage, P. Malagutti, J. W. Riddell, R. Morello, D. Agostini, and M. Hamon
Diagnostic Performance of 16- and 64-Section Spiral CT for Coronary Artery Bypass Graft Assessment: Meta-Analysis
Radiology,
June 1, 2008;
247(3):
679 - 686.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. J Schunemann, A. D Oxman, J. Brozek, P. Glasziou, R. Jaeschke, G. E Vist, J. W Williams Jr, R. Kunz, J. Craig, V. M Montori, et al.
Grading quality of evidence and strength of recommendations for diagnostic tests and strategies
BMJ,
May 17, 2008;
336(7653):
1106 - 1110.
[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]
|
|
|
|
|
|
|
S. Achenbach, U. Ropers, A. Kuettner, K. Anders, T. Pflederer, S. Komatsu, W. Bautz, W. G. Daniel, and D. Ropers
Randomized Comparison of 64-Slice Single- and Dual-Source Computed Tomography Coronary Angiography for the Detection of Coronary Artery Disease
J. Am. Coll. Cardiol. Img.,
March 1, 2008;
1(2):
177 - 186.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A.C. Lima
Another Step Forward in CT Angiography
J. Am. Coll. Cardiol. Img.,
March 1, 2008;
1(2):
187 - 189.
[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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
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]
|
|
|
|
