Accuracy of dual-source CT coronary angiography: first experience in a high pre-test probability population without heart rate control

Abstract

The aim of this study was to assess the diagnostic accuracy of dualsource computed tomography (DSCT) for evaluation of coronary artery disease (CAD) in a population with extensive coronary calcifications without heart rate control. Thirty patients (24 male, 6 female, mean age 63.1±11.3 years) with a high pre-test probability of CAD underwent DSCT coronary angiography and invasive coronary angiography (ICA) within 14 ± 9 days. No beta-blockers were administered prior to the scan. Two readers independently assessed image quality of all coronary segments with a diameter ≥1.5 mm using a four-point score (1: excellent to 4: not assessable) and qualitatively assessed significant stenoses as narrowing of the luminal diameter >50%. Causes of false-positive (FP) and false-negative (FN) ratings were assigned to calcifications or motion artifacts. ICA was considered the standard of reference. Mean body mass index was 28.3 ± 3.9 kg/m 2 (range 22.4-36.3 kg/m 2 ), mean heart rate during CT was 70.3 ± 14.2 bpm (range 47-102 bpm), and mean Agatston score was 821 ± 904 (range 0-3,110). Image quality was diagnostic (scores 1-3) in 98.6% (414/420) of segments (mean image quality score 1.68 ± 0.75); six segments in three patients were considered not assessable (1.4%). DSCT correctly identified 54 of 56 significant coronary stenoses. Severe calcifications accounted for false ratings in nine segments (eight FP/one FN) and motion artifacts in two segments (one FP/one FN). Overall sensitivity, specificity, positive and negative predictive value for evaluating CAD were 96.4, 97.5, 85.7, and 99.4%, respectively. First experience indicates that DSCT coronary angiography provides high diagnostic accuracy for assessment of CAD in a high pre-test probability population with extensive coronary calcifications and without heart rate control.

Detection of Relevant Coronary Artery Disease Using Dual-Source Computed Tomography in a High Probability Patient Series Comparison With Invasive Angiography

“…8,10,11 Considering the study by Busch et al, DSCT presents itself superior to 64-slice MDCT for the detection of CAD: in a small cohort of 10 patients each, DSCT was superior to 64-slice MDCT for the detection of CAD; DSCT demonstrated a sensitivity and specificity of 100% for both, whereas thea 64-slice scanner achieved a sensitivity of 100%, but a reduced specificity of 90%; the mean heart rate of patients examined with the DSCT scanner was 80 bpm, but the mean heart rate of patients scanned by MDCT was not given. 8 Similar to the results of our study, Leber et al, Scheffel et al, and Ropers et al demonstrated, that an excellent overall diagnostic accuracy and an NPV of 99% in per segment analysis can be achieved using DSCT for the detection of CAD in their studies with 90, 30, and 100 enrolled patients, respectively.…”

“…8 Similar to the results of our study, Leber et al, Scheffel et al, and Ropers et al demonstrated, that an excellent overall diagnostic accuracy and an NPV of 99% in per segment analysis can be achieved using DSCT for the detection of CAD in their studies with 90, 30, and 100 enrolled patients, respectively. 10,11,41 The patients enrolled in the studies of Scheffel et al and Leber et al had mean heart rates of 73 and 70.3 bpm, respectively, and a pre-test likelihood of CAD ranging from "low" to "intermediate" in the study by Leber et al to "high" in the study by Scheffel et al In the study by Ropers et al, the mean heart rate was 64±13 bpm, which is in fact at the level of earlier studies with 64-slice MDCT. 41 In addition, the prevalence of CAD in the latter study is lower than in all studies of DSCT previously published (only 41%).…”

“…6 Recent studies using DSCT have shown encouraging results for visualization of the coronary arteries independent of heart rate; however, only small numbers of patients have been included and the correlation to quantitative coronary angiography (QCA) has so far barely been provided. [7][8][9][10] Thus, the purpose of the present study was to assess the feasibility of DSCT for detection of relevant coronary artery stenoses in a cohort of 76 patients with clinically suspected coronary artery disease (CAD) and compare the results with those from invasive angiography without preceding heart rate control.…”

Effect of Decrease in Heart Rate Variability on the Diagnostic Accuracy of 64-MDCT Coronary Angiography

“…Fourth, factors such as the influence of intracoronary attenuation of contrast agent on the diagnostic accuracy of CT coronary angiography [26] were not studied. Fifth, we did not use the most recent CT scanner technology to assess the effect of heart rate variables on diagnostic accuracy [27]. Sixth, because of the lack of a reference standard, we did not assess the effect of heart rate variability on identifying and characterizing coronary plaques.…”

Coronary angiography and dual-source computed tomography are complementary methods in diagnosis of significant stenosis of the right coronary artery originating from the left aortic sinus

“…Moreover, initial experience have already shown that DSCT permits imaging of the coronary arteries in a substantially increased number of patients compared to earlier scanner generations [12]. Thus, as suggested recently, it seems to be questionable whether coronary angiography is still a gold standard in the examination of patients with coronary anomalies [13][14][15]. On the other hand, the catheterization technique is still indispensable for endovascular treatment of these patients.…”