title: Uses and limitations of 40 slice multi-detector row spiral computed tomography for diagnosing coronary lesions in unselected patients referred for routine invasive coronary angiography.
abstract: OBJECTIVE
  The value of multi-detector row computed tomography (MDCT) in routine cardiology practice is uncertain. We examined the applicability of MDCT imaging for the diagnosis of obstructive coronary artery disease in a routine clinical setting.
  
  
  METHODS
  MDCT scanning (40 slice) was performed in 111 unselected patients referred for invasive coronary angiography (ICA) and findings were compared to an independent quantitative assessment of the ICA on a segmental, vessel and patient basis.
  
  
  RESULTS
  Sensitivity and positive predictive value for segmental disease (72.2 and 70.9% respectively, overall) were higher in patients aged > or = 60 years and history of disease > or = 1 year, whereas specificity and negative predictive value were high in all groups. In the patient-based analysis, sensitivity and positive predictive value (84.7 and 87.8%, respectively) were higher, the latter in keeping with the high-patient prevalence of disease, but specificity and negative predictive value (61.5 and 55.2%) were low.
  
  
  CONCLUSIONS
  Usefulness of MDCT was significantly influenced by age, duration of coronary artery disease and female gender, and on a patient-based analysis its diagnostic accuracy was not sufficient to replace ICA in a routine clinical setting.
authors.affiliation: Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. halon@clalit.org.il
authors.forename: David A
authors.initials: DA
authors.lastname: Halon
authors.forename: Tamar
authors.initials: T
authors.lastname: Gaspar
authors.forename: Salim
authors.initials: S
authors.lastname: Adawi
authors.forename: Ronen
authors.initials: R
authors.lastname: Rubinshtein
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Schliamser
authors.forename: Nathan
authors.initials: N
authors.lastname: Peled
authors.forename: Basil S
authors.initials: BS
authors.lastname: Lewis
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000379:methods*