Noninvasive detection of coronary lesions using 16-detector multislice spiral computed tomography technology: initial clinical results.

OBJECTIVES The aim of our study was to evaluate the feasibility of detecting coronary artery lesions using a new computed tomography (CT) scanner with 16 detectors and faster gantry rotation. BACKGROUND Computed tomography angiography of the coronaries permits assessment of the coronaries; however, image quality is still impaired by motion artifacts and calcifications. METHODS Sixty patients scheduled for conventional coronary angiography (CCA) were additionally studied by multislice spiral computed tomography (MSCT). Calcium scores and a contrast-enhanced visualization of the coronaries were performed and analyzed regarding evaluability, presence of coronary artery lesions, and correct clinical diagnosis. RESULTS Calcium scoring was successful in all patients; 58 of 60 patients had a diagnostic contrast-enhanced scan. Mean calcium score was 506 +/- 743 Agatston score equivalent (ASE); 13 of 58 (22%) patients had an ASE >or=1,000, 46 of 58 (78%) patients <1,000. In 763 coronary segments, CCA detected a total of 75 lesions >or=50%. The MSCT correctly assessed 54 of these. Twenty-one lesions were missed or incorrectly underestimated. Sensitivity was 72%, specificity 97%. When restricting analysis to patients with an ASE <1,000, 40 significant lesions >or=50% were seen on CCA, and MSCT correctly detected 39 lesions (sensitivity 98%, specificity 98%). Regardless of any threshold, the correct clinical diagnosis could be obtained in 58 of 60 (97%) of all patients. CONCLUSIONS In individuals with low-to-moderate amounts of coronary artery calcium, 16-detector CT coronary angiography has high sensitivity and specificity for the diagnosis of significant coronary artery stenosis.

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