title: Does clinical pretest probability influence image quality and diagnostic accuracy in dual-source coronary CT angiography?
abstract: OBJECTIVE
  To prospectively evaluate the influence of the clinical pretest probability assessed by the Morise score onto image quality and diagnostic accuracy in coronary dual-source computed tomography angiography (DSCTA).
  
  
  METHODS
  In 61 patients, DSCTA and invasive coronary angiography were performed. Subjective image quality and accuracy for stenosis detection (>50%) of DSCTA with invasive coronary angiography as gold standard were evaluated. The influence of pretest probability onto image quality and accuracy was assessed by logistic regression and chi-square testing. Correlations of image quality and accuracy with the Morise score were determined using linear regression.
  
  
  RESULTS
  Thirty-eight patients were categorized into the high, 21 into the intermediate, and 2 into the low probability group. Accuracies for the detection of significant stenoses were 0.94, 0.97, and 1.00, respectively. Logistic regressions and chi-square tests showed statistically significant correlations between Morise score and image quality (P < .0001 and P < .001) and accuracy (P = .0049 and P = .027). Linear regression revealed a cutoff Morise score for a good image quality of 16 and a cutoff for a barely diagnostic image quality beyond the upper Morise scale.
  
  
  CONCLUSIONS
  Pretest probability is a weak predictor of image quality and diagnostic accuracy in coronary DSCTA. A sufficient image quality for diagnostic images can be reached with all pretest probabilities. Therefore, coronary DSCTA might be suitable also for patients with a high pretest probability.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany. Christoph.thomas@med.uni-tuebingen.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Thomas
authors.forename: Harald
authors.initials: H
authors.lastname: Brodoefel
authors.forename: Ilias
authors.initials: I
authors.lastname: Tsiflikas
authors.forename: Friederike
authors.initials: F
authors.lastname: Bruckner
authors.forename: Anja
authors.initials: A
authors.lastname: Reimann
authors.forename: Dominik
authors.initials: D
authors.lastname: Ketelsen
authors.forename: Tanja
authors.initials: T
authors.lastname: Drosch
authors.forename: Claus D
authors.initials: CD
authors.lastname: Claussen
authors.forename: Andreas
authors.initials: A
authors.lastname: Kopp
authors.forename: Martin
authors.initials: M
authors.lastname: Heuschmid
authors.forename: Christof
authors.initials: C
authors.lastname: Burgstahler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods*