Document Detail


A systematic review on diagnostic accuracy of CT-based detection of significant coronary artery disease.
MedLine Citation:
PMID:  17590554     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Systematic review of diagnostic accuracy of contrast enhanced coronary computed tomography (CE-CCT). BACKGROUND: Noninvasive detection of coronary artery stenosis (CAS) by CE-CCT as an alternative to catheter-based coronary angiography (CCA) may improve patient management. METHODS: Forty-one articles published between 1997 and 2006 were included that evaluated native coronary arteries for significant stenosis and used CE-CCT as diagnostic test and CCA as reference standard. Study group characteristics, study methodology and diagnostic outcomes were extracted. Pooled summary sensitivity and specificity of CE-CCT were calculated using a random effects model (1) for all coronary segments, (2) assessable segments, and (3) per patient. RESULTS: The 41 studies totaled 2515 patients (75% males; mean age: 59 years, CAS prevalence: 59%). Analysis of all coronary segments yielded a sensitivity of 95% (80%, 89%, 86%, 98% for electron beam CT, 4/8-slice, 16-slice and 64-slice MDCT, respectively) for a specificity of 85% (77%, 84%, 95%, 91%). Analysis limited to segments deemed assessable by CT showed sensitivity of 96% (86%, 85%, 98%, 97%) for a specificity of 95% (90%, 96%, 96%, 96%). Per patient, sensitivity was 99% (90%, 97%, 99%, 98%) and specificity was 76% (59%, 81%, 83%, 92%). Heterogeneity was quantitatively important but not explainable by patient group characteristics or study methodology. CONCLUSIONS: Current diagnostic accuracy of CE-CCT is high. Advances in CT technology have resulted in increases in diagnostic accuracy and proportion of assessable coronary segments. However, per patient, accuracy may be lower and CT may have more limited clinical utility in populations at high risk for CAD.
Authors:
Bertrand Janne d'Othée; Uwe Siebert; Ricardo Cury; Hossein Jadvar; Edward J Dunn; Udo Hoffmann
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Publication Detail:
Type:  Journal Article; Review     Date:  2007-06-27
Journal Detail:
Title:  European journal of radiology     Volume:  65     ISSN:  0720-048X     ISO Abbreviation:  Eur J Radiol     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-02-26     Completed Date:  2008-06-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8106411     Medline TA:  Eur J Radiol     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  449-61     Citation Subset:  IM    
Affiliation:
Beth Israel Deaconess Medical Center, Department of Radiology, Harvard Medical School, 330 Brookline Avenue, W/CC-385, Boston, MA 02215-5400, United States. bjanne@bidmc.harvard.edu
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MeSH Terms
Descriptor/Qualifier:
Contrast Media
Coronary Disease / radiography*
Humans
ROC Curve
Sensitivity and Specificity
Tomography, X-Ray Computed / methods*
Chemical
Reg. No./Substance:
0/Contrast Media

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