Circulation. 2004;110:2638-2643
Published online before print October 18, 2004, doi: 10.1161/01.CIR.0000145614.07427.9F
Published online before print October 18, 2004, doi: 10.1161/01.CIR.0000145614.07427.9F
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(Circulation. 2004;110:2638-2643.)
© 2004 American Heart Association, Inc.
Imaging |
Predictive Value of 16-Slice Multidetector Spiral Computed Tomography to Detect Significant Obstructive Coronary Artery Disease in Patients at High Risk for Coronary Artery Disease
Patient- Versus Segment-Based Analysis
From the Department of Radiology (U.H., F.M., R.C.C., M.F., S. Abbara, T.J.B., S. Achenbach) and the Division of Cardiology (F.M., I.-k.J., L.J.D., S. Achenbach), Massachusetts General Hospital, Boston, Mass, and the Department of Internal Medicine II (S. Achenbach), University of Erlangen, Erlangen, Germany.
Correspondence to Udo Hoffmann, MD, Department of Radiology, Massachusetts General Hospital, 100 Charles River Plaza, Ste 400, Boston, MA 02114. E-mail uhoffman{at}partners.org
Received February 23, 2004; de novo received April 16, 2004; revision received June 21, 2004; accepted June 22, 2004.
Background— In this study, we investigated the diagnostic value and limitations of multidetector computed tomography (MDCT)–based noninvasive detection of significant obstructive coronary artery disease (CAD) in a consecutive high-risk patient population with inclusion of all coronary segments.
Methods and Results— In a prospective, blinded, standard cross-sectional technology assessment, a cohort of 33 consecutive patients with a positive stress test result underwent 16-slice MDCT and selective coronary angiography for the detection of significant obstructive CAD. We assessed the diagnostic accuracy of MDCT in a segment-based and a patient-based model and determined the impact of stenosis location and the presence of calcification on diagnostic accuracy in both models. Analysis of all 530 coronary segments demonstrated moderate sensitivity (63%) and excellent specificity (96%) with a moderate positive predictive value of 64% and an excellent negative predictive value (NPV) of 96% for the detection of significant coronary stenoses. Assessment restricted to either proximal coronary segments or segments with excellent image quality (83% of all segments) led to an increase in sensitivity (70% and 82%, respectively), and high specificities were maintained (94% and 93%, respectively). In a patient-based model, the NPV of MDCT for significant CAD was limited to 75%. Coronary calcification was the major cause of false-positive findings (94%).
Conclusions— For all coronary segments included, 16-slice MDCT has moderate diagnostic value for the detection of significant obstructive coronary artery stenosis in a population with a high prevalence of CAD. The moderate NPV of patient-based detection of CAD suggests a limited impact on clinical decision-making in high-risk populations.
Key Words: tomography • atherosclerosis • coronary disease
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