Image quality and diagnostic accuracy of 16-slice multidetector computed tomography for the detection of coronary artery disease in obese patients

Abstract

Background: Cardiac multislice spiral computed tomography (MSCT) scanners permit visualization of the coronary arteries with an overall good sensitivity (sens) and specificity (spec). However, in obese patients (pts), who are at higher risk to develop coronary artery disease (CAD), image quality of MSCT is supposed to be limited. At present, there are no data whether the accuracy of MSCT depends on the body mass index (BMI). Thus, we compared the catheter-controlled MSCT results from normal weight and obese pts in a cohort of 117 pts with regard to sens, spec, positive predictive value (PPV), negative predictive value (NPV) and image quality. 3 pts (group I 1, group II 2) had to be excluded from analysis due to technical problems. Group I had significantly less risk factors (Po0.001) and image quality was significantly better than in group II and III (Po0.05). Group II and III did not differ with regard to risk factors or image quality. Conclusions: Overweight and obesity have an impact on MSCT image quality but did not hamper the diagnostic accuracy. Thus, MSCT is a noninvasive method to detect or rule out CAD also in pts with higher BMI. These retrospective data have to be confirmed in larger prospective trials.

Development and Validation of a Predictive Screening Tool for Uninterpretable Coronary CT Angiography Results

“…11,[15][16][17] One small retrospective study using older CCTA technology in 53 individuals aged Ͼ65 found that advancing age adversely affected image quality but did not hamper diagnostic accuracy. 16 Similarly, we identified 2 age groups (65 to Ͻ75 and Ն75 years) to carry escalating risk for obtaining Ն1 uninterpretable coronary segment by CCTA. Uninterpretable coronary segments are not universal in elderly persons, and even at the most advanced ages (Ͼ75 years), we found that Ͼ70% of individuals have all coronary segments interpretable.…”

“…15,16 Control of heart rate and use of adequate rate-lowering techniques are important technical considerations to improve quality and results in CCTA. Similarly, future studies and predictive models that account for antecedent CACSs are needed and may provide tiered selection approach resource utilization in CCTA.…”

Challenges in Cardiac Risk Assessment in Bariatric Surgery Patients

“…One retrospective analysis of 117 patients in obese subjects found no statistical difference in CAD detection in normal weight, overweight, and obese patients when compared with conventional coronary angiography [29]. Despite this single trial, most radiologists believe that depth-dependent spatial resolution is worse with increasing torso size and weight restrictions on CT scanner tables (approximately 300-350 lbs in most cases) may limit the use of this imaging technique in some patients.…”

Sixty-four–slice multidetector computed tomography: the future of ED cardiac care

“…Initial studies reported sensitivity and specificity rates of 59% to 95% and 79% to 98%, respectively, primarily in patients with stable angina pectoris referred for cardiac catheterization ( Table 1). The rate of adequate visualization of coronary vessels in these studies ranged from 68% to 96% [18][19][20][21][22][23][24][25][26][27][28]. These results have compared favorably with other modalities such as intravascular ultrasound and cardiac magnetic resonance imaging [29,30] but are still inadequate.…”

“…One study found that although patients in the lowest body mass index (BMI) category had significantly higher-quality images, there were no differences in sensitivity and specificity among groups [20].Fifty percent of patients in the study of Raff et al had a BMI 30 kg/m 2 . For these patients, sensitivity and specificity dropped to 90% and 86%, respectively.…”