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64-slice computed tomography coronary angiography: diagnostic accuracy in the real world

Angiografia coronarica con tomografia computerizzata a 64 strati: accuratezza diagnostica nel mondo reale

  • Cardiac Radiology Cardioradiologia
  • Published:
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Abstract

Purpose

This study was done to evaluate the diagnostic accuracy of 64-slice computed tomography coronary angiography (CTCA) for the detection of significant coronary artery stenosis in the real clinical world.

Materials and method

From the CTCA database of our institution, we enrolled 145 patients (92 men, 52 women, mean age 63.4 ± 10.2 years) with suspected coronary artery disease. All patients presented with atypical or typical chest pain and underwent CTCA and conventional coronary angiography (CA). For the CTCA scan (Sensation 64, Siemens, Germany), we administered an IV bolus of 100 ml of iodinated contrast material (Iomeprol 400 mgI/ml, Bracco, Italy). The CTCA and CA reports used to evaluate diagnostic accuracy adopted ≥50% and ≥70%, respectively, as thresholds for significant stenosis.

Result

Eleven patients were excluded from the analysis because of the nondiagnostic quality of CTCA. The prevalence of disease demonstrated at CA was 63% (84/134). Sensitivity, specificity and positive and negative predictive values for CTCA on a per-segment, per-vessel, and per-patient basis were 75.6%, 85.1%, 97.6%; 86.9%, 81.8%, 58.0%; 48.2%, 68.1%, 79.6%; and 95.7%, 92.3%, 93.5%, respectively. Only two out of 134 eligible patients were false negative. Heart rate did not significantly influence diagnostic accuracy, whereas the absence or minimal presence of coronary calcification improved diagnostic accuracy. The positive and negative likelihood ratios at the per-patient level were 2.32 and 0.041, respectively.

Conclusion

CTCA in the real clinical world shows a diagnostic performance lower than reported in previous validation studies. The excellent negative predictive value and negative likelihood ratio make CTCA a noninvasive gold standard for exclusion of significant coronary artery disease.

Riassunto

Obiettivo

Valutare l’accuratezza diagnostica dell’angiografia coronarica non invasiva con tomografia computerizzata (CT-CA) a 64 strati nell’individuazione delle stenosi coronariche significative (riduzione del lume coronarico ≥50%) basando la valutazione sulla refertazione clinica.

Materiali e metodi

Dal database della CT-CA sono stati arruolati nello studio 145 pazienti (92 maschi, 52 femmine, età media 63,4±10,2 anni) con sospetta malattia coronarica. I pazienti si presentavano con dolore toracico atipico o angina pectoris stabile e hanno poi eseguito CT-CA e coronarografia convenzionale (CAG). Per la scansione CT-CA (Sensation 64, Siemens, Germania) sono stati iniettati endovena 100 ml di mezzo di contrasto. (Iomeprol 400 mgI/ml, Bracco, Italia). I referti della CT-CA e della CAG sono utilizzati per la valutazione dell’accuratezza diagnostica utilizzano la definizione di stenosi ≥50% per la CT-CA e ≥70% per la CAG.

Risultati

Undici pazienti sono stati esclusi dall’analisi per CT-CA di qualità insufficiente. La prevalenza di malattia dimostrata alla CAG era del 63% (84/134). Sensibilità, specificità, valore predittivo positivo e negativo della CT-CA nella determinazione delle stenosi significative utilizzando un’analisi per segmento, per vaso e per paziente sono risultate del 75,6%, 85,1%, 97,6%; 86,9%, 81,8%, 58,0%; 48,2%, 68,1%, 79,6%; e 95,7%, 92,3%, 93,5%, rispettivamente. Solo due pazienti su 134 eleggibili per lo studio sono risultati falsi negativi. La frequenza cardiaca non ha mostrato influenzare significativamente l’accuratezza diagnostica, mentre la presenza di scarse o assenti calcificazioni coronariche ha determinato un incremento dei valori di accuratezza diagnostica. I likelihood ratio positivo e negativo nell’analisi per paziente sono risultati 2,32 e 0,041, rispettivamente.

Conclusioni

La CT-CA nel mondo reale mostra una performance diagnostica inferiore rispetto agli studi di validazione pubblicati in letteratura. I valori ottimali di valore predittivo negativo e likelihood ratio negativo collocano la CT-CA tra le metodiche non invasive gold standard per l’esclusione di malattia coronarica critica.

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Authors and Affiliations

  1. Dipartimento di Radiologia e Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy

    F. Cademartiri, E. Maffei, F. Notarangelo, F. Ugo, A. Palumbo, D. Lina, A. Aldrovandi, E. Solinas, C. Reverberi, A. Menozzi & L. Vignali

  2. Dipartimento di Radiologia e Cardiologia, Erasmus Medical Center, Rotterdam, Holland

    F. Cademartiri, N. R. Mollet & D. Ardissino

  3. DIBIMEL, Sezione di Scienze Radiologiche, Università di Palermo, Parma, Italy

    M. Midiri

  4. Dipartimento di Radiologia, Università degli Studi di Verona, Verona, Italy

    R. Malagò

  5. Dipartimento di Emergenza, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy

    G. Cervellin

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  1. F. Cademartiri
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  2. E. Maffei
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  3. F. Notarangelo
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  4. F. Ugo
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  5. A. Palumbo
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  6. D. Lina
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  7. A. Aldrovandi
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  8. E. Solinas
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  9. C. Reverberi
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  10. A. Menozzi
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  11. L. Vignali
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  12. R. Malagò
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  13. M. Midiri
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  14. N. R. Mollet
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  15. G. Cervellin
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  16. D. Ardissino
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Corresponding author

Correspondence to F. Cademartiri.

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Cademartiri, F., Maffei, E., Notarangelo, F. et al. 64-slice computed tomography coronary angiography: diagnostic accuracy in the real world. Radiol med 113, 163–180 (2008). https://doi.org/10.1007/s11547-008-0241-1

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  • DOI: https://doi.org/10.1007/s11547-008-0241-1

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