Diagnostic accuracy of second-generation dual-source computed tomography coronary angiography with iterative reconstructions: a real-world experience

Abstract

CTCA with second-generation DSCT in the real clinical world shows a diagnostic performance comparable with previously reported validation studies. The excellent negative predictive value and likelihood ratio make CTCA a first-line noninvasive method for diagnosing obstructive CAD.

SIRM–SIC appropriateness criteria for the use of Cardiac Computed Tomography. Part 1: Congenital heart diseases, primary prevention, risk assessment before surgery, suspected CAD in symptomatic patients, plaque and epicardial adipose tissue characterization, and functional assessment of stenosis

“…In past studies adopting old technology, it was found that the accuracy of CCTA was influenced by the pre-test probability (PTP) of CAD [62], being particularly high for patients with low-to-intermediate PTP of CAD [63,64] driven by the very high NPV of CCTA [65][66][67][68]. Recent technological advancement, with improvement of spatial and temporal resolution, has led to a significant improvement also of the PPV and of the specificity [69][70][71][72]. These findings, associated with the tendency of clinical risk scores to overestimate the pre-test probability of obstructive CAD [1,73,74], led to consider CCTA irrespective of PTP, with the exception of patients with very high PTP (> 90%) in whom ICA is indicated, and for patients with very low clinical likelihood (≤ 5%), in whom no further test is indicated (ESC 2019).…”

The Role of Iterative Reconstruction Techniques in Cardiovascular CT

“…Several real-world observational studies have recorded cardiovascular CT dosimetry data after implementation of IR methods and likewise shown significant dose reductions without unacceptable sacrifices in SIQ [18, 31, 34 • ]. The few studies that have assessed the diagnostic accuracy of IR using intravascular ultrasound (for coronary artery plaque characterization) or invasive coronary angiography (for coronary artery stenosis detection and quantification) have reported equivalent or improved accuracy compared with FBP [12,25,26,35,36].…”

Cardiac CT perfusion and FFRCTA: pathophysiological features in ischemic heart disease

“…In the last decade, rapid technological improvements of CCT technology resulting in reduction of the scan time, motion artefacts and radiation dose exposure, while yielding higher spatial and temporal resolution (25)(26)(27), have widened CCT field of application, from anatomical detection of CAD to physiological assessment of myocardial ischemia. The first human report of stress myocardial CCT perfusion (CCTP) by Kurata et al was published in 2005 with a 16-slice CT scanner and using adenosine triphosphate stress (28).…”

“…the rest phase was acquired in the single-energy mode; *, global radiation dose of the stress-rest protocol; § , accuracy of CT perfusion integrated with the coronary anatomic data; a , data regarding coronary stenosis >70% by QCA performed in25 out of 30 patients; b , data regarding FFR-hemodynamically significant stenosis; c , data regarding coronary stenosis ≥50% by CTCA; d , data regarding coronary stenosis ≥50% by QCA; e , data regarding coronary stenosis >50% by CTCA. CCTP, cardiac computed tomography perfusion; 1st and 2nd, first and second generation; CAD, coronary artery disease; CTCA, computed tomography coronary angiography acquired in the single-energy mode; DS, Dual-Source scanner; FFR, fractional flow reserve; LE, late-enhancement; MRI, magnetic resonance imaging; NA, non-assessable; No, patients' number; NPV, negative predictive value; PPV, positive predictive value; QCA, quantitative coronary angiography; SE, sensitivity; SP, specificity; Semiq, semiquantitative analysis using a stress score; SPECT, myocardial perfusion scan; TPR, Transmural perfusion ratio; TAG, transluminal attenuation gradient.…”