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

Abstract

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±11.3 years) with a high pre-test probability of CAD underwent DSCT coronary angiography and invasive coronary angiography (ICA) within 14 ± 9 days. No beta-blockers were administered prior to the scan. Two readers independently assessed image quality of all coronary segments with a diameter ?1.5 mm 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 ± 3.9 kg/m2 (range 22.4–36.3 kg/m2), mean heart rate during CT was 70.3 ± 14.2 bpm (range 47–102 bpm), 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.

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

Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.

Eur Radiol. 2006 Dec;16(12):2739-47. Epub 2006 Sep 19.