Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction.
BACKGROUND
We analyzed the accuracy of multi-detector row spiral computed tomography (MDCT) using a 16-slice CT scanner with improved spatial and temporal resolution, as well as routine premedication with beta-blockers for detection of coronary stenoses.


RESULTS
Seventy-seven patients with suspected coronary disease were studied by MDCT (12x0.75-mm cross-sections, 420 ms rotation, 100 mL contrast agent IV at 5 mL/s). Patients with a heart rate above 60/min received 50 mg atenolol before the scan. In axial MDCT images and multiplanar reconstructions, all coronary arteries and side branches with a diameter of 1.5 mm or more were assessed for the presence of stenoses exceeding 50% diameter reduction. In comparison to invasive coronary angiography, MDCT correctly classified 35 of 41 patients (85%) as having at least 1 coronary stenosis and correctly detected 57 of 78 coronary lesions (73%). After excluding 38 of 308 coronary arteries (left main, left anterior descending, left circumflex, and right coronary artery in 77 patients) classified as unevaluable by MDCT (12%), 57 of 62 lesions were detected, and absence of stenosis was correctly identified in 194 of 208 arteries (sensitivity: 92%; specificity: 93%; accuracy: 93%; positive and negative predictive values: 79% and 97%).


CONCLUSIONS
MDCT coronary angiography with improved spatial resolution and premedication with oral beta-blockade permits detection of coronary artery stenoses with high accuracy and a low rate of unevaluable arteries.
Ropers
Dieter
D
Department of Cardiology, University of Erlangen-Nürnberg, Germany.
Baum
Ulrich
U
Pohle
Karsten
K
Anders
Katharina
K
Ulzheimer
Stefan
S
Ohnesorge
Bernd
B
Schlundt
Christian
C
Bautz
Werner
W
Daniel
Werner G
WG
Achenbach
Stephan
S
D000319:Adrenergic beta-Antagonists; D001262:Atenolol; D003287:Contrast Media / Q000008:administration & dosage; D017023:Coronary Angiography / Q000295:instrumentation / Q000379:methods; D023921:Coronary Stenosis / Q000145:classification / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003331:Coronary Vessels; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000295:instrumentation* / Q000379:methods*; D014654:Vascular Patency
D000319:Adrenergic beta-Antagonists; D003287:Contrast Media; D001262:Atenolol