Noninvasive Coronary Angiography With Multislice Computed Tomography

ContextMultislice computed tomography (MSCT) has recently evolved as a modality for noninvasive coronary imaging.ObjectiveTo assess the accuracy and robustness of MSCT vs the criterion standard of invasive coronary angiography for detection of obstructive coronary artery disease.Design, Setting, and PatientsProspective, single-center study conducted in a referral center setting in Germany and enrolling 103 consecutive patients (mean age, 61.5 [SD, 9.7] years) from November 2003–August 2004 who were undergoing both invasive coronary angiography and MSCT using a scanner with 16 detector rows.Main Outcome MeasuresBlinded results for both modalities compared using the patient as the primary unit of analysis, with supplementary segment- and vessel-based analyses.ResultsOne thousand three hundred eighty-four segments (≥1.5 mm diameter) were identified by invasive coronary angiography; nondiagnostic image quality of MSCT was identified for only 88 (6.4%) of these segments, mainly due to faster heart rates. Compared with invasive coronary angiography for detection of significant lesions (>50% stenosis), segment-based sensitivity, specificity, and positive and negative predictive values of MSCT were 95%, 98%, 87%, and 99%, respectively. Quantitative comparison of MSCT and invasive coronary angiography showed good correlation (r = 0.87, P<.001), with MSCT systematically measuring greater-percentage stenoses (bias, +12%). In the patient-based analysis, the area under the receiver operating characteristic curve was 0.97 (95% confidence interval, 0.90-1.00), indicating high discriminative power to identify patients who might be candidates for revascularization (>50% left main artery stenosis and/or >70% stenosis in any other epicardial vessel). Threshold optimization allowed either detection of these patients with 100% sensitivity at a reasonable false-positive rate (specificity, 76.5%; MSCT stenosis, >66%) or optimization of both the sensitivity and specificity (>90%; MSCT stenosis, >76%).ConclusionsMultislice computed tomography provides high accuracy for noninvasive detection of suspected obstructive coronary artery disease. This promising technology has potential to complement diagnostic invasive coronary angiography in routine clinical care.

[1]  P. Humphrey,et al.  Histologic Grade, DNA Ploidy, and Intraglandular Tumor Extent as Indicators of Tumor Progression of Clinical Stage B Prostatic Carcinoma: A Direct Comparison , 1991, The American journal of surgical pathology.

[2]  J. Crowley,et al.  Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. , 2004, The New England journal of medicine.

[3]  Maximilian F. Reiser,et al.  Multi-slice CT in Cardiac Imaging , 2002, Springer Berlin Heidelberg.

[4]  Richard D. White,et al.  Noninvasive imaging of coronary arteries: current and future role of multi-detector row CT. , 2004, Radiology.

[5]  Russell V. Lenth,et al.  Some Practical Guidelines for Effective Sample Size Determination , 2001 .

[6]  James A Hanley,et al.  Prostate cancer and the Will Rogers phenomenon. , 2005, Journal of the National Cancer Institute.

[7]  E. Antman,et al.  ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). , 2002, Journal of the American College of Cardiology.

[8]  J. Murray,et al.  ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. , 1999, Journal of the American College of Cardiology.

[9]  Michael Grass,et al.  Noninvasive coronary angiography with 16-detector row CT: effect of heart rate. , 2005, Radiology.

[10]  U Joseph Schoepf,et al.  CT of coronary artery disease. , 2004, Journal of thoracic imaging.

[11]  C. Claussen,et al.  Influence of heart rate on vessel visibility in noninvasive coronary angiography using new multislice computed tomography: experience in 94 patients. , 2002, Clinical imaging.

[12]  K S Panageas,et al.  Statistical issues in analysis of diagnostic imaging experiments with multiple observations per patient. , 2001, Radiology.

[13]  Stephen Schroeder,et al.  Diagnostic accuracy of noninvasive coronary imaging using 16-detector slice spiral computed tomography with 188 ms temporal resolution. , 2005, Journal of the American College of Cardiology.

[14]  W. Bautz,et al.  Detection of Coronary Artery Stenoses With Thin-Slice Multi-Detector Row Spiral Computed Tomography and Multiplanar Reconstruction , 2003, Circulation.

[15]  Michael Grass,et al.  Artifact analysis and reconstruction improvement in helical cardiac cone beam CT , 2004, IEEE Transactions on Medical Imaging.

[16]  Heshui Shi,et al.  Noninvasive coronary imaging with MDCT in comparison to invasive conventional coronary angiography: a fast-developing technology. , 2004, AJR. American journal of roentgenology.

[17]  Mathias Prokop,et al.  Multislice CT: technical principles and future trends , 2003, European radiology.

[18]  E. Wenkel,et al.  Noninvasive visualization of coronary arteries using contrast-enhanced multidetector CT: influence of heart rate on image quality and stenosis detection. , 2002, AJR. American journal of roentgenology.

[19]  T Nielsen,et al.  Automatic phase determination for retrospectively gated cardiac CT. , 2004, Medical physics.

[20]  Richard P. Lewis,et al.  A Critical Review of the Systolic Time Intervals , 2005 .

[21]  S. Achenbach.  Detection of coronary stenoses by multidetector computed tomography: it's all about resolution. , 2004, Journal of the American College of Cardiology.

[22]  T Nielsen,et al.  Helical cardiac cone beam reconstruction using retrospective ECG gating. , 2003, Physics in medicine and biology.

[23]  R. Reiter,et al.  Molecular markers and prostate cancer prognosis. , 2004, Clinical prostate cancer.

[24]  Pedro A. Lemos,et al.  Reliable Noninvasive Coronary Angiography With Fast Submillimeter Multislice Spiral Computed Tomography , 2002, Circulation.

[25]  M A Hlatky,et al.  American College of Cardiology/Society for Cardiac Angiography and Interventions Clinical Expert Consensus Document on cardiac catheterization laboratory standards. A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. , 2001 .

[26]  B. Ohnesorge,et al.  Heart Rate Adaptive Optimization of Spatial and Temporal Resolution for Electrocardiogram-Gated Multislice Spiral CT of the Heart , 2001, Journal of computer assisted tomography.

[27]  D. Altman,et al.  Comparing methods of measurement: why plotting difference against standard method is misleading , 1995, The Lancet.

[28]  Filippo Cademartiri,et al.  Multislice spiral computed tomography coronary angiography in patients with stable angina pectoris. , 2004, Journal of the American College of Cardiology.

[29]  T Nielsen,et al.  Adaptive temporal resolution optimization in helical cardiac cone beam CT reconstruction. , 2003, Medical physics.

[30]  A. Yeung,et al.  Accuracy of Electronic Digital Calipers Compared With Quantitative Angiography in Measuring Coronary Arterial Diameter , 1993, Circulation.

[31]  R. Frye,et al.  A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. , 1975, Circulation.

[32]  Elliot K Fishman,et al.  Current concepts in multi-detector row CT evaluation of the coronary arteries: principles, techniques, and anatomy. , 2003, Radiographics : a review publication of the Radiological Society of North America, Inc.

[33]  P. D. de Feyter,et al.  Noninvasive multi-slice computed tomography coronary angiography: an emerging clinical modality. , 2004, Journal of the American College of Cardiology.

[34]  Michael Grass,et al.  Cardiac image reconstruction on a 16-slice CT scanner using a retrospectively ECG-gated multicycle 3D back-projection algorithm , 2003, SPIE Medical Imaging.

[35]  Patrick W Serruys,et al.  Improved diagnostic accuracy with 16-row multi-slice computed tomography coronary angiography. , 2005, Journal of the American College of Cardiology.