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Circulation, Vol 89, 285-290, Copyright © 1994 by American Heart Association
JA Fallavollita, AS Brody, IL Bunnell, K Kumar and JM Canty Jr
BACKGROUND: The predominant cause of coronary artery calcification is
atherosclerosis. Although fast x-ray computed tomography (CT) has been
demonstrated to be a sensitive technique to detect coronary calcification,
the increasing prevalence of calcification with age has been associated
with a low specificity for identifying obstructive atherosclerosis. We
hypothesized that the specificity of this test would be improved in a
younger patient population, making it more useful in the diagnosis of
coronary artery disease. METHODS AND RESULTS: We compared fast CT-detected
calcification with coronary angiography in 106 patients under the age of 50
years. Nonenhanced fast CT scans consisting of 20 contiguous 3-mm tomograms
of the proximal coronary arteries were obtained during a single breath
hold. A positive scan was defined as 4 contiguous voxels (> or = 1 mm2)
of density > 130 Hounsfield units in the region of the epicardial
coronary arteries. Calcification detected by fast CT had an 85% sensitivity
to predict patients with significant coronary artery disease (> or = 50%
diameter stenosis), with a specificity of 45%. Although the sensitivity to
detect multivessel disease was 94%, the sensitivity to detect single-
vessel disease was 75%. Changing the threshold for defining a positive fast
CT scan from 4 to 2 contiguous voxels produced a small improvement in
sensitivity, to 88%, but reduced specificity to 36%. CONCLUSIONS: Although
the specificity to detect angiographically significant coronary disease
with fast CT improves in a younger patient population, it continues to be
relatively low. In contrast to older patient populations, a small but
significant number of patients < 50 years old with angiographically
significant coronary artery disease do not have coronary calcification
demonstrated by fast CT. Thus, caution should be used in excluding
significant coronary artery disease on the basis of a negative fast CT
study.
ARTICLES
Fast computed tomography detection of coronary calcification in the diagnosis of coronary artery disease. Comparison with angiography in patients < 50 years old
Department of Medicine, State University of New York, Buffalo School of Biomedical Sciences.
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