title: Accuracy of dual-source CT coronary angiography: First experience in a high pre-test probability population without heart rate control.
abstract: The aim of this study was to assess the diagnostic accuracy of dual-source computed tomography (DSCT) for evaluation of coronary artery disease (CAD) in a population with extensive coronary calcifications without heart rate control. Thirty patients (24 male, 6 female, mean age 63.1+/-11.3 years) with a high pre-test probability of CAD underwent DSCT coronary angiography and invasive coronary angiography (ICA) within 14+/-9 days. No beta-blockers were administered prior to the scan. Two readers independently assessed image quality of all coronary segments with a diameter > or =1.5 mm using a four-point score (1: excellent to 4: not assessable) and qualitatively assessed significant stenoses as narrowing of the luminal diameter >50%. Causes of false-positive (FP) and false-negative (FN) ratings were assigned to calcifications or motion artifacts. ICA was considered the standard of reference. Mean body mass index was 28.3+/-3.9 kg/m2 (range 22.4-36.3 kg/m2), mean heart rate during CT was 70.3+/-14.2 bpm (range 47-102 bpm), and mean Agatston score was 821+/-904 (range 0-3,110). Image quality was diagnostic (scores 1-3) in 98.6% (414/420) of segments (mean image quality score 1.68+/-0.75); six segments in three patients were considered not assessable (1.4%). DSCT correctly identified 54 of 56 significant coronary stenoses. Severe calcifications accounted for false ratings in nine segments (eight FP/one FN) and motion artifacts in two segments (one FP/one FN). Overall sensitivity, specificity, positive and negative predictive value for evaluating CAD were 96.4, 97.5, 85.7, and 99.4%, respectively. First experience indicates that DSCT coronary angiography provides high diagnostic accuracy for assessment of CAD in a high pre-test probability population with extensive coronary calcifications and without heart rate control.
authors.affiliation: Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
authors.forename: Hans
authors.initials: H
authors.lastname: Scheffel
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
authors.forename: André
authors.initials: A
authors.lastname: Plass
authors.forename: Robert
authors.initials: R
authors.lastname: Vachenauer
authors.forename: Lotus
authors.initials: L
authors.lastname: Desbiolles
authors.forename: Oliver
authors.initials: O
authors.lastname: Gaemperli
authors.forename: Tiziano
authors.initials: T
authors.lastname: Schepis
authors.forename: Thomas
authors.initials: T
authors.lastname: Frauenfelder
authors.forename: Thomas
authors.initials: T
authors.lastname: Schertler
authors.forename: Lars
authors.initials: L
authors.lastname: Husmann
authors.forename: Jürg
authors.initials: J
authors.lastname: Grunenfelder
authors.forename: Michele
authors.initials: M
authors.lastname: Genoni
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Kaufmann
authors.forename: Borut
authors.initials: B
authors.lastname: Marincek
authors.forename: Sebastian
authors.initials: S
authors.lastname: Leschka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D002114:Calcinosis / Q000000981:diagnostic imaging; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed