Accuracy of dual-source CT coronary angiography: first experience in a high pre-test probability population without heart rate control

Scheffel, Hans ; Alkadhi, Hatem ; Plass, André ; Vachenauer, Robert ; Desbiolles, Lotus ; Gaemperli, Oliver ; Schepis, Tiziano ; Frauenfelder, Thomas ; Schertler, Thomas ; Husmann, Lars ; Grunenfelder, Jürg ; Genoni, Michele ; Kaufmann, Philipp ; Marincek, Borut ; Leschka, Sebastian

In: European Radiology, 2006, vol. 16, no. 12, p. 2739-2747

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    Summary
    The aim of this study was to assess the diagnostic accuracy of dual-source computed tomography (DSCT) for evaluation of coronary artery disease (CAD) in a population with extensive coronary calcifications without heart rate control. Thirty patients (24 male, 6 female, mean age 63.1±11.3years) with a high pre-test probability of CAD underwent DSCT coronary angiography and invasive coronary angiography (ICA) within 14±9days. No beta-blockers were administered prior to the scan. Two readers independently assessed image quality of all coronary segments with a diameter ≥1.5mm using a four-point score (1: excellent to 4: not assessable) and qualitatively assessed significant stenoses as narrowing of the luminal diameter >50%. Causes of false-positive (FP) and false-negative (FN) ratings were assigned to calcifications or motion artifacts. ICA was considered the standard of reference. Mean body mass index was 28.3±3.9kg/m2 (range 22.4-36.3kg/m2), mean heart rate during CT was 70.3±14.2bpm (range 47-102bpm), and mean Agatston score was 821±904 (range 0-3,110). Image quality was diagnostic (scores 1-3) in 98.6% (414/420) of segments (mean image quality score 1.68±0.75); six segments in three patients were considered not assessable (1.4%). DSCT correctly identified 54 of 56 significant coronary stenoses. Severe calcifications accounted for false ratings in nine segments (eight FP/one FN) and motion artifacts in two segments (one FP/one FN). Overall sensitivity, specificity, positive and negative predictive value for evaluating CAD were 96.4, 97.5, 85.7, and 99.4%, respectively. First experience indicates that DSCT coronary angiography provides high diagnostic accuracy for assessment of CAD in a high pre-test probability population with extensive coronary calcifications and without heart rate control