title: Clinical value of MDCT in the diagnosis of coronary artery disease in patients with a low pretest likelihood of significant disease.
abstract: OBJECTIVE
  The aim of this study was to evaluate the clinical value of MDCT in the diagnosis of coronary artery disease in a population having a low pretest likelihood of significant disease.
  
  
  METHODS
  Sixty-four patients with suspected coronary artery disease and a low pretest likelihood of significant disease according to the criteria of the American Heart Association underwent both MDCT of the heart and quantitative conventional coronary angiography (QCA). MDCT examinations were performed on a 16-MDCT scanner. CT data sets were evaluated on a per-patient basis and a per-segment basis and were classified as indicating no disease, nonsignificant disease (stenoses </= 50%), or significant disease (stenoses > 50%). Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 16-MDCT in the detection or exclusion of significant and nonsignificant coronary artery disease were evaluated on both per-patient and per-segment bases.
  
  
  RESULTS
  Regarding the success rate of 16-MDCT, 94% (60/64) of patients and 92% (388/420) of vessel segments were of sufficient quality for diagnosis. In the remaining 60 patients evaluated, QCA revealed significant coronary artery disease, nonsignificant disease, and no disease in 8.3% (5/60), 75.0% (45/60), and 16.7% (10/60) of cases, respectively, on a per-patient basis, and in 1.3% (5/388), 23.2% (90/388), and 75.5% (293/388) of cases, respectively, on a per-segment basis. The sensitivity, specificity, NPV, and PPV of 16-MDCT for the detection of significant coronary artery disease were 80.0%, 94.5%, 98.1%, and 57.1%, respectively, on a per-patient basis, and 80.0%, 99.2%, 99.7%, and 57.1% on a per-segment basis.
  
  
  CONCLUSIONS
  In a population having a low pretest likelihood of significant coronary artery disease, 16-MDCT shows a moderate to high sensitivity and high NPV for the detection or exclusion of significant disease, but has a somewhat reduced PPV compared with QCA.
authors.affiliation: Department of Clinical Radiology, University Hospitals-Grosshadern, Ludwig-Maximilians University of Munich, Grosshadern Campus, Marchioninistr. 15, Munich 81377, Germany. Konstantin.Nikolaou@med.uni-muenchen.de
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
authors.forename: Carsten
authors.initials: C
authors.lastname: Rist
authors.forename: Bernd J
authors.initials: BJ
authors.lastname: Wintersperger
authors.forename: Tobias F
authors.initials: TF
authors.lastname: Jakobs
authors.forename: Roland
authors.initials: R
authors.lastname: van Gessel
authors.forename: Miles A
authors.initials: MA
authors.lastname: Kirchin
authors.forename: Andreas
authors.initials: A
authors.lastname: Knez
authors.forename: Franz
authors.initials: F
authors.lastname: von Ziegler
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.forename: Christoph R
authors.initials: CR
authors.lastname: Becker
mesh_terms: D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods