Usefulness of multislice computed tomography for detecting obstructive coronary artery disease

doi:10.1016/S0002-9149(02)02238-5

The American Journal of Cardiology

Volume 89, Issue 8, 15 April 2002, Pages 913-918

https://doi.org/10.1016/S0002-9149(02)02238-5 Get rights and content

Abstract

The latest generation of multislice spiral computed tomography (MSCT) scanners is capable of noninvasive coronary angiography. We evaluated its diagnostic accuracy to detect stenotic coronary artery disease (CAD). In 53 patients with suspected CAD, contrast-enhanced MSCT and conventional angiography were performed. The CT data were acquired within a single breathhold, and isocardiophasic slices were reconstructed by means of retrospective electrocardiographic gating. Coronary segments of ≥2 mm in diameter, measured by quantitative angiography, were evaluated. In 70% of the 358 available segments, image quality was regarded as adequate for assessment. The overall sensitivity, specificity, and positive and negative predictive values to detect ≥50% stenotic lesions in the assessable segments were 82% (42 of 51 lesions), 93% (285 of 307 nonstenotic segments), and 66% and 97%, respectively, regarding conventional quantitative angiography as the gold standard. Proximal segments were assessable in 92%, and distal segments and side branches in 71% and 50%, respectively. Including the undetected lesions in nonassessable segments, overall sensitivity decreased to 61% but remained 82% for lesions in proximal coronary segments. MSCT correctly predicted absent, single, or multiple lesions in 55% of patients. Thus, despite potentially high image quality, current MSCT protocols offer only reasonable diagnostic accuracy in an unselected patient group with a high prevalence of CAD.

Section snippets

Study group:

MSCT angiography was performed in 53 patients, who were referred for angiographic evaluation of suspected CAD. Patient characteristics are listed in Table 1. Patients who previously underwent angioplasty with stent implantation or coronary bypass surgery were excluded. Further exclusion criteria were irregular heart rates, previous allergic reaction to iodine contrast media, renal insufficiency (serum creatinine >100 mmol/L), pregnancy, respiratory impairment, unstable clinical status, or

Results

Except for 2 cases of a mild allergic skin reaction to the contrast medium, no adverse events were encountered. The average scan time was 37 ± 4 seconds, and the entire examination was generally completed within 20 minutes. Depending on the data quality and complexity of the coronary status, postprocessing and assessment required 10 to 30 minutes.

After exclusion of all segments that were either anatomically absent, too small (<2.0-mm vessel diameter), or not enhanced due to complete occlusion

Discussion

Advanced therapeutic options and improved patient survival have created a need for earlier and repeat coronary visualization in more and older patients. Despite the diagnostic superiority of selective x-ray coronary angiography, safety and budgetary concerns have promoted the development of noninvasive alternatives. In a preliminary study, we evaluated the feasibility of MSCT coronary angiography and described a variety of clinical cases, including patients with bypass grafts and intracoronary

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Die DSCT-Technologie verkürzt die zeitliche Auflösung auf 83 ms pro Herzphase. In einer Pilotstudie wird die klinische Wertigkeit des Verfahrens überprüft.
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Von den formal 750 AHA-Segmenten kamen 655 zur Darstellung (87,3%). 591 Segmente (90,2%) waren uneingeschränkt, 49 (7,5%) leicht eingeschränkt und 15 (2,3%) deutlich eingeschränkt beurteilbar. 508 (77,6%) Segmente waren morphologisch unauffällig, 92 (14,0%) mit Wandunregelmäßigkeiten, 42 (6,4%) mit Stenosen <70% und 13 (2,0%) mit Stenosen > 70%. Bei 31 Patienten (62%) wurde keine weitere Diagnostik oder invasive Therapie empfohlen, bei 8 Patienten (16%) ein Ischämienachweis gefordert, bei 11 Patienten (22%) erfolgte die Empfehlung zur Koronarangiographie. Mit Ausnahme von 1 Stenosenüberwertung wurden die übrigen DSCT-Befunde bestätigt.
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Out of 750 possible AHA-segments, 655 were depicted (87,3%). 591 segments (90,2%) were assessed without any limitation of quality, 49 (7,5%) segments showed moderate, and 15 (2,3%) segments severe limitation in image quality. 508 (77,6%) segments were without pathological findings, 92 (14,0%) segments had minimal atherosclerotic lesions, 42 (6,4%) segments suffered from stenoses with lumen reduction less than 70%, and 13 (2,0%) showed significant stenoses of more than 70%. In 31 patients (62%), coronary heart disease was ruled out by CT angiography without any need for further non-invasive or invasive diagnostics. 8 patients (16%) underwent stress-testing for ischemia. In 11 (22%) patients coronary angiography was recommended, and DSCT findings were confirmed in 10 cases. Only one LCx stenosis was overestimated in DSCT.
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Usefulness of multislice computed tomography for detecting obstructive coronary artery disease

Abstract

Section snippets

Study group:

Results

Discussion

Prog Cardiovasc Dis

Lancet

Am J Cardiol

Eur J Radiol

Coronary arteries

Eur Radiol

Cardiac imaging by means of electrocardiographically gated multisection spiral CTinitial experience

Radiology

Technical aspects and applications of fast multislice cardiac CT

A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association

Circulation