Accuracy of 64-MDCT in the diagnosis of ischemic heart disease.
OBJECTIVE
The aim of this study was to evaluate the potential clinical value of a new generation of 64-MDCT systems with that of invasive coronary angiography in the diagnosis of coronary artery disease (CAD).


METHODS
Seventy-two consecutive patients with known or suspected CAD underwent both 64-MDCT and quantitative coronary angiography (QCA). A CT system with acquisition of 64 slices per gantry rotation was used with a spatial resolution of 0.4 x 0.4 x 0.4 mm and a gantry rotation time of 330 milliseconds. Sensitivity, specificity, and diagnostic accuracy of 64-MDCT in the detection or exclusion of CAD were evaluated on both a per patient and a per segment basis.


RESULTS
Sixty-eight of 72 coronary CT angiograms (CTAs) (94%) were of diagnostic image quality. QCA showed significant CAD (i.e., one or more stenoses in > 50%) in 57% (39/68) and nonsignificant disease or healthy CTAs in 43% (29/68) of the patients. Sensitivity, specificity, and the negative predictive value (NPV) of 64-MDCT per patient were 97%, 79%, and 96%, respectively. Per segment, 923 of 1,020 coronary artery segments were assessable (90%). For the detection of stenoses of more than 50% and more than 75% per segment, 64-MDCT showed a sensitivity of 82% and 86%, respectively. Per segment, specificity and NPV were as high as 95% and 97%, respectively.


CONCLUSIONS
In clinical routine, coronary CTA will primarily be used for risk stratification on a per patient basis. In the present study, coronary 64-MDCT showed a high diagnostic accuracy on both per patient and per segment analyses.
Nikolaou
Konstantin
K
Department of Clinical Radiology, University Hospitals, Ludwig-Maximilians University, Klinikum Grosshadern, Marchioninistr. 15, 81377 Munich, Germany. Konstantin.Nikolaou@med.uni-muenchen.de
Knez
Andreas
A
Rist
Carsten
C
Wintersperger
Bernd J
BJ
Leber
Alexander
A
Johnson
Thorsten
T
Reiser
Maximilian F
MF
Becker
Christoph R
CR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed