title: Feasibility of gadolinium-diethylene triamine pentaacetic acid enhanced multidetector computed tomography for the evaluation of coronary artery disease.
abstract: BACKGROUND
  Multidetector computed tomography (MDCT) has been proposed as a noninvasive method for the diagnosis of obstructive coronary artery disease (CAD). In patients with high risk of iodinated contrast adverse effects such as acute allergic-type reactions, the use of gadolinium could be an alternative.
  
  
  OBJECTIVE
  We sought to evaluate the feasibility of gadolinium-enhanced MDCT for the diagnosis of obstructive CAD.
  
  
  METHODS
  Twenty patients (mean age, 61 years; range, 50-73 years) referred for X-ray coronary angiography were studied by both gadolinium and iodine-enhanced 16-row MDCT coronary angiography. The degree of enhancement and the accuracy for detection of obstructive CAD (>50% diameter reduction) were evaluated with X-ray coronary angiography as the standard. Renal nephrotoxicity was strictly monitored.
  
  
  RESULTS
  Gadolinium- and iodine-enhanced MDCT showed adequate visualization of the coronary arteries in 310 of the 312 coronary artery segments that were available by X-ray angiography, respectively. The average density of the coronary arteries in both iodine and gadolinium CT scans was 253.65 Hounsfield unit (HU) and 135.20 HU, respectively. In a per-coronary segment analysis, gadolinium- and iodine-enhanced MDCT showed sensitivities of 89% vs 84%, specificities of 96% vs 95%, and negative predictive values of 97% vs 96%, respectively. In a per-patient analysis, both gadolinium- and iodine-enhanced MDCT showed sensitivities of 92.85% vs specificities of 83.33%. Intermethod agreement between gadolinium- and iodine-enhanced MDCT (kappa) was 0.95 (P < 0.0001).
  
  
  CONCLUSIONS
  Our preliminary results indicate lower attenuation with gadolinium but similar diagnostic accuracy for the detection of obstructive CAD when compared with iodine-enhanced MDCT. Therefore, gadolinium is a feasible alternative contrast agent for patients with iodine contrast allergy referred for MDCT coronary angiography.
authors.affiliation: Department of Radiology, Diagnóstico Maipú, Buenos Aires, Argentina. investigacion@diagnosticomaipu.com.ar
authors.forename: Patricia
authors.initials: P
authors.lastname: Carrascosa
authors.forename: Carlos
authors.initials: C
authors.lastname: Capuñay
authors.forename: Marcelo
authors.initials: M
authors.lastname: Bettinotti
authors.forename: Alejandro
authors.initials: A
authors.lastname: Goldsmit
authors.forename: Alejandro
authors.initials: A
authors.lastname: Deviggiano
authors.forename: Jorge
authors.initials: J
authors.lastname: Carrascosa
authors.forename: Mario J
authors.initials: MJ
authors.lastname: García
mesh_terms: D000368:Aged; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007455:Iodine; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007455:Iodine; D019786:Gadolinium DTPA