title: [Diagnostic accuracy of contrast-enhanced 64-row MSCT coronary angiography in patients with severe coronary calcification in the clinical routine].
abstract: OBJECTIVE
  Our aim was to evaluate the diagnostic accuracy of contrast-enhanced 64-MSCT coronary angiography (MSCT-CA) in patients with severe coronary calcification.
  
  
  METHODS
  110 patients with an Agatston score > 400 were included in this retrospective analysis. Each patient underwent both conventional coronary angiography and MSCT-CA. No patient was excluded from the study because of coronary artery bypass grafting or coronary stenting. The results of MSCT-CA were compared with those of conventional coronary angiography and the diagnostic accuracy for detecting a hemodynamically significant stenosis was determined for coronary segments, vessels and patients.
  
  
  RESULTS
  The average Agatston score for the study population was 1368 ± 1105. At least one significant stenosis was detected in 97 patients (88%) during conventional coronary angiography defining the gold standard. The sensitivity, specificity, positive and negative predictive values of MSCT-CA for detecting a significant stenosis were 54%, 83%, 52% and 85% for coronary segments (n = 1384), 80%, 70%, 74% and 77% for coronary vessels (n = 440), and 100%, 31%, 92% and 100% for patients (n = 110), respectively. No significant correlation could be observed between the degree of coronary calcification and the number of misclassified coronary segments.
  
  
  CONCLUSIONS
  Artifacts caused by severe coronary calcification decrease the diagnostic accuracy of MSCT-CA. Performing MSCT-CA in patients with an Agatston score > 400 with the drawbacks of contrast media application and radiation exposure should be critically questioned and this decision should be made on an individual basis.
authors.affiliation: Klinische Abteilung für Kardiologie, Universitätsklinik für Innere Medizin, Medizinische Universtität Graz, Österreich.
authors.forename: G
authors.initials: G
authors.lastname: Steinwender
authors.forename: D
authors.initials: D
authors.lastname: Szolar
authors.forename: K
authors.initials: K
authors.lastname: Preidler
authors.forename: M
authors.initials: M
authors.lastname: Tillich
authors.forename: R
authors.initials: R
authors.lastname: Zweiker
authors.forename: N
authors.initials: N
authors.lastname: Watzinger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D002114:Calcinosis / Q000000981:diagnostic imaging*; D055424:Cardiac-Gated Imaging Techniques; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014283:Triiodobenzoic Acids
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; D007472:Iohexol; C044834:iodixanol