Noninvasive Coronary Angiography by 320-Row Computed Tomography With Lower Radiation Exposure and Maintained Diagnostic Accuracy: Comparison of Results With Cardiac Catheterization in a Head-to-Head Pilot Investigation

Background— Noninvasive coronary angiography with the use of multislice computed tomography (CT) scanners is feasible with high sensitivity and negative predictive value; however, the radiation exposure associated with this technique is rather high. We evaluated coronary angiography using whole-heart 320-row CT, which avoids exposure-intensive overscanning and overranging. Methods and Results— A total of 30 consecutive patients with suspected coronary artery disease referred for clinically indicated conventional coronary angiography (CCA) were included in this prospective intention-to-diagnose study. CT was performed with the use of up to 320 simultaneous detector rows before same-day CCA, which, together with quantitative analysis, served as the reference standard. The per-patient sensitivity and specificity for CT compared with CCA were 100% (95% confidence interval [CI], 72 to 100) and 94% (95% CI, 73 to 100), respectively. Per-vessel versus per-segment sensitivity and specificity were 89% (95% CI, 62 to 98) and 96% (95% CI, 90 to 99) versus 78% (95% CI, 56 to 91) and 98% (95% CI, 96 to 99), respectively. Interobserver agreement between the 2 readers was significantly better for CCA (97% of 121 coronary arteries) than for CT (90%; P=0.04). Percent diameter stenosis determined with the use of CT showed good correlation with CCA (P<0.001, R=0.81) without significant underestimation or overestimation (−3.1±24.4%; P=0.08). Intraindividual comparison of CT with CCA revealed a significantly smaller effective radiation dose (median, 4.2 versus 8.5 mSv; P<0.05) and amount of contrast agent required (median, 80 versus 111 mL; P<0.001) for 320-row CT. The majority of patients (87%) indicated that they would prefer CT over CCA for future diagnostic imaging (P<0.001). Conclusions— CT with the use of emerging technology has the potential to significantly reduce the radiation dose and amount of contrast agent required compared with CCA while maintaining high diagnostic accuracy.

[1]  J. Iglehart Health insurers and medical-imaging policy--a work in progress. , 2009, The New England journal of medicine.

[2]  Bernd Hamm,et al.  Determining optimal acquisition parameters for computed tomography coronary angiography: evaluation of a software-assisted, breathhold exam simulation. , 2009, Academic radiology.

[3]  N. Paul,et al.  Perioperative β-Blockers : Use With Caution Perioperative β Blockers in Patients Having Non-Cardiac Surgery : A Meta-Analysis , 2010 .

[4]  R. Redberg,et al.  Pay now, benefits may follow--the case of cardiac computed tomographic angiography. , 2008, The New England journal of medicine.

[5]  M. Budoff,et al.  Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Indi , 2008, Journal of the American College of Cardiology.

[6]  Walter Huda,et al.  Converting dose-length product to effective dose at CT. , 2008, Radiology.

[7]  P. Houck,et al.  Sample size and power calculations based on generalized linear mixed models with correlated binary outcomes , 2008, Comput. Methods Programs Biomed..

[8]  Bernd Hamm,et al.  Three-vessel coronary artery disease examined with 320-slice computed tomography coronary angiography. , 2008, European heart journal.

[9]  H. Otero,et al.  Initial evaluation of coronary images from 320-detector row computed tomography , 2008, The International Journal of Cardiovascular Imaging.

[10]  Rémy Morello,et al.  Coronary arteries: diagnostic performance of 16- versus 64-section spiral CT compared with invasive coronary angiography--meta-analysis. , 2007, Radiology.

[11]  D. Brenner,et al.  Computed tomography--an increasing source of radiation exposure. , 2007, The New England journal of medicine.

[12]  Gabriel P Krestin,et al.  64-slice computed tomography coronary angiography in patients with high, intermediate, or low pretest probability of significant coronary artery disease. , 2007, Journal of the American College of Cardiology.

[13]  A. Einstein,et al.  Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. , 2007, JAMA.

[14]  S. Lewis,et al.  Regression analysis , 2007, Practical Neurology.

[15]  Bernd Hamm,et al.  Cost effectiveness of coronary angiography and calcium scoring using CT and stress MRI for diagnosis of coronary artery disease , 2007, European Radiology.

[16]  B. Hamm,et al.  Patient Acceptance of Noninvasive and Invasive Coronary Angiography , 2007, PloS one.

[17]  K. Furie,et al.  Heart disease and stroke statistics--2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2007, Circulation.

[18]  Bernd Hamm,et al.  Coronary Artery Stenosis Quantification Using Multislice Computed Tomography , 2007, Investigative radiology.

[19]  Marco Valgimigli,et al.  Diagnostic performance of multislice spiral computed tomography of coronary arteries as compared with conventional invasive coronary angiography: a meta-analysis. , 2006, Journal of the American College of Cardiology.

