Multislice computed tomography coronary angiography at a local hospital: Pitfalls and potential.
OBJECTIVE
To evaluate whether the favorable results achieved with multislice computed tomography (MSCT) of coronary arteries at larger centers could be paralleled at a local hospital.


METHODS
Fifty consecutive patients with suspected coronary artery disease scheduled for invasive investigation with quantitative coronary angiography (QCA) at a university hospital underwent MSCT with a 16-slice scanner at a local hospital. Diagnostic accuracy of MSCT for coronary artery disease was assessed using a 16-segment coronary artery model with QCA as the gold standard.


RESULTS
Segments with diameter <2 mm, as defined by QCA, segments distal to occlusions, and stented segments were excluded. Of the remaining 489 segments, 73 (15%) were not assessable with MSCT. Sensitivity, specificity, and positive and negative predictive values for significant (>50%) stenosis for the 416 assessable segments were 92%, 82%, 53%, and 98%, respectively.


CONCLUSIONS
Our beginners' experience demonstrated favorable results regarding sensitivity and negative predictive value. The positive predictive value, however, was unsatisfactory. Calcifications were identified as the most important factor for false-positive results with MSCT. With widespread use of MSCT coronary angiography, there is a risk of recruiting patients without significant coronary artery disease to unnecessary and potentially harmful invasive procedures.
Kolnes
K
K
Department of Radiology, Volda Hospital, Volda, Norway. kristian.kolnes@tussa.com
Velle
Ose H
OH
Hareide
S
S
Hegbom
K
K
Wiseth
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014283:Triiodobenzoic Acids
D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol