The effect of calcium score on the diagnostic accuracy of coronary computed tomography angiography

Abstract

The influence of coronary calcification on the diagnostic performance of coronary computed tomography angiography (CTA) remains controversial. This study attempts to assess the effect of coronary calcium score (CS) on the diagnostic accuracy of detecting coronary artery disease (CAD) using 64-row multidetector computed tomography (MDCT). Over a period of 2 years and 9 months, 113 symptomatic patients (37-87 year-old, mean 62.3, 92 males) underwent 64-row MDCT for coronary CS and CTA. All had conventional coronary angiography (CCA) within 90 (mean 9.6) days. Coronary CTA was evaluated with CCA as the gold standard. Of 113 patients, 18 patients had a CS of 0, 18 had scores between 1 and 100, 27 between 101 and 400, and 50 had scores >400. With respect to patient-based analysis, the accuracy of CTA was 90.3%, the sensitivity was 95%, and the specificity was 78.8%. Regarding patients with CS > 400, the accuracy, sensitivity, and specificity were 92, 95.6, and 60%, respectively. On vessel-based analysis, the specificity of CTA in different vessels with CS < [double bond] 400 and CS > 400 was as follows: right coronary artery 87.1% versus 87.5% (P = 0.924); left main artery 94.8% versus 66.7% (P = 0.173); left anterior descending artery 77.1% versus 27.3% (P = 0.001); and left circumflex artery 83.3% versus 42.8% (P = 0.011). A high CS does not significantly affect the diagnostic accuracy and sensitivity of CTA; however, it significantly decreases the specificity, particularly the left anterior descending and left circumflex arteries.

Diagnostic Value of Coronary CT Angiography With Use of Left Coronary Bifurcation Angle in Coronary Artery Disease

“…Low diagnostic specificity and PPV of CCTA in calcified plaques is mainly due to high false positive rates caused by blooming artifacts which result from heavy calcification in the coronary arteries. [11][12][13][14][15] This is a widely known limitation of CCTA. Some recent studies have addressed this issue by showing the improved diagnostic performance of CCTA with use of bifurcation angle measurement when compared to the conventional approach based on coronary lumen stenosis.…”

“…[6][7][8][9][10] It is well known that high calcification or high calcium score in the coronary arteries results in false positive results, thus leading to low specificity and positive predictive value (PPV). [11][12][13][14][15] This limitation has been addressed to some extent with use of image processing methods as reported in some studies. [16][17][18] Another approach to improve diagnostic value of CCTA in the diagnosis of calcified plaques is to use left coronary bifurcation angle as opposed to the conventional method of measuring coronary lumen stenosis.…”

Comparison of the Left Main Coronary Bifurcating Angle among Patients with Normal, Non-significantly and Significantly Stenosed Left Coronary Arteries

“…The 64-detector CT angiography was also performed in accordance with the prior suggested criteria 20 . Retrospective ECG gating was employed with the timing bolus method.…”

2013 Esc Guidelines on the Management of Stable Coronary Artery Disease

“…Учитывая, что специфичность КТА коронарных артерий уменьшается при увеличении количества коронарного кальция [103,155,156], и было обнару-жено, что у симптоматических пациентов с индексом Агатстона >400 широко встречаются стенозы коро-нарных артерий [157], целесообразно не переходить к КТА коронарных артерий, если индекс коронар-ного кальция >400 [158]. Тем не менее, на уровне КТА коронарных артерий следует рассматривать как альтернативу стресс-методам визуализации в плане исключения СИБС у пациентов с низкой или промежуточной ПТВ выявления СИБС, у которых можно ожидать хорошего качества изображения.…”