Circulation. 2004;110:2638-2643
Published online before print October 18, 2004, doi: 10.1161/01.CIR.0000145614.07427.9F
Published online before print October 18, 2004, doi: 10.1161/01.CIR.0000145614.07427.9F
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2004;110:2638-2643.)
© 2004 American Heart Association, Inc.
Imaging |
Predictive Value of 16-Slice Multidetector Spiral Computed Tomography to Detect Significant Obstructive Coronary Artery Disease in Patients at High Risk for Coronary Artery Disease
Patient- Versus Segment-Based Analysis
From the Department of Radiology (U.H., F.M., R.C.C., M.F., S. Abbara, T.J.B., S. Achenbach) and the Division of Cardiology (F.M., I.-k.J., L.J.D., S. Achenbach), Massachusetts General Hospital, Boston, Mass, and the Department of Internal Medicine II (S. Achenbach), University of Erlangen, Erlangen, Germany.
Correspondence to Udo Hoffmann, MD, Department of Radiology, Massachusetts General Hospital, 100 Charles River Plaza, Ste 400, Boston, MA 02114. E-mail uhoffman{at}partners.org
Received February 23, 2004; de novo received April 16, 2004; revision received June 21, 2004; accepted June 22, 2004.
Background— In this study, we investigated the diagnostic value and limitations of multidetector computed tomography (MDCT)–based noninvasive detection of significant obstructive coronary artery disease (CAD) in a consecutive high-risk patient population with inclusion of all coronary segments.
Methods and Results— In a prospective, blinded, standard cross-sectional technology assessment, a cohort of 33 consecutive patients with a positive stress test result underwent 16-slice MDCT and selective coronary angiography for the detection of significant obstructive CAD. We assessed the diagnostic accuracy of MDCT in a segment-based and a patient-based model and determined the impact of stenosis location and the presence of calcification on diagnostic accuracy in both models. Analysis of all 530 coronary segments demonstrated moderate sensitivity (63%) and excellent specificity (96%) with a moderate positive predictive value of 64% and an excellent negative predictive value (NPV) of 96% for the detection of significant coronary stenoses. Assessment restricted to either proximal coronary segments or segments with excellent image quality (83% of all segments) led to an increase in sensitivity (70% and 82%, respectively), and high specificities were maintained (94% and 93%, respectively). In a patient-based model, the NPV of MDCT for significant CAD was limited to 75%. Coronary calcification was the major cause of false-positive findings (94%).
Conclusions— For all coronary segments included, 16-slice MDCT has moderate diagnostic value for the detection of significant obstructive coronary artery stenosis in a population with a high prevalence of CAD. The moderate NPV of patient-based detection of CAD suggests a limited impact on clinical decision-making in high-risk populations.
Key Words: tomography • atherosclerosis • coronary disease
Related Article:
Circulation 2004 110: 2551.
This article has been cited by other articles:
 |
|
 |
|
  J. D. Dodd, J. Rieber, E. Pomerantsev, V. Chaithiraphan, S. Achenbach, J. M. Moreiras, S. Abbara, U. Hoffmann, T. J. Brady, and R. C. Cury Quantification of Nonculprit Coronary Lesions: Comparison of Cardiac 64-MDCT and Invasive Coronary Angiography Am. J. Roentgenol., August 1, 2008; 191(2): 432 - 438. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Bluemke, S. Achenbach, M. Budoff, T. C. Gerber, B. Gersh, L. D. Hillis, W. G. Hundley, W. J. Manning, B. F. Printz, M. Stuber, et al. Noninvasive Coronary Artery Imaging: Magnetic Resonance Angiography and Multidetector Computed Tomography Angiography: A Scientific Statement From the American Heart Association Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention, and the Councils on Clinical Cardiology and Cardiovascular Disease in the Young Circulation, July 29, 2008; 118(5): 586 - 606. [Full Text] [PDF]
|
|
|
|
|
|
J. L. Kelly, D. Thickman, S. D. Abramson, P. R. Chen, S. F. Smazal, M. J. Fleishman, and S. C. Lingam Coronary CT Angiography Findings in Patients Without Coronary Calcification Am. J. Roentgenol., July 1, 2008; 191(1): 50 - 55. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Aziz, K. Berger, K. Claycombe, R. Huang, R. Patel, and G. S. Abela Noninvasive Detection and Localization of Vulnerable Plaque and Arterial Thrombosis With Computed Tomography Angiography/Positron Emission Tomography Circulation, April 22, 2008; 117(16): 2061 - 2070. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Gottlieb and J. A.C. Lima Screening High-Risk Patients With Computed Tomography Angiography Circulation, March 11, 2008; 117(10): 1318 - 1332. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Schroeder, S. Achenbach, F. Bengel, C. Burgstahler, F. Cademartiri, P. de Feyter, R. George, P. Kaufmann, A. F. Kopp, J. Knuuti, et al. Cardiac computed tomography: indications, applications, limitations, and training requirements: Report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology Eur. Heart J., February 2, 2008; 29(4): 531 - 556. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Horiguchi, M. Kiguchi, C. Fujioka, Y. Shen, R. Arie, K. Sunasaka, and K. Ito Radiation Dose, Image Quality, Stenosis Measurement, and CT Densitometry Using ECG-Triggered Coronary 64-MDCT Angiography: A Phantom Study Am. J. Roentgenol., February 1, 2008; 190(2): 315 - 320. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Hausleiter, T. Meyer, M. Hadamitzky, M. Zankl, P. Gerein, K. Dorrler, A. Kastrati, S. Martinoff, and A. Schomig Non-invasive coronary computed tomographic angiography for patients with suspected coronary artery disease: the Coronary Angiography by Computed Tomography with the Use of a Submillimeter resolution (CACTUS) trial Eur. Heart J., December 2, 2007; 28(24): 3034 - 3041. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
X. Liu, X. Zhao, J. Huang, C. J. Francois, D. Tuite, X. Bi, D. Li, and J. C. Carr Comparison of 3D Free-Breathing Coronary MR Angiography and 64-MDCT Angiography for Detection of Coronary Stenosis in Patients with High Calcium Scores Am. J. Roentgenol., December 1, 2007; 189(6): 1326 - 1332. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V Russo, V Gostoli, L Lovato, M Montalti, A Marzocchi, G Gavelli, A Branzi, R Di Bartolomeo, and R Fattori Clinical value of multidetector CT coronary angiography as a preoperative screening test before non-coronary cardiac surgery Heart, December 1, 2007; 93(12): 1591 - 1598. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Gilard, G. Le Gal, J.-C. Cornily, U. Vinsonneau, C. Joret, P.-Y. Pennec, J. Mansourati, and J. Boschat Midterm Prognosis of Patients With Suspected Coronary Artery Disease and Normal Multislice Computed Tomographic Findings: A Prospective Management Outcome Study Arch Intern Med, August 13, 2007; 167(15): 1686 - 1689. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. R. Mollet, F. Cademartiri, C. Van Mieghem, B. Meijboom, F. Pugliese, G. Runza, T. Baks, J. Dikkeboer, E. P. McFadden, M. P. Freericks, et al. Adjunctive value of CT coronary angiography in the diagnostic work-up of patients with typical angina pectoris Eur. Heart J., August 1, 2007; 28(15): 1872 - 1878. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. K. Vanhoenacker, M. H. Heijenbrok-Kal, R. Van Heste, I. Decramer, L. R. Van Hoe, W. Wijns, and M. G. M. Hunink Diagnostic Performance of Multidetector CT Angiography for Assessment of Coronary Artery Disease: Meta-analysis Radiology, August 1, 2007; 244(2): 419 - 428. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. J. Schoepf, P. L. Zwerner, G. Savino, C. Herzog, J. M. Kerl, and P. Costello Coronary CT Angiography Radiology, July 1, 2007; 244(1): 48 - 63. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Ferencik, D. Ropers, S. Abbara, R. C. Cury, U. Hoffmann, K. Nieman, T. J. Brady, F. Moselewski, W. G. Daniel, and S. Achenbach Diagnostic Accuracy of Image Postprocessing Methods for the Detection of Coronary Artery Stenoses by Using Multidetector CT Radiology, June 1, 2007; 243(3): 696 - 702. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Andreini, G. Pontone, M. Pepi, G. Ballerini, A. L. Bartorelli, A. Magini, C. Quaglia, E. Nobili, and P. Agostoni Diagnostic Accuracy of Multidetector Computed Tomography Coronary Angiography in Patients With Dilated Cardiomyopathy J. Am. Coll. Cardiol., May 22, 2007; 49(20): 2044 - 2050. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. L. Raff and J. A. Goldstein Coronary Angiography by Computed Tomography: Coronary Imaging Evolves J. Am. Coll. Cardiol., May 8, 2007; 49(18): 1830 - 1833. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. F. Di Carli and R. Hachamovitch New Technology for Noninvasive Evaluation of Coronary Artery Disease Circulation, March 20, 2007; 115(11): 1464 - 1480. [Full Text] [PDF]
|
|
|
|
|
|
