Abstract 3086: Diagnostic Accuracy Of Dual Source-MDCT For Detection Of Significant Coronary Artery Stenoses In Comparison To Invasive Coronary Angiography
Background: 64-Slice Multi Detector Computed Tomography (MDCT) reliably permits detection of coronary artery stenoses, but due to motion artifacts a high number of coronary segments is considered unassessable at heart rates of > 60 bpm. We examined the feasibility of Dual-Source Computed Tomography (DSCT) for the assessment of coronary artery stenoses in an unselected cohort of patients with supposed coronary disease without precedent heart rate control in comparison to invasive angiography.
Methods: 76 consecutive patients (29 female, 47 male, mean age 65.5±10 y) with suspected coronary artery disease underwent DSCT (Siemens Somatom Definition, rotation 330 ms, collimation 64 x 0.6 mm, temporal resolution 83 ms). No heart rate control was performed prior to the examination. Data sets were reconstructed in 5%-intervals and data set with best image quality was evaluated by two expert observers in consensus. A stenosis of > 50 % diameter reduction was considered significant, coronary segments considered unevaluable in CT were regarded as false positive results. Quantitative coronary angiography (QCA) served as standard of reference.
Results: Mean heart rate during scan was 68±9 bpm, mean Agatston score was 100±560. A total of 304 coronary arteries and 1160 coronary segments were included into the study, all but 2 segments could be visualized without motion artifacts. 58 coronary stenoses were correctly detected by CT-angiography (2 in LM, 29 in LAD, 15 in RCX and 12 in RCA), whereas 8 lesions considered relevant in DSCT resulted to be < 50% of diameter reduction in QCA. 237 coronary arteries were evaluated true negative in CT, one coronary lesion was missed by DSCT. In segment based analysis sensitivity was 98.3%, specificity 96.7% and overall accuracy 97%; patient based analysis revealed a sensitivity of 100%, specificity of 83.3% and overall accuracy of 92.1%, respectively. Negative and positive predictive value were 99.9% and 86.6% for segment based and 100% and 86.9% for patient based analysis.
Conclusion: Even at high heart rate levels DSCT provides for detection of significant coronary artery stenoses with high accuracy in coronary segment based as well as patient based analysis and thus correlates well with invasive coronary angiography.