Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease: Patient- versus segment-based analysis

Udo Hoffmann, Fabian Moselewski, Ricardo C. Cury, Maros Ferencik, Ik Kyung Jang, Larry J. Diaz, Suhny Abbara, Thomas J. Brady, Stephan Achenbach

    Research output: Contribution to journalArticle

    386 Scopus citations

    Abstract

    Background-In this study, we investigated the diagnostic value and limitations of multidetector computed tomography (MDCT)-based noninvasive detection of significant obstructive coronary artery disease (CAD) in a consecutive high-risk patient population with inclusion of all coronary segments. Methods and Results-In a prospective, blinded, standard cross-sectional technology assessment, a cohort of 33 consecutive patients with a positive stress test result underwent 16-slice MDCT and selective coronary angiography for the detection of significant obstructive CAD. We assessed the diagnostic accuracy of MDCT in a segment-based and a patient-based model and determined the impact of stenosis location and the presence of calcification on diagnostic accuracy in both models. Analysis of all 530 coronary segments demonstrated moderate sensitivity (63%) and excellent specificity (96%) with a moderate positive predictive value of 64% and an excellent negative predictive value (NPV) of 96% for the detection of significant coronary stenoses. Assessment restricted to either proximal coronary segments or segments with excellent image quality (83% of all segments) led to an increase in sensitivity (70% and 82%, respectively), and high specificities were maintained (94% and 93%, respectively). In a patient-based model, the NPV of MDCT for significant CAD was limited to 75%. Coronary calcification was the major cause of false-positive findings (94%). Conclusions-For all coronary segments included, 16-slice MDCT has moderate diagnostic value for the detection of significant obstructive coronary artery stenosis in a population with a high prevalence of CAD. The moderate NPV of patient-based detection of CAD suggests a limited impact on clinical decision-making in high-risk populations.

    Original languageEnglish (US)
    Pages (from-to)2638-2643
    Number of pages6
    JournalCirculation
    Volume110
    Issue number17
    DOIs
    StatePublished - Oct 26 2004

    Keywords

    • Atherosclerosis
    • Coronary disease
    • Tomography

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Physiology (medical)

    Fingerprint Dive into the research topics of 'Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease: Patient- versus segment-based analysis'. Together they form a unique fingerprint.

  • Cite this