[Noninvasive detection of coronary stenosis using 16-slice detector computed tomography in carefully selected patients].
OBJECTIVE
Due to technical improvements, multislice spiral computed tomography (MSCT) has become available for the noninvasive visualization of human coronary arteries. The current scanner generation provides 16 detector slices. The aim of the present study was to evaluate the influence of a careful patient selection on the diagnostic accuracy of noninvasive angiography.


METHODS
Out of a study population of 60 patients, 36 with mild coronary calcifications (Agatston score < 500) were selected for the present retrospective analysis. In addition to conventional coronary angiography (CCA), all patients underwent a noninvasive MSCT examination of the coronary arteries. All coronary segments were assessed with respect to image quality and presence of severe lesions with a diameter stenosis >or = 50%. The MSCT examinations were performed using a Sensation 16 scanner (Siemens Medical Systems, Forchheim, Germany).


RESULTS
The Agatston score of the study population was 83.3 +/- 125.4 (0-491.3), calcium mass 14.7 +/- 21.4 (0-83) mg CaHA (calcium hydroxyapatite). Diagnostic image quality could be obtained in 391/455 coronary segments (86%). 26 lesions > or = 50% could be detected by MSCT, CCA confirmed the presence of 21 lesions. No false-negative results were obtained (sensitivity: 100%, specificity: 99%, positive predictive value: 0.81, negative predictive value: 1.0).


CONCLUSIONS
The new MSCT generation with 16 detector slices permits a noninvasive visualization of the coronary arteries with good image quality. It could be shown that a careful patient selection is of major importance for the diagnostic accuracy of MSCT imaging. It appears to be useful to perform a stepwise imaging, starting with a native scan to rule out severe calcifications. Prospective multicenter trials with larger patient numbers are required to confirm these initial results.
Beck
Torsten
T
Abteilung für Kardiologie, Medizinische Klinik, Eberhard-Karls-Universität Tübingen, Tübingen.
Kuettner
Axel
A
Burgstahler
Christof
C
Brückner
Ariane
A
Heuschmid
Martin
M
Herdeg
Christian
C
Kopp
Andreas F
AF
Claussen
Claus D
CD
Schroeder
Stephen
S
D002114:Calcinosis / Q000000981:diagnostic imaging*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D006801:Humans; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed