Accuracy of 16-row multidetector computed tomography for the assessment of coronary artery stenosis

Mario J. Garcia, Jonathan Lessick, Martin H K Hoffmann

Research output: Contribution to journalArticle

252 Citations (Scopus)

Abstract

Context: Multidetector computed tomography (MDCT) has been proposed as a noninvasive method to evaluate coronary anatomy. Objective: To determine the diagnostic accuracy of 16-row MDCT for the detection of obstructive coronary disease based exclusively on quantitative analysis and performed in a multicenter study. Design, Setting, and Patients: Eleven participating sites prospectively enrolled 238 patients who were clinically referred for nonemergency coronary angiography from June 2004 through March 2005. Following a low-dose MDCT scan to evaluate coronary artery calcium, 187 patients with an Agatston score of less than 600 underwent contrast-enhanced MDCT. Conventional angiography was performed 1 to 14 days after MDCT. Conventional angiographic and MDCT studies were analyzed by independent core laboratories. Main Outcome Measures: Segment-based and patient-based sensitivities and specificities for the detection of luminal stenosis of more than 50% (of luminal diameter) and more than 70% (of luminal diameter) based on quantitative coronary angiography. Results: Of 1629 nonstented segments larger than 2 mm in diameter, there were 89 (5.5%) in 59 (32%) of 187 patients with stenosis of more than 50% by conventional angiography. Of the 1629 segments, 71% were evaluable on MDCT. After censoring all nonevaluable segments as positive, the sensitivity for detecting more than 50% luminal stenoses was 89%; specificity, 65%; positive predictive value, 13%; and negative predictive value, 99%. In a patient-based analysis, the sensitivity for detecting patients with at least 1 positive segment was 98%; specificity, 54%; positive predictive value, 50%; and negative predictive value, 99%. After censoring all nonevaluable segments as positive, the sensitivity for detecting more than 70% luminal stenoses was 94%; specificity, 67%; positive predictive value, 6%; and negative predictive value, 99%. In a patient-based analysis, the sensitivity for detecting patients with at least 1 positive segment was 94%; specificity, 51%; positive predictive value, 28%; and negative predictive value, 98%. Conclusions: The results of this study indicate that MDCT coronary angiography performed with 16-row scanners is limited by a high number of nonevaluable cases and a high false-positive rate. Thus, its routine implementation in clinical practice is not justified. Nevertheless, given its high sensitivity and negative predictive value, 16-row MDCT may be useful in excluding coronary disease in selected patients in whom a false-positive or inconclusive stress test result is suspected.

Original languageEnglish (US)
Pages (from-to)403-411
Number of pages9
JournalJournal of the American Medical Association
Volume296
Issue number4
DOIs
StatePublished - Jul 26 2006
Externally publishedYes

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Multidetector Computed Tomography
Coronary Stenosis
Pathologic Constriction
Coronary Angiography
Coronary Disease
Angiography
Exercise Test
Multicenter Studies
Anatomy
Coronary Vessels
Outcome Assessment (Health Care)
Calcium
Sensitivity and Specificity

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Accuracy of 16-row multidetector computed tomography for the assessment of coronary artery stenosis. / Garcia, Mario J.; Lessick, Jonathan; Hoffmann, Martin H K.

In: Journal of the American Medical Association, Vol. 296, No. 4, 26.07.2006, p. 403-411.

Research output: Contribution to journalArticle

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abstract = "Context: Multidetector computed tomography (MDCT) has been proposed as a noninvasive method to evaluate coronary anatomy. Objective: To determine the diagnostic accuracy of 16-row MDCT for the detection of obstructive coronary disease based exclusively on quantitative analysis and performed in a multicenter study. Design, Setting, and Patients: Eleven participating sites prospectively enrolled 238 patients who were clinically referred for nonemergency coronary angiography from June 2004 through March 2005. Following a low-dose MDCT scan to evaluate coronary artery calcium, 187 patients with an Agatston score of less than 600 underwent contrast-enhanced MDCT. Conventional angiography was performed 1 to 14 days after MDCT. Conventional angiographic and MDCT studies were analyzed by independent core laboratories. Main Outcome Measures: Segment-based and patient-based sensitivities and specificities for the detection of luminal stenosis of more than 50{\%} (of luminal diameter) and more than 70{\%} (of luminal diameter) based on quantitative coronary angiography. Results: Of 1629 nonstented segments larger than 2 mm in diameter, there were 89 (5.5{\%}) in 59 (32{\%}) of 187 patients with stenosis of more than 50{\%} by conventional angiography. Of the 1629 segments, 71{\%} were evaluable on MDCT. After censoring all nonevaluable segments as positive, the sensitivity for detecting more than 50{\%} luminal stenoses was 89{\%}; specificity, 65{\%}; positive predictive value, 13{\%}; and negative predictive value, 99{\%}. In a patient-based analysis, the sensitivity for detecting patients with at least 1 positive segment was 98{\%}; specificity, 54{\%}; positive predictive value, 50{\%}; and negative predictive value, 99{\%}. After censoring all nonevaluable segments as positive, the sensitivity for detecting more than 70{\%} luminal stenoses was 94{\%}; specificity, 67{\%}; positive predictive value, 6{\%}; and negative predictive value, 99{\%}. In a patient-based analysis, the sensitivity for detecting patients with at least 1 positive segment was 94{\%}; specificity, 51{\%}; positive predictive value, 28{\%}; and negative predictive value, 98{\%}. Conclusions: The results of this study indicate that MDCT coronary angiography performed with 16-row scanners is limited by a high number of nonevaluable cases and a high false-positive rate. Thus, its routine implementation in clinical practice is not justified. Nevertheless, given its high sensitivity and negative predictive value, 16-row MDCT may be useful in excluding coronary disease in selected patients in whom a false-positive or inconclusive stress test result is suspected.",
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N2 - Context: Multidetector computed tomography (MDCT) has been proposed as a noninvasive method to evaluate coronary anatomy. Objective: To determine the diagnostic accuracy of 16-row MDCT for the detection of obstructive coronary disease based exclusively on quantitative analysis and performed in a multicenter study. Design, Setting, and Patients: Eleven participating sites prospectively enrolled 238 patients who were clinically referred for nonemergency coronary angiography from June 2004 through March 2005. Following a low-dose MDCT scan to evaluate coronary artery calcium, 187 patients with an Agatston score of less than 600 underwent contrast-enhanced MDCT. Conventional angiography was performed 1 to 14 days after MDCT. Conventional angiographic and MDCT studies were analyzed by independent core laboratories. Main Outcome Measures: Segment-based and patient-based sensitivities and specificities for the detection of luminal stenosis of more than 50% (of luminal diameter) and more than 70% (of luminal diameter) based on quantitative coronary angiography. Results: Of 1629 nonstented segments larger than 2 mm in diameter, there were 89 (5.5%) in 59 (32%) of 187 patients with stenosis of more than 50% by conventional angiography. Of the 1629 segments, 71% were evaluable on MDCT. After censoring all nonevaluable segments as positive, the sensitivity for detecting more than 50% luminal stenoses was 89%; specificity, 65%; positive predictive value, 13%; and negative predictive value, 99%. In a patient-based analysis, the sensitivity for detecting patients with at least 1 positive segment was 98%; specificity, 54%; positive predictive value, 50%; and negative predictive value, 99%. After censoring all nonevaluable segments as positive, the sensitivity for detecting more than 70% luminal stenoses was 94%; specificity, 67%; positive predictive value, 6%; and negative predictive value, 99%. In a patient-based analysis, the sensitivity for detecting patients with at least 1 positive segment was 94%; specificity, 51%; positive predictive value, 28%; and negative predictive value, 98%. Conclusions: The results of this study indicate that MDCT coronary angiography performed with 16-row scanners is limited by a high number of nonevaluable cases and a high false-positive rate. Thus, its routine implementation in clinical practice is not justified. Nevertheless, given its high sensitivity and negative predictive value, 16-row MDCT may be useful in excluding coronary disease in selected patients in whom a false-positive or inconclusive stress test result is suspected.

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