Clinical use of multislice spiral computed tomography in 210 highly preselected patients: experience with 4- and 16 slice technology

Torsten Beck ¹, Christof Burgstahler ¹, Axel Kuettner ¹, Andreas F Kopp ¹, Martin Heuschmid ¹, Claus D Claussen ¹ and Stephen Schroeder ^1*

¹ University of Tuebingen, Germany

^* To whom correspondence should be addressed. E-mail: stephen.schroeder{at}med.uni-tuebingen.de.

Accepted 1 December 2004

Abstract

Background: Multi-slice spiral computed tomography (MSCT) scanners can visualize human coronary arteries non-invasively. Comparative studies with invasive coronary angiography (ICA) revealed a high negative predictive value, suggesting that MSCT might be useful for the exclusion of coronary artery disease (CAD). Thus, MSCT might help to reduce the total number of ICA. Initially, 4-slice scanners were used, since 2002 16-slice scanners with improved temporal and spatial resolution are available. We used both scanner generations to evaluate the need for an ICA in patients (pts) with unclear chest pain. We report on our initial experience using MSCT coronary imaging, as well as on differences in diagnostic accuracy between 4-slice and 16-slice MSCT technology.

Methods and results: 210 pts underwent MSCT coronary angiography (4-slices: n=120, 16-slices: n=90, suspicion of CAD: n=159, suspicion of restenosis: n=51). Recommendations for further diagnostics were based on the MSCT results. A telephone interview was performed after 449+169 days to evaluate the further clinical course. MSCT detected significant lesions in 94/210 (45%) pts and an ICA was recommended. MSCT excluded significant lesions in 116/210 (55%) pts. An ICA was actually performed in 44/210 (21%) pts (corresponding results: 27/44 [61%], false positive: 11/44 [25%], false negative: 6/44 [14%]). No statistical differences were found between 4- and 16-slice imaging. No major cardiac event occurred during follow-up.

Conclusions: MSCT was found to be useful to evaluate the need for invasive diagnostics. However, the false negative results underline that further improvements of image quality are required until it might replace ICA in carefully selected pts.

Keywords: atherosclerosis, coronary artery disease, imaging techniques, invasive coronary angiography (ICA), multi-slice spiral computed tomography (MSCT)

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