Article Text

PDF
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
  1. M A S Cordeiro1,
  2. J M Miller1,
  3. A Schmidt1,
  4. A C Lardo1,*,
  5. B D Rosen1,
  6. D E Bush1,
  7. J A Brinker1,,
  8. D A Bluemke2,
  9. E P Shapiro1,
  10. J A C Lima1,
  1. 1Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. 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

Abstract

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

Methods: ECG gated 32 × 0.5-MDCTA (32 × 0.5 mm cross sections, 0.35 × 0.35 × 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 × 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 × 0.5-MDCTA accurately excludes ⩾ 50% stenoses in patients with advanced CAD and high calcium scores with an overall diagnostic accuracy of 91%.

  • 32×0.5-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
  • imaging
  • computed tomography
  • coronary angiography
  • coronary disease
  • stenosis

Statistics from Altmetric.com

Footnotes

  • * Also the Departments of Radiology, Biomedical Engineering, and Surgery

  • Also the Department of Radiology

  • Published Online First 26 October 2005

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.