The diagnostic performance of coronary artery angiography with 64-MSCT and post 64-MSCT: systematic review and meta-analysis.
OBJECTIVE
To comprehensively investigate the diagnostic performance of coronary artery angiography with 64-MDCT and post 64-MDCT.


METHODS
PubMed was searched for all published studies that evaluated coronary arteries with 64-MDCT and post 64-MDCT. The clinical diagnostic role was evaluated by applying the likelihood ratios (LRs) to calculate the post-test probability based on Bayes' theorem.


RESULTS
91 studies that met our inclusion criteria were ultimately included in the analysis. The pooled positive and negative LRs at patient level were 8.91 (95% CI, 7.53, 10.54) and 0.02 (CI, 0.01, 0.03), respectively. For studies that did not claim that non-evaluable segments were included, the pooled positive and negative LRs were 11.16 (CI, 8.90, 14.00) and 0.01 (CI, 0.01, 0.03), respectively. For studies including uninterruptable results, the diagnostic performance decreased, with the pooled positive LR 7.40 (CI, 6.00, 9.13) and negative LR 0.02 (CI, 0.01, 0.03). The areas under the summary ROC curve were 0.98 (CI, 0.97 to 0.99) for 64-MDCT and 0.96 (CI, 0.94 to 0.98) for post 64-MDCT, respectively. For references explicitly stating that the non-assessable segments were included during analysis, a post-test probability of negative results >95% and a positive post-test probability <95% could be obtained for patients with a pre-test probability of <73% for coronary artery disease (CAD). On the other hand, when the pre-test probability of CAD was >73%, the diagnostic role was reversed, with a positive post-test probability of CAD >95% and a negative post-test probability of CAD <95%.


CONCLUSIONS
The diagnostic performance of post 64-MDCT does not increase as compared with 64-MDCT. CTA, overall, is a test of exclusion for patients with a pre-test probability of CAD<73%, while for patients with a pre-test probability of CAD>73%, CTA is a test used to confirm the presence of CAD.
Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China.
Min
M
Li
Department of Medical Engineering, Jinan Military General Hospital, Jinan, Shandong Province, China.
Xiang-Min
XM
Du
Department of Cardiology, General Hospital of the Second Artillery, Beijing, China.
Zhi-Tao
ZT
Jin
Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China.
Zhao-Hui
ZH
Peng
Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China.
Juan
J
Ding
Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China.
Li
L
Li
D000368:Aged; D001499:Bayes Theorem; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D016206:Databases, Bibliographic; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000295:instrumentation / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity