CARDIOVASCULAR MEDICINE

Non-invasive half millimetre 32 detector row computed tomography angiography accurately excludes significant stenoses in patients with advanced coronary artery disease and high calcium scores

M A S Cordeiro¹, J M Miller¹, A Schmidt¹, A C Lardo^1,*, B D Rosen¹, D E Bush¹, J A Brinker^1,, D A Bluemke², E P Shapiro¹, J A C Lima^1,

¹ Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
² Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Correspondence to:
Dr J A C Lima
The Johns Hopkins Hospital, 600 N Wolfe Street, Blalock 524D1, Baltimore, MD 21287-0409, USA; jlima{at}jhmi.edu

Objective: To show an overall diagnostic accuracy 90% for detection of 50% stenoses by coronary half millimetre 32 detector row computed tomography angiography (32 x 0.5-MDCTA) in patients with advanced coronary artery disease (CAD) and a high likelihood of raised calcium scores.

Methods: ECG gated 32 x 0.5-MDCTA (32 x 0.5 mm cross sections, 0.35 x 0.35 x 0.35 mm³ isotropic voxels, 400 ms rotation) was performed after injection of iodixanol (120 ml, 320 mg/ml) in 30 consecutive patients (25 men, mean (SD) age 59 (13) years, body mass index 26.2 (4.9) kg/m²). Native arteries, including 1.5 mm branches, and bypass grafts were screened for 50% stenoses. Stents were excluded. Conventional coronary angiography (performed 18 (12) days before 32 x 0.5-MDCTA) was analysed by quantitative coronary angiography.

Results: Median Agatston calcium score was 510 (range 3–5066). Sensitivity, specificity, and positive and negative predictive values for detection of 50% stenoses in native arteries were 76% (29 of 38), 94% (190 of 202), 71% (29 of 41), and 96% (190 of 199), respectively. Overall diagnostic accuracy was 91% (219 of 240). Due to the following artefacts 20% (69 of 352) of the vessels were excluded: motion, noise, and low contrast enhancement isolated or in combination (45 of 69 (65%)); image distortion by implantable cardioverter-defibrillator or pacemaker leads (18 of 69 (26%)); and blooming secondary to severe calcification (6 of 69 (9%)).

Conclusions: Coronary 32 x 0.5-MDCTA accurately excludes 50% stenoses in patients with advanced CAD and high calcium scores with an overall diagnostic accuracy of 91%.

Abbreviations: 32x0.5-MDCTA, half millimetre 32 detector row computed tomography angiography; CAD, coronary artery disease; CCA, conventional coronary angiography; CT, computed tomography; ICD, implantable cardioverter-defibrillator; LAD, left anterior descending; LCx, left circumflex; MDCTA, multidetector row computed tomography angiography; QCA, quantitative coronary angiography; RCA, right coronary artery

Keywords: imaging; computed tomography; coronary angiography; coronary disease; stenosis

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