Image quality and diagnostic accuracy of 16-slice multidetector spiral computed tomography for the detection of coronary artery disease in elderly patients.
OBJECTIVE
To determine the image quality and diagnostic accuracy of cardiac multislice spiral computed tomography (MSCT) in elderly patients (>65 years old) in comparison to younger patients, this retrospective analysis was performed.


METHODS
The catheter-controlled MSCT results from patients older than 65 years of age were compared with the results of younger patients in a cohort of 117 patients with regard to sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and image quality. Fifty-three patients were older than 65 years of age (group 1: 31 men, age range: 72.2 +/- 4.1 years, number of risk factors: 2.6 +/- 1.3, Agatston score: 866 +/- 1090) and 64 were younger (group 2: 45 men, age range: 57.4 +/- 6.1 years, number of risk factors: 2.6 +/- 1.0, Agatston score: 765 +/- 1013). All patients were examined by MSCT (Sensation 16 Speed 4 D; Siemens, Forchheim, Germany, with a gantry rotation time of 375 milliseconds) and invasive coronary angiography. The MSCT results were compared blinded with the results of the coronary angiography with regard to the presence or absence of significant stenosis (>50%) in a 13-segment model. Image quality was assessed on a qualitative scale between 1 (very good) and 5 (insufficient image quality) for each segment.


RESULTS
Sensitivity, specificity, PPV, and NPP were not different statistically in both groups (group 1: 0.80/0.96/0.89/0.93 and group 2: 0.89/0.98/0.93/0.97). Three patients (all <65 years old) had to be excluded from analysis because of technical problems. Image quality was significantly better in group 2. Gender, body mass index, number of risk factors, and mean heart rate were not significantly different in either group.


CONCLUSIONS
Age has an impact on MSCT image quality but did not hamper diagnostic accuracy. Thus, MSCT is a noninvasive method to detect or rule out coronary artery disease independently of age. These retrospective data have to be confirmed in larger prospective trials.
Burgstahler
Christof
C
Division of Cardiology, Department of Internal Medicine, Eberhard-Karls-University, Tuebingen, Germany.
Beck
Torsten
T
Kuettner
Axel
A
Reimann
Anja
A
Kopp
Andreas F
AF
Heuschmid
Martin
M
Claussen
Claus D
CD
Schroeder
Stephen
S
D000367:Age Factors; D000368:Aged; D000465:Algorithms; D016477:Artifacts; D015331:Cohort Studies; D003287:Contrast Media / Q000008:administration & dosage; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000379:methods* / Q000592:standards*
D003287:Contrast Media