Review
Diagnostic value of multislice computed tomography angiography in coronary artery disease: A meta-analysis

https://doi.org/10.1016/j.ejrad.2006.06.009Get rights and content

Abstract

Purpose

To perform a meta-analysis of the diagnostic value of multislice CT (MSCT) angiography in the detection of coronary artery disease (CAD) when compared to conventional coronary angiography.

Materials and methods

A search of PubMed and MEDLINE databases for English literature was performed. Only studies with at least 10 patients comparing MSCT angiography with conventional coronary angiography in the detection of CAD were included. Diagnostic value of MSCT angiography compared to coronary angiography was compared and analyzed at segment-, vessel- and patient-based assessment.

Results

47 studies (67 comparisons) met the criteria and were included in our study. Pooled overall sensitivity, specificity and 95% confidence interval for MSCT angiography in the detection of CAD were 83% (79%, 89%), 93% (91%, 96%) at segment-based analysis; 90% (87%, 94%), 87% (80%, 93%) at vessel-based analysis; and 91% (88%, 95%), 86% (81%, 92%) at patient-based analysis, respectively. Diagnostic accuracy of MSCT angiography in evaluating assessable segments was significantly improved with 64-slice scanners when compared to that with 4- and 16-slice scanners (p < 0.05).

Conclusion

Our meta-analysis showed that MSCT angiography has potential diagnostic accuracy in the detection of CAD. Diagnostic performance of MSCT angiography has been significantly improved with the latest 64-slice CT, with resultant high qualitative and quantitative diagnostic accuracy. 16-slice CT was limited in spatial resolution which makes it difficult to perform quantitative assessment of coronary artery stenoses.

Introduction

Coronary artery disease (CAD) is the leading cause of death in Western countries [1]. The standard of reference for diagnosis of CAD is still conventional coronary angiography, with the advantage of high spatial resolution and temporal resolution. However, it is an invasive and expensive procedure with associated morbidity and mortality [2]. Furthermore, coronary angiography usually requires a short hospital stay and causes discomfort for the patients. It is reported that only one-third of all conventional coronary angiography examinations in the United States are performed in conjunction with an interventional procedure, while the rest are performed only for diagnostic purposes, which is only for verification of the presence and degree of CAD [1]. Therefore, a non-invasive technique for imaging of the coronary artery disease is highly desirable.

Imaging of the heart has always been technically challenging due to the heart's continuous movement. Over the past decade, non-invasive coronary imaging modalities have undergone rapid developments, such as electron beam computed tomography and magnetic resonance imaging [3], [4]. Despite encouraging results, neither of these techniques has been considered suitable for routine clinical use. Imaging of the heart has moved into the diagnostic era with the introduction of multislice CT angiography (MSCT) and development of electrocardiography-synchronized scanning and reconstruction techniques [5], [6].

Currently, MSCT scanner permits acquisition of volume data with up to 64 slices per rotation (330–500 ms) in a single breath hold. In recent years, considerable interest has concentrated on the beneficial use of high-spatial resolution of MSCT for non-invasive investigation of the coronary arterial tree [7], [8], [9], [10]. Studies involving the application of MSCT angiography in CAD were aimed to investigate whether MSCT can replace coronary angiography in the non-invasive detection and diagnosis of CAD [7], [8], [9], [10], [11], [12]. Although earlier results were promising, MSCT angiography was not found to reach the diagnostic accuracy as that provided by conventional coronary angiography. However, it seems questionable whether it is worthwhile pursuing MSCT angiography in cardiac imaging indefinitely because radiation dose is an important issue resulting from MSCT. Therefore, we aimed in this study to perform a meta-analysis of MSCT angiography in the detection of CAD with regard to the diagnostic value in comparison to conventional coronary angiography, based on the current available results.

Section snippets

Criteria for data selection

A search of PubMed and MEDLINE databases for English literature was performed by two reviewers (ZS, WJ) for articles describing the diagnostic value of MSCT angiography in CAD when compared to conventional coronary angiography (last search May 2006). The articles must be peer-reviewed and published in English language. We used key words describing MSCT angiography in coronary artery disease; MSCT and coronary artery stenosis or disease; coronary MSCT. We limited our search to reports on human

General information

Forty-eight studies met criteria and 47 (67 separate comparisons) were included for the analysis [7], [8], [9], [10], [11], [12], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55] as two studies used similar dataset and one of them was excluded [47]. There were 10 studies involved 30 comparisons

Discussion

The technique of MSCT angiography in cardiac imaging is evolving rapidly. This has been represented by the development of more detector rows of MSCT scanners in clinical practice. Theoretically, emergence of increased MSCT detector rows should be followed by subsequent improvement in image quality in patients with high heart rate or in evaluation of peripheral/distal coronary artery segments. Our analysis confirmed this hypothesis to some extents. Diagnostic accuracy of MSCT acquired with 16-

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