Assessment of coronary stenosis by a 16-slice MDCT scanner in asymptomatic diabetic patients starting dialysis therapy.
BACKGROUND
The accuracy for the detection of coronary stenosis by multidetector row computed tomography (MDCT) has been getting more recognition. However, the usefulness of MDCT in patients with chronic kidney disease (CKD) has not been confirmed.


METHODS
Weanalyzed 19 consecutive patients with asymptomatic diabetic CKD who underwent both MDCT and coronary angiography (CAG) at the initiation of dialysis. The definition of stenosis in this study was lesions with > or =50% stenosis by CAG.


RESULTS
CAG revealed stenosis in 35 of 76 branches in 19 patients. Vessel diameter could not be evaluated by MDCT in 11 (14%) major vessels because of motion artifacts, pericardial effusion, pleural effusion, and severe calcification. Almost all of such lesions were located in the right coronary (4/11; 36%) or left circumflex (5/11; 45%) artery. The sensitivity, specificity, positive and negative predictive values of MDCT for a diagnosis of stenosis in the 65 evaluable major vessels were 86, 81, 78, and 88%, respectively. The severity of vessel calcification was increased in a stepwise manner with increments in the proportion of major vessels with > or =50% stenosis (p = 0.004 for trend).


CONCLUSIONS
MDCT seemed to be an effective non-invasive method of screening patients with diabetic CKD for CAD.
Department of Nephrology, Izumisano Municipal Hospital, Rinku General Medical Center, Izumisano, Japan.
Kenichiro
K
Iio
Yasuyuki
Y
Nagasawa
Tomonori
T
Kimura
Keita
K
Yamasaki
Yoshihiro
Y
Takeda
Takayuki
T
Hamano
Hirotsugu
H
Iwatani
Satoru
S
Sumitsuji
Yoshiyuki
Y
Nagai
Takahito
T
Ito
Enyu
E
Imai
Terumasa
T
Hayashi
D000368:Aged; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D048909:Diabetes Complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000000981:diagnostic imaging* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*