Document Detail


Radiation dose and diagnostic accuracy of multidetector computed tomography for the detection of significant coronary artery stenoses A meta-analysis.
MedLine Citation:
PMID:  21978473     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
We conducted a meta-analysis evaluating the critical ratio between effective radiation dose (ED), feasibility (Fe) and diagnostic accuracy (Ac) of multidetector computed tomography (MDCT) for the detection of significant coronary artery disease. By using our predetermined criteria, we selected human studies published in English in which the ED and raw data of Ac vs. invasive coronary angiography in a segment based model were specified. Data from 31 studies including 3661 patients (mean age 61.9±4.5years, heart rate 62.5±6.7bpm) and 50,236 coronary artery segments were analysed and are reported. Overall, Fe, sensitivity, specificity, negative predictive value, positive predictive value, Ac and ED were 95%, 90%, 96%, 99%, 69%, 95% and 10.4±5.4mSv, respectively. Multivariate analysis showed that prospective ECG-gating (-8.8mSv CI95% -13.4 to -4.3mSv, p=0.001), dual-source (-3.7mSv CI95% -7.9 to 0mSv, p=0.05) and BMI-adapted scanning protocols (-4.5mSv CI95% -8.7 to -2.7mSv, p=0.03) were independent predictors of ED reduction. In patients with low heart rate, the best compromise between ED, Fe and Ac (2.5mSv, 97% and 98%, respectively) was obtained combining prospective ECG-gating and BMI-adapted scanning protocols, while in patients with high heart rate the strategy associated with the best results (10mSv, 98% and 97%, respectively) was the use of dual-source MDCT with retrospective ECG gating and modulation dose. In conclusion, careful selection of CT scanning protocols according to the patient's characteristics is critical for keeping the radiation exposure "as low as reasonably achievable" (ALARA) without impairing Fe and Ac.
Authors:
Gianluca Pontone; Daniele Andreini; Antonio L Bartorelli; Erika Bertella; Saima Mushtaq; Andrea Annoni; Alberto Formenti; Luisa Chiappa; Sarah Cortinovis; Andrea Baggiano; Edoardo Conte; Francesca Bovis; Fabrizio Veglia; Claudia Foti; Giovanni Ballerini; Cesare Fiorentini; Mauro Pepi
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-10-4
Journal Detail:
Title:  International journal of cardiology     Volume:  -     ISSN:  1874-1754     ISO Abbreviation:  -     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Affiliation:
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
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