[20]  Patrik Rogalla,et al.  Noninvasive Detection of Coronary Artery Stenoses with Multislice Computed Tomography or Magnetic Resonance Imaging , 2006, Annals of Internal Medicine.

[21]  P. Greenland Who Is a Candidate for Noninvasive Coronary Angiography? , 2006, Annals of Internal Medicine.

[22]  B. Hamm,et al.  Multislice CT Coronary Angiography: Effect of Sublingual Nitroglycerine on the Diameter of Coronary Arteries , 2006, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[23]  Peter Wilde,et al.  Comparison of radiation doses from multislice computed tomography coronary angiography and conventional diagnostic angiography. , 2006, Journal of the American College of Cardiology.

[24]  R. Cury,et al.  Coronary CT angiography. , 2006, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[25]  Udo Hoffmann,et al.  Accuracy of 16-slice multi-detector CT to quantify the degree of coronary artery stenosis: assessment of cross-sectional and longitudinal vessel reconstructions. , 2006, European journal of radiology.

[26]  Jeroen J. Bax,et al.  Meta-analysis of comparative diagnostic performance of magnetic resonance imaging and multislice computed tomography for noninvasive coronary angiography. , 2006, American heart journal.

[27]  S. Achenbach,et al.  Comparison of the degree of coronary stenoses by multidetector computed tomography versus by quantitative coronary angiography. , 2005, The American journal of cardiology.

[28]  G. Raff,et al.  Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. , 2005, Journal of the American College of Cardiology.

[29]  B. Gerber,et al.  Head-to-head comparison of three-dimensional navigator-gated magnetic resonance imaging and 16-slice computed tomography to detect coronary artery stenosis in patients. , 2005, Journal of the American College of Cardiology.

[30]  Heshui Shi,et al.  Noninvasive coronary angiography with multislice computed tomography. , 2005, JAMA.

[31]  B. Hamm,et al.  Multislice CT Coronary Angiography: Evaluation of an Automatic Vessel Detection Tool , 2004, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[32]  Patrik Rogalla,et al.  Multisegment and Halfscan Reconstruction of 16-Slice Computed Tomography for Detection of Coronary Artery Stenoses , 2004, Investigative radiology.

[33]  P. Bossuyt,et al.  Sources of Variation and Bias in Studies of Diagnostic Accuracy , 2004, Annals of Internal Medicine.

[34]  J. Knottnerus,et al.  Assessment of the accuracy of diagnostic tests: the cross-sectional study. , 2003, Journal of clinical epidemiology.

[35]  David Moher,et al.  The STARD Statement for Reporting Studies of Diagnostic Accuracy: Explanation and Elaboration , 2003, Annals of Internal Medicine [serial online].

[36]  D. Rennie,et al.  Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative , 2003, BMJ : British Medical Journal.

[37]  E. Hunsche,et al.  [Costs of coronary heart diseases over the remaining life time in coronary heart disease cases--an analysis of the current status of coronary heart disease cases in Germany from the social perspective]. , 1999, Zeitschrift fur Kardiologie.

[38]  K. Lauterbach,et al.  Kosten koronarer Herzkrankheiten über die verbleibende Lebenszeit von KHK-Fällen – Eine Analyse des aktuellen Bestandes an KHK-Fällen in Deutschland aus gesellschaftlicher Perspektive , 1999, Zeitschrift für Kardiologie.

[39]  E. Antman,et al.  Evidence-Based Coronary Care , 1997, Annals of Internal Medicine.

[40]  C. Martin,et al.  Effective doses for coronary angiography. , 1996, The British journal of radiology.

[41]  D A Clark,et al.  Cardiac catheterization 1990: a report of the Registry of the Society for Cardiac Angiography and Interventions (SCA&I). , 1991, Catheterization and cardiovascular diagnosis.

[42]  I Russell,et al.  Statistics--with confidence? , 1991, The British journal of general practice : the journal of the Royal College of General Practitioners.

[43]  R. Detrano,et al.  Quantification of coronary artery calcium using ultrafast computed tomography. , 1990, Journal of the American College of Cardiology.

[44]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[45]  G. Diamond,et al.  Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. , 1979, The New England journal of medicine.

[46]  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.

[47]  D. Jewitt,et al.  Manual of Otolaryngology , 1969 .

[48]  D. M. Ellis,et al.  Applied Regression Analysis , 1968 .

[49]  N. Paul,et al.  Coronary CT angiography using 64 detector rows: methods and design of the multi-centre trial CORE-64 , 2008, European Radiology.

[50]  M. Smithson Statistics with confidence , 2000 .

[51]  Purushottam W. Laud,et al.  Diagnostic tests , 2020, Bayesian Thinking in Biostatistics.

[52]  S. Shaughnessy,et al.  Do No Harm: Health Systems’ Duty to Promote Clinician Well-Being , 2022, American Journal of Hospital Medicine.