title: Patient characteristics as predictors of image quality and diagnostic accuracy of MDCT compared with conventional coronary angiography for detecting coronary artery stenoses: CORE-64 Multicenter International Trial.
abstract: OBJECTIVE
  The purpose of the study was to investigate patient characteristics associated with image quality and their impact on the diagnostic accuracy of MDCT for the detection of coronary artery stenosis.
  
  
  METHODS
  Two hundred ninety-one patients with a coronary artery calcification (CAC) score of <or=600 Agatston units (214 men and 77 women; mean age, 59.3+/-10.0 years [SD]) were analyzed. An overall image quality score was derived using an ordinal scale. The accuracy of quantitative MDCT to detect significant (>or=50%) stenoses was assessed using quantitative coronary angiography (QCA) per patient and per vessel using a modified 19-segment model. The effect of CAC, obesity, heart rate, and heart rate variability on image quality and accuracy were evaluated by multiple logistic regression. Image quality and accuracy were further analyzed in subgroups of significant predictor variables. Diagnostic analysis was determined for image quality strata using receiver operating characteristic (ROC) curves.
  
  
  RESULTS
  Increasing body mass index (BMI) (odds ratio [OR]=0.89, p<0.001), increasing heart rate (OR=0.90, p<0.001), and the presence of breathing artifact (OR=4.97, p<or=0.001) were associated with poorer image quality whereas sex, CAC score, and heart rate variability were not. Compared with examinations of white patients, studies of black patients had significantly poorer image quality (OR=0.58, p=0.04). At a vessel level, CAC score (10 Agatston units) (OR=1.03, p=0.012) and patient age (OR=1.02, p=0.04) were significantly associated with the diagnostic accuracy of quantitative MDCT compared with QCA. A trend was observed in differences in the areas under the ROC curves across image quality strata at the vessel level (p=0.08).
  
  
  CONCLUSIONS
  Image quality is significantly associated with patient ethnicity, BMI, mean scan heart rate, and the presence of breathing artifact but not with CAC score at a patient level. At a vessel level, CAC score and age were associated with reduced diagnostic accuracy.
authors.affiliation: Department of Radiology, Charité, Universitätsmedizin Berlin Medical School, Humboldt-Universität und Freie Univartment ersität zu Berlin, Berlin, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Dewey
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Vavere
authors.forename: Armin
authors.initials: A
authors.lastname: Arbab-Zadeh
authors.forename: Julie M
authors.initials: JM
authors.lastname: Miller
authors.forename: Leonardo
authors.initials: L
authors.lastname: Sara
authors.forename: Christopher
authors.initials: C
authors.lastname: Cox
authors.forename: Ilan
authors.initials: I
authors.lastname: Gottlieb
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Yoshioka
authors.forename: Narinder
authors.initials: N
authors.lastname: Paul
authors.forename: John
authors.initials: J
authors.lastname: Hoe
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
authors.forename: Albert C
authors.initials: AC
authors.lastname: Lardo
authors.forename: Joao A
authors.initials: JA
authors.lastname: Lima
authors.forename: Melvin E
authors.initials: ME
authors.lastname: Clouse
mesh_terms: D016477:Artifacts; D015992:Body Mass Index; D002114:Calcinosis / Q000000981:diagnostic imaging*; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D011857:Radiographic Image Interpretation, Computer-Assisted; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*