Document Detail

Diagnostic accuracy and image quality of cardiac dual-source computed tomography in patients with arrhythmia.
MedLine Citation:
PMID:  19246109     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Cardiac multi-detector computed tomography (MDCT) permits accurate visualization of high-grade coronary artery stenosis. However, in patients with heart rate irregularities, MDCT was found to have limitations. Thus, the aim of the present study was to evaluate the diagnostic accuracy of a new dual-source computed tomography (DSCT) scanner generation with 83 ms temporal resolution in patients without stable sinus rhythm. METHODS: 44 patients (31 men, mean age 67.5+/-9.2 years) without stable sinus rhythm and scheduled for invasive coronary angiography (ICA) because of suspected (n=17) or known coronary artery disease (CAD, n=27) were included in this study. All patients were examined with DSCT (Somatom Definition, Siemens). Besides assessment of total calcium score, all coronary segments were analyzed with regard to the presence of significant coronary artery lesions (>50%). The findings were compared to ICA in a blinded fashion. RESULTS: During CT examination, heart rhythm was as follows: 25 patients (57%) atrial fibrillation, 7 patients (16%) ventricular extrasystoles (two of them with atrial fibrillation), 4 patients (9%) supraventricular extrasystoles, 10 patients (23%) sinus arrhythmia (heart rate variability>10 bpm). Mean heart rate was 69+/-14 bpm, median 65 bpm. Mean Agatston score equivalent (ASE) was 762, ranging from 0 to 4949.7 ASE. Prevalence of CAD was 68% (30/44). 155 segments (27%) showed "step-ladder" artifacts and 28 segments (5%) could not be visualized by DSCT. Only 70 segments (12%) were completely imaged without any artifacts. Based on a coronary segment model, sensitivity was 73%, specificity 91%, positive predictive value 63%, and negative predictive value 94% for the detection of significant lesions (>or=50% diameter stenosis). Overall accuracy was 88%. CONCLUSIONS: In patients with heart rate irregularities, including patients with atrial fibrillation and a high prevalence of coronary artery disease, the diagnostic yield of dual-source computed tomography is still hampered due to a high number of segments with "step-ladder" artifacts.
Ilias Tsiflikas; Tanja Drosch; Harald Brodoefel; Christoph Thomas; Anja Reimann; Alexander Till; Daniel Nittka; Andreas F Kopp; Stephen Schroeder; Martin Heuschmid; Christof Burgstahler
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Publication Detail:
Type:  Clinical Trial; Journal Article; Validation Studies     Date:  2009-02-25
Journal Detail:
Title:  International journal of cardiology     Volume:  143     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-19     Completed Date:  2010-10-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  79-85     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.
Department of Diagnostic Radiology, University Hospital Tuebingen, and Department of Internal Medicine-Sports Medicine, University of Tuebingen, Germany.
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MeSH Terms
Arrhythmias, Cardiac / radiography*
Coronary Angiography / standards
Coronary Stenosis / radiography*
Image Processing, Computer-Assisted / methods,  standards
Middle Aged
Predictive Value of Tests
Reference Standards
Reproducibility of Results
Sensitivity and Specificity
Tomography, X-Ray Computed / methods*,  standards*

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