Concerning a recent publication on accuracy of the MDCT 64

Sofiane Hadjadj, MD, Montreal, has sent the following question:

concerning a recent publication on accuracy of the MDCT 64:
according to the study published in the  NEJM Volume 359:2324-2336   \”The patient-based diagnostic accuracy of quantitative CT angiography for detecting or ruling out stenoses of 50% or more according to conventional angiography revealed an AUC of 0.93 (95% confidence interval [CI], 0.90 to 0.96), with a sensitivity of 85% (95% CI, 79 to 90), a specificity of 90% (95% CI, 83 to 94), a positive predictive value of 91% (95% CI, 86 to 95), and a negative predictive value of 83% (95% CI, 75 to 89\”, what have the opinion of the DSCT expert.

thank you

Stephan Achenbach, MD, University Hospital Erlangen:

In that study, the authors emphasized avoiding false-positive results (A. Zadeh, personal communication) and therefore head a high threshold for stenosis detection, which avoided false positive findings at the cost of  a higher rate of false negative findings. The ROC curve contained in the paper nicely shows that a lower threshold for stenosis detection would have led to the exact same results as the ACCURACY trial, with a higher sensitivity and lower specificity.

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