S. Rispler, Z. Keidar, E. Ghersin, A. Roguin, A. Soil, R. Dragu, D. Litmanovich, A. Frenkel, D. Aronson, A. Engel, et al. Integrated Single-Photon Emission Computed Tomography and Computed Tomography Coronary Angiography for the Assessment of Hemodynamically Significant Coronary Artery Lesions J. Am. Coll. Cardiol., March 13, 2007; 49(10): 1059 - 1067. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Abbara, A. J. Pena, P. Maurovich-Horvat, J. Butler, D. E. Sosnovik, A. Lembcke, R. C. Cury, U. Hoffmann, M. Ferencik, and T. J. Brady Feasibility and Optimization of Aortic Valve Planimetry with MDCT Am. J. Roentgenol., February 1, 2007; 188(2): 356 - 360. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Ropers, F.-K. Pohle, A. Kuettner, T. Pflederer, K. Anders, W. G. Daniel, W. Bautz, U. Baum, and S. Achenbach Diagnostic Accuracy of Noninvasive Coronary Angiography in Patients After Bypass Surgery Using 64-Slice Spiral Computed Tomography With 330-ms Gantry Rotation Circulation, November 28, 2006; 114(22): 2334 - 2341. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Achenbach Computed Tomography Coronary Angiography J. Am. Coll. Cardiol., November 21, 2006; 48(10): 1919 - 1928. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. Hoffmann, J. T. Nagurney, F. Moselewski, A. Pena, M. Ferencik, C. U. Chae, R. C. Cury, J. Butler, S. Abbara, D. F. Brown, et al. Coronary Multidetector Computed Tomography in the Assessment of Patients With Acute Chest Pain Circulation, November 21, 2006; 114(21): 2251 - 2260. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Hamon, G. G.L. Biondi-Zoccai, P. Malagutti, P. Agostoni, R. Morello, M. Valgimigli, and M. Hamon Diagnostic Performance of Multislice Spiral Computed Tomography of Coronary Arteries as Compared With Conventional Invasive Coronary Angiography: A Meta-Analysis J. Am. Coll. Cardiol., November 7, 2006; 48(9): 1896 - 1910. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Schuijf, W. Wijns, J. W. Jukema, I. DeCramer, D. E. Atsma, A. de Roos, M. P.M. Stokkel, P. Dibbets-Schneider, E. E. van der Wall, and J. J. Bax A Comparative Regional Analysis of Coronary Atherosclerosis and Calcium Score on Multislice CT Versus Myocardial Perfusion on SPECT J. Nucl. Med., November 1, 2006; 47(11): 1749 - 1755. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. Hoffmann, A. J. Pena, F. Moselewski, M. Ferencik, S. Abbara, R. C. Cury, C. U. Chae, and J. T. Nagurney MDCT in early triage of patients with acute chest pain. Am. J. Roentgenol., November 1, 2006; 187(5): 1240 - 1247. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Budoff, S. Achenbach, R. S. Blumenthal, J. J. Carr, J. G. Goldin, P. Greenland, A. D. Guerci, J. A.C. Lima, D. J. Rader, G. D. Rubin, et al. Assessment of Coronary Artery Disease by Cardiac Computed Tomography: A Scientific Statement From the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology Circulation, October 17, 2006; 114(16): 1761 - 1791. [Full Text] [PDF]
|
|
|
|
 |
|
 C. M. Jones, T. Athanasiou, N. Dunne, J. Kirby, S. Attaran, A. Chow, S. Purkayastha, and A. Darzi Multi-slice computed tomography in coronary artery disease. Eur. J. Cardiothorac. Surg., September 1, 2006; 30(3): 443 - 450. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Ferencik, R. C. Chan, S. Achenbach, J. B. Lisauskas, S. L. Houser, U. Hoffmann, S. Abbara, R. C. Cury, B. E. Bouma, G. J. Tearney, et al. Arterial Wall Imaging: Evaluation with 16-Section Multidetector CT in Blood Vessel Phantoms and ex Vivo Coronary Arteries Radiology, September 1, 2006; 240(3): 708 - 716. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Onuma, K. Tanabe, G. Nakazawa, J. Aoki, H. Nakajima, K. Ibukuro, and K. Hara Noncardiac Findings in Cardiac Imaging With Multidetector Computed Tomography J. Am. Coll. Cardiol., July 18, 2006; 48(2): 402 - 406. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Yamanaka, M. Fujita, K. Doi, H. Tsuneyoshi, A. Yamazato, K. Ueno, E. Zen, and M. Komeda Multislice Computed Tomography Accurately Quantifies Left Atrial Size and Function After the MAZE Procedure Circulation, July 4, 2006; 114(1_suppl): I-5 - I-9. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Nikolaou, A. Knez, C. Rist, B. J. Wintersperger, A. Leber, T. Johnson, M. F. Reiser, and C. R. Becker Accuracy of 64-MDCT in the diagnosis of ischemic heart disease. Am. J. Roentgenol., July 1, 2006; 187(1): 111 - 117. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. K. Pannu, J. E. Jacobs, S. Lai, and E. K. Fishman Coronary CT angiography with 64-MDCT: assessment of vessel visibility. Am. J. Roentgenol., July 1, 2006; 187(1): 119 - 126. