title: Role of 16-multidetector computed tomography in the assessment of coronary artery stenoses: A prospective study of consecutive patients.
abstract: BACKGROUND
  Recent studies have demonstrated a high sensitivity (S) of 16-multidetector computed tomography (16-MDCT) for the detection of significant coronary artery stenoses. Whether these results are applicable to clinical practice is unclear. Therefore, the aim of the present study was to compare 16-MDCT angiography with conventional coronary angiography (CCA) for the detection of significant coronary artery stenoses in a consecutive series of patients.
  
  
  METHODS
  A total of 93 consecutive patients (mean [+/- SD] age 59+/-9 years), in whom CCA was performed for stable angina pectoris, underwent 16-MDCT angiography (16x0.75 mm, table feed 6.5 mm/s, rotation time 0.42 s; Sensation 16, Siemens Medical Solutions, Germany) the day before performing CCA. Patients with diabetes mellitus, serum creatinine level higher than 132.6 mumol/L and/or acute coronary syndromes were excluded. Two observers blinded to CCA results evaluated MDCT angiograms according to standard criteria. Segment-based (13 segments per patient) and patient-based (at least one stenosis greater than 50% lumen diameter reduction) analyses were performed.
  
  
  RESULTS
  A total of 1209 segments were analyzed. Of these segments, 173 (14%) were excluded due to poor image quality or massive calcification. In 86 segments, CCA revealed significant coronary artery stenosis (greater than 50% diameter reduction). However, 16-MDCT detected only 47 of these, resulting in a S of 55% and a specificity (SP) of 97% (positive predictive value 64%; negative predictive value 96%). On a patient-based analysis, the S increased to 89%, whereas the SP still remained high (87%).
  
  
  CONCLUSIONS
  In this relatively large consecutive cohort, S for the detection of significant coronary artery stenoses was moderate on a segment-based analysis but increased on a patient-based analysis using 16-MDCT. In contrast, SP was high in both analyses, supporting the use of 16-MDCT for the exclusion of significant coronary artery stenoses. Further improvement of spatial and temporal resolution in MDCT technology may lead to a lower exclusion rate and higher S.
authors.affiliation: Division of Cardiology;
authors.forename: Thomas
authors.initials: T
authors.lastname: Postel
authors.forename: Matthias
authors.initials: M
authors.lastname: Frick
authors.forename: Gudrun
authors.initials: G
authors.lastname: Feuchtner
authors.forename: Hannes
authors.initials: H
authors.lastname: Alber
authors.forename: Ralf
authors.initials: R
authors.lastname: Zwick
authors.forename: Alois
authors.initials: A
authors.lastname: Suessenbacher
authors.forename: Ammar
authors.initials: A
authors.lastname: Mallouhi
authors.forename: Guy
authors.initials: G
authors.lastname: Friedrich
authors.forename: Otmar
authors.initials: O
authors.lastname: Pachinger
authors.forename: Dieter Zur
authors.initials: DZ
authors.lastname: Nedden
authors.forename: Franz
authors.initials: F
authors.lastname: Weidinger