title: Diagnostic performance evaluation of a computer-aided simple triage system for coronary CT angiography in patients with intermediate risk for acute coronary syndrome.
abstract: OBJECTIVE
  Given the significance of coronary artery disease as the most important socioeconomic health care problem in the Western World, the application of computer-aided simple triage (CAST) systems to this disease would be desirable.
  
  
  METHODS
  In total, 93 patients with acute chest pain and an intermediate risk score for acute coronary syndrome underwent coronary computed tomography angiography (cCTA). Among those, 74 were of adequate image quality for automated analysis by a commercially available CAST system (COR Analyzer, RCADIA, Haifa, Israel). CAST findings were compared to human expert interpretation for the detection of significant stenosis (≥50%) in the left main, left anterior descending, circumflex, right coronary artery, or arterial branches. Further, one inexperienced observer evaluated all studies for significant stenoses alone and after 1 month guided by a CAST system as an initial read.
  
  
  RESULTS
  Human expert interpretation identified 37/74 patients with stenosis ≥50%, whereas the CAST detected 45 patients. The CAST system demonstrated a sensitivity of 100%/79% and a specificity of 78%/89% on a per-patient/per-vessel level, respectively. With CAST, the inexperienced readers' per-vessel sensitivity and positive predictive values significantly improved (P = .011, P = .009) from 69% and 41% to 91% and 74%, respectively.
  
  
  CONCLUSIONS
  The investigated CAST system for automatic stenosis detection can accurately identify patients with coronary artery stenosis ≥50% and may be of use as initial interpretation and triage of cCTA studies as well as a second reader for inexperienced readers, in absence of expert readers.
authors.affiliation: Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany. mr.meyer.mathias@gmail.com
authors.forename: Mathias
authors.initials: M
authors.lastname: Meyer
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
authors.forename: Christian
authors.initials: C
authors.lastname: Fink
authors.forename: Roman
authors.initials: R
authors.lastname: Goldenberg
authors.forename: Paul
authors.initials: P
authors.lastname: Apfaltrer
authors.forename: Joachim
authors.initials: J
authors.lastname: Gruettner
authors.forename: Diana
authors.initials: D
authors.lastname: Vajcs
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schoenberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Henzler
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D017023:Coronary Angiography / Q000379:methods / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000706:statistics & numerical data*; D014218:Triage / Q000379:methods / Q000706:statistics & numerical data*
keywords: Coronary CT angiography; chest pain patient triage; computed-aided detection; computer-aided simple triage; coronary artery stenosis