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. Hoffmann, M. Ferencik, R. C. Cury, and A. J. Pena Coronary CT Angiography J. Nucl. Med., May 1, 2006; 47(5): 797 - 806. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C Peebles Computed tomographic coronary angiography: how many slices do you need? Heart, May 1, 2006; 92(5): 582 - 584. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M A S Cordeiro, J M Miller, A Schmidt, A C Lardo, B D Rosen, D E Bush, J A Brinker, D A Bluemke, E P Shapiro, and J A C Lima Non-invasive half millimetre 32 detector row computed tomography angiography accurately excludes significant stenoses in patients with advanced coronary artery disease and high calcium scores Heart, May 1, 2006; 92(5): 589 - 597. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. Hoffmann, F. Moselewski, K. Nieman, I.-K. Jang, M. Ferencik, A. M. Rahman, R. C. Cury, S. Abbara, H. Joneidi-Jafari, S. Achenbach, et al. Noninvasive Assessment of Plaque Morphology and Composition in Culprit and Stable Lesions in Acute Coronary Syndrome and Stable Lesions in Stable Angina by Multidetector Computed Tomography J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1655 - 1662. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A.S. Cordeiro and J. A.C. Lima Atherosclerotic plaque characterization by multidetector row computed tomography angiography. J. Am. Coll. Cardiol., April 18, 2006; 47(8 Suppl): C40 - C47. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Escolar, G. Weigold, A. Fuisz, and N. J. Weissman New imaging techniques for diagnosing coronary artery disease. Can. Med. Assoc. J., February 14, 2006; 174(4): 487 - 495. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Thrall Reinventing Radiology in the Digital Age Part III. Facilities, Work Processes, and Job Responsibilities Radiology, December 1, 2005; 237(3): 790 - 793. [Full Text] [PDF]
|
|
|
|
|
|
P M Donnelly, J D S Higginson, and P D Hanley Multidetector CT coronary angiography: have we found the holy grail of non-invasive coronary imaging? Heart, November 1, 2005; 91(11): 1385 - 1388. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Gaspar, D. A. Halon, B. S. Lewis, S. Adawi, J. E. Schliamser, R. Rubinshtein, M. Y. Flugelman, and N. Peled Diagnosis of Coronary In-Stent Restenosis With Multidetector Row Spiral Computed Tomography J. Am. Coll. Cardiol., October 18, 2005; 46(8): 1573 - 1579. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Achenbach, D. Ropers, F.-K. Pohle, D. Raaz, J. von Erffa, A. Yilmaz, G. Muschiol, and W. G. Daniel Detection of coronary artery stenoses using multi-detector CT with 16x0.75 collimation and 375 ms rotation Eur. Heart J., October 1, 2005; 26(19): 1978 - 1986. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Gibbons and P. A. Araoz The Year in Cardiac Imaging J. Am. Coll. Cardiol., August 2, 2005; 46(3): 542 - 551. [Full Text] [PDF]
|
|
|
|
|
|
G. L. Raff, M. J. Gallagher, W. W. O'Neill, and J. A. Goldstein Diagnostic Accuracy of Noninvasive Coronary Angiography Using 64-Slice Spiral Computed Tomography J. Am. Coll. Cardiol., August 2, 2005; 46(3): 552 - 557. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Schmermund and R. Erbel Non-invasive computed tomographic coronary angiography: the end of the beginning Eur. Heart J., August 1, 2005; 26(15): 1451 - 1453. [Full Text] [PDF]
|
|
|
|
|
|
M. J. Budoff, M. C. Cohen, M. J. Garcia, J. McB. Hodgson, W. G. Hundley, J. A.C. Lima, W. J. Manning, G. M. Pohost, P. M. Raggi, G. P. Rodgers, et al. ACCF/AHA Clinical Competence Statement on Cardiac Imaging With Computed Tomography and Magnetic Resonance: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training J. Am. Coll. Cardiol., July 19, 2005; 46(2): 383 - 402. [Full Text] [PDF]
|
|
|
|
|
|
A. W. Leber, A. Knez, F. von Ziegler, A. Becker, K. Nikolaou, S. Paul, B. Wintersperger, M. Reiser, C. R. Becker, G. Steinbeck, et al. Quantification of Obstructive and Nonobstructive Coronary Lesions by 64-Slice Computed Tomography: A Comparative Study With Quantitative Coronary Angiography and Intravascular Ultrasound J. Am. Coll. Cardiol., July 5, 2005; 46(1): 147 - 154. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Achenbach and W. G. Daniel Computed Tomography of the Coronary Arteries: More Than Meets the (Angiographic) Eye J. Am. Coll. Cardiol., July 5, 2005; 46(1): 155 - 157. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Wexler Invited Commentary RadioGraphics, March 1, 2005; 25(2): 438 - 440. [Full Text] [PDF]
|
|