title: Forty-slice spiral computed tomography of the coronary arteries: assessment of image quality and diagnostic accuracy in a non-selected patient population.
abstract: OBJECTIVE
  To investigate prospectively the image quality and diagnostic accuracy of 40-slice computed tomography (CT) for the detection of hemodynamically significant coronary artery disease (CAD) in a non-selected, consecutive patient cohort.
  
  
  METHODS
  Forty consecutive patients (28 men, 12 women) underwent both 40-slice CT and conventional invasive coronary angiography (ICA) within 10+/-7 days. The results of both methods were compared on a per-segment and per-patient basis, using ICA as the standard of reference.
  
  
  RESULTS
  According to ICA, significant CAD was present in 30/40 patients (75%). Of a total of 545 segments, 43 segments (7.9%) could not be sufficiently evaluated by CT due to motion artifacts in 15 segments (34.9%), small vessel size and suboptimal contrast enhancement in 14 segments (32.6%), severe calcification in 10 segments (23.3%), and opacified adjacent structures such as cardiac veins in four segments (9.3%). Segment-based analysis for detection of significant stenosis >50% yielded an overall sensitivity, specificity, positive predictive value, and negative predictive value of 87%, 99%, 98%, and 95%, respectively. Restricting the assessment to clinically relevant proximal coronary segments led to an increase in sensitivity to 96%, specificity to 99%, and negative predictive value to 99%. Patient-based analysis demonstrated a high negative predictive value (91%) of CT for excluding significant CAD, even when all segments were included in the analysis.
  
  
  CONCLUSIONS
  In a non-selected patient population with a high prevalence of CAD, 40-slice CT demonstrates high diagnostic accuracy in the assessment of significant CAD per patient and per segment.
authors.affiliation: Institut Frühwald/Steiner/Obermayer, Kremsergasse 16A, 3100 St. Pölten, Austria. claudiagrosse@gmx.at
authors.forename: C
authors.initials: C
authors.lastname: Grosse
authors.forename: S
authors.initials: S
authors.lastname: Globits
authors.forename: K
authors.initials: K
authors.lastname: Hergan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D003287:Contrast Media / Q000008:administration & dosage; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods; D015641:Radiography, Interventional / Q000379:methods*; D012015:Reference Standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000379:methods*
chemical_list: D003287:Contrast Media