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Role of 16-multidetector computed tomography in the assessment of coronary artery stenoses: A prospective study of consecutive patients.
MedLine Citation:
PMID:  18650996     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Recent studies have demonstrated a high sensitivity (S) of 16-multidetector computed tomography (16-MDCT) for the detection of significant coronary artery stenoses. Whether these results are applicable to clinical practice is unclear. Therefore, the aim of the present study was to compare 16-MDCT angiography with conventional coronary angiography (CCA) for the detection of significant coronary artery stenoses in a consecutive series of patients.
METHOD: A total of 93 consecutive patients (mean [+/- SD] age 59+/-9 years), in whom CCA was performed for stable angina pectoris, underwent 16-MDCT angiography (16x0.75 mm, table feed 6.5 mm/s, rotation time 0.42 s; Sensation 16, Siemens Medical Solutions, Germany) the day before performing CCA. Patients with diabetes mellitus, serum creatinine level higher than 132.6 mumol/L and/or acute coronary syndromes were excluded. Two observers blinded to CCA results evaluated MDCT angiograms according to standard criteria. Segment-based (13 segments per patient) and patient-based (at least one stenosis greater than 50% lumen diameter reduction) analyses were performed.
RESULTS: A total of 1209 segments were analyzed. Of these segments, 173 (14%) were excluded due to poor image quality or massive calcification. In 86 segments, CCA revealed significant coronary artery stenosis (greater than 50% diameter reduction). However, 16-MDCT detected only 47 of these, resulting in a S of 55% and a specificity (SP) of 97% (positive predictive value 64%; negative predictive value 96%). On a patient-based analysis, the S increased to 89%, whereas the SP still remained high (87%).
CONCLUSION: In this relatively large consecutive cohort, S for the detection of significant coronary artery stenoses was moderate on a segment-based analysis but increased on a patient-based analysis using 16-MDCT. In contrast, SP was high in both analyses, supporting the use of 16-MDCT for the exclusion of significant coronary artery stenoses. Further improvement of spatial and temporal resolution in MDCT technology may lead to a lower exclusion rate and higher S.
Authors:
Thomas Postel; Matthias Frick; Gudrun Feuchtner; Hannes Alber; Ralf Zwick; Alois Suessenbacher; Ammar Mallouhi; Guy Friedrich; Otmar Pachinger; Dieter Zur Nedden; Franz Weidinger
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Experimental and clinical cardiology     Volume:  12     ISSN:  1205-6626     ISO Abbreviation:  Exp Clin Cardiol     Publication Date:  2007  
Date Detail:
Created Date:  2008-07-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9715903     Medline TA:  Exp Clin Cardiol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  149-52     Citation Subset:  -    
Affiliation:
Division of Cardiology;
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