Italian multicenter, prospective study to evaluate the negative predictive value of 16- and 64-slice MDCT imaging in patients scheduled for coronary angiography (NIMISCAD-Non Invasive Multicenter Italian Study for Coronary Artery Disease)

Abstract

This was a prospective, multicenter study designed to evaluate the utility of MDCT in the diagnosis of coronary artery disease (CAD) in patients scheduled for elective coronary angiography (CA) using different MDCT systems from different manufacturers. Twenty national sites prospectively enrolled 367 patients between July 2004 and June 2006. Computed tomography (CT) was performed using a standardized/optimized scan protocol for each type of MDCT system (> or =16 slices) and compared with quantitative CA performed within 2 weeks of MDCT. A total of 284 patients (81%) were studied by 16-slice MDCT systems, while 66 patients (19%) by 64-slice MDCT scanners. The primary analysis was on-site/off-site evaluation of the negative predictive value (NPV) on a per-patient basis. Secondary analyses included on-site evaluation on a per-artery and per-segment basis. On-site evaluation included 327 patients (CAD prevalence 58%). NPV, positive predictive value (PPV), sensitivity, specificity, and diagnostic accuracy (DA) were 0.91 (95% CI 0.85-0.95), 0.91 (95% CI 0.86-0.95), 0.94 (95% CI 0.89-0.97), 0.88 (95% CI 0.81-0.93), and 0.91 (95% CI 0.88-0.94), respectively. Off-site analysis included 295 patients (CAD prevalence 56%). NPV, PPV, sensitivity, specificity, and DA were 0.73 (95% CI 0.65-0.79), 0.93 (95% CI 0.87-0.97), 0.73 (95% CI 0.65-0.79), 0.93 (95% CI 0.87-0.97), and 0.82 (95% CI 0.77-0.86), respectively. The results of this study demonstrate the utility of MDCT in excluding significant CAD even when conducted by centers with varying degrees of expertise and using different MDCT machines.

Low dose CT of the heart: a quantum leap into a new era of cardiovascular imaging

“…Numerous meta-analyses and several multicentre trials have bolstered this evidence in recent years [9][10][11][12][13][14][15]. CTCA can therefore be seen as the modality of choice for ruling out coronary artery disease (CAD).…”

Accuracy of coronary artery stenosis detection with CT versus conventional coronary angiography compared with composite findings from both tests as an enhanced reference standard

“…Recent studies agree that the diagnostic accuracy of 64-slice CCTA is constantly high [6,7,[16][17][18] and rather independent of the pre-test likelihood of CAD [19]. Conversely, the specificity and positive predictive value remain comparatively low [1,6].…”

MDCT assessment of CAD in type-2 diabetic subjects with diabetic neuropathy: the role of Charcot neuro-arthropathy

“…The MDCT-CA is the exclusive non-invasive diagnostic test able to directly detect the coronary ATS, and differentiate between normal, non-obstructive atherosclerotic, and obstructive atherosclerotic or occluded coronary arteries. The MDCT is a well-established non-invasive diagnostic tool for the exclusion of significant CAD in patients with intermediate-to-low pre-test probability [30][31][32], mostly because of its high NPV. On the contrary, the major limitation of MDCT is its low specificity and PPV, as well as the lower DA in patients with a high amount of coronary calcium [33], as typically may be for those patients with higher pre-test probability for CAD.…”