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

• DOI: 10.1161/01.cir.0000145614.07427.9f
• Publication Date: 2004-10-19T00:17:06Z
• Authors: Udo Hoffmann; Fabian Moselewski; Ricardo C. Cury; Maros Ferencik; Ik-kyung Jang; Larry J. Diaz; Suhny Abbara; Thomas J. Brady; Stephan Achenbach
• Keywords: Male; Coronary Stenosis; Coronary Artery Disease; Middle Aged; Coronary Angiography; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Risk Factors; Humans; False Positive Reactions; Female; Prospective Studies; False Negative Reactions; Tomography, Spiral Computed

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.