title: Diagnostic accuracy of dual-source CT coronary angiography in a population unselected for degree of coronary artery calcification and without heart rate modification.
abstract: OBJECTIVE
  To assess the ability of coronary angiography performed using dual-source computed tomography (DSCT) to evaluate coronary artery disease (CAD) in a population with unselected heart rates and extensive coronary calcification.
  
  
  METHODS
  Forty-four patients at intermediate to high risk for CAD underwent both DSCT coronary angiography and invasive coronary angiography (ICA) within 30 days. No beta blockers were administered prior to imaging. Image quality and quantitatively stenosis of all coronary segments with a diameter > or = 1.5mm were accessed. Patients were stratified according to mean heart rate (< 70 versus > or = 70 bpm) and heart rate variability (< 10 versus > or = 10 bpm). DSCT detection of coronary stenosis by segment, vessel, and patient characteristics were compared to the reference standard of ICA.
  
  
  RESULTS
  Diagnostic accuracy for all patients was high regarding sensitivity (97%), positive predictive value (PPV, 84.2%), and negative predictive value (NPV, 83.3%) but low regarding specificity (45.5%) with a moderate interobserver agreement (Kappa = 0.50). The accuracy for vessel-based diagnosis was high regarding sensitivity (96.6%), specificity (80.8%), PPV (80.3%), and NPV (96.7%). The segment-based diagnostic results revealed a moderate interobserver agreement for image quality and sensitivity, specificity, PPV and NPV for all segments of 66.9, 97.8, 90.8, and 89.9%, respectively.
  
  
  CONCLUSIONS
  DSCT coronary angiography has high diagnostic accuracy in assessing CAD among patients at intermediate to high risk without using heart rate-modulating premedication. DSCT is not superior to ICA for diagnosis of calcified segments.
authors.affiliation: Department of Medical Imaging, Far Eastern Memorial Hospital, Pan-Chiao, Taiwan. bcjlin@gmail.com
authors.forename: C-J
authors.initials: CJ
authors.lastname: Lin
authors.forename: J-C
authors.initials: JC
authors.lastname: Hsu
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Lai
authors.forename: K-L
authors.initials: KL
authors.lastname: Wang
authors.forename: J-Y
authors.initials: JY
authors.lastname: Lee
authors.forename: A-H
authors.initials: AH
authors.lastname: Li
authors.forename: S-H
authors.initials: SH
authors.lastname: Chu
mesh_terms: D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging*; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D004812:Epidemiologic Methods; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*