Diagnostic accuracy of dual-source CT coronary angiography in a population unselected for degree of coronary artery calcification and without heart rate modification

Lin, C.-J.; Hsu, J.-C.; Lai, Y.-J.; Wang, K.-L.; Lee, J.-Y.; Li, A.-H.; Chu, S.-H.

doi:10.1016/j.crad.2009.09.012

« Previous Next »Clinical Radiology
Volume 65, Issue 2 , Pages 109-117, February 2010

Diagnostic accuracy of dual-source CT coronary angiography in a population unselected for degree of coronary artery calcification and without heart rate modification

C.-J. Lin
- Department of Medical Imaging, Far Eastern Memorial Hospital, Pan-Chiao, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan
- Guarantor and correspondent: C.-J. Lin, Department of Medical Imaging, Far Eastern Memorial Hospital, No 21, Nan-Ya South Road, Section 2, Pan-Chiao 220, Taiwan. Tel.: +886 2 89514571; fax: +886 2 89676701.
J.-C. Hsu
- National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Cardiovascular Medicine, Far Eastern Memorial Hospital, Pan-Chiao City, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan
Y.-J. Lai
- Department of Medical Imaging, Far Eastern Memorial Hospital, Pan-Chiao, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan
K.-L. Wang
- Department of Medical Imaging, Far Eastern Memorial Hospital, Pan-Chiao, Taiwan
- Department of Radiological Technology, Yuanpei University, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan
J.-Y. Lee
- Department of Medical Imaging, Far Eastern Memorial Hospital, Pan-Chiao, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan
A.-H. Li
- Division of Cardiovascular Medicine, Far Eastern Memorial Hospital, Pan-Chiao City, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan
S.-H. Chu
- Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, Pan-Chiao City, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan

Received 2 April 2009; received in revised form 22 September 2009; accepted 30 September 2009.

Aim

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.

Materials and 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 ≥1.5mm were accessed. Patients were stratified according to mean heart rate (<70 versus ≥70bpm) and heart rate variability (<10 versus ≥10bpm). 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.

Conclusion

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.