Cardiac

European Radiology

, Volume 16, Issue 12, pp 2739-2747

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Accuracy of dual-source CT coronary angiography: first experience in a high pre-test probability population without heart rate control

  • Hans ScheffelAffiliated withInstitute of Diagnostic Radiology, University Hospital Zurich
  • , Hatem AlkadhiAffiliated withInstitute of Diagnostic Radiology, University Hospital Zurich Email author 
  • , André PlassAffiliated withClinic for Cardiovascular Surgery
  • , Robert VachenauerAffiliated withClinic for Cardiovascular Surgery
  • , Lotus DesbiollesAffiliated withInstitute of Diagnostic Radiology, University Hospital Zurich
  • , Oliver GaemperliAffiliated withCardiovascular Center, University Hospital Zurich
  • , Tiziano SchepisAffiliated withCardiovascular Center, University Hospital Zurich
  • , Thomas FrauenfelderAffiliated withInstitute of Diagnostic Radiology, University Hospital Zurich
  • , Thomas SchertlerAffiliated withInstitute of Diagnostic Radiology, University Hospital Zurich
    • , Lars HusmannAffiliated withInstitute of Diagnostic Radiology, University Hospital Zurich
    • , Jürg GrunenfelderAffiliated withClinic for Cardiovascular Surgery
    • , Michele GenoniAffiliated withClinic for Cardiovascular Surgery
    • , Philipp A. KaufmannAffiliated withCardiovascular Center, University Hospital ZurichCenter for Integrative Human Physiology, University of Zurich
    • , Borut MarincekAffiliated withInstitute of Diagnostic Radiology, University Hospital Zurich
    • , Sebastian LeschkaAffiliated withInstitute of Diagnostic Radiology, University Hospital Zurich

Abstract

The aim of this study was to assess the diagnostic accuracy of dual-source computed tomography (DSCT) for evaluation of coronary artery disease (CAD) in a population with extensive coronary calcifications without heart rate control. Thirty patients (24 male, 6 female, mean age 63.1±11.3 years) with a high pre-test probability of CAD underwent DSCT coronary angiography and invasive coronary angiography (ICA) within 14±9 days. No beta-blockers were administered prior to the scan. Two readers independently assessed image quality of all coronary segments with a diameter ≥1.5 mm using a four-point score (1: excellent to 4: not assessable) and qualitatively assessed significant stenoses as narrowing of the luminal diameter >50%. Causes of false-positive (FP) and false-negative (FN) ratings were assigned to calcifications or motion artifacts. ICA was considered the standard of reference. Mean body mass index was 28.3±3.9 kg/m2 (range 22.4–36.3 kg/m2), mean heart rate during CT was 70.3±14.2 bpm (range 47–102 bpm), and mean Agatston score was 821±904 (range 0–3,110). Image quality was diagnostic (scores 1–3) in 98.6% (414/420) of segments (mean image quality score 1.68±0.75); six segments in three patients were considered not assessable (1.4%). DSCT correctly identified 54 of 56 significant coronary stenoses. Severe calcifications accounted for false ratings in nine segments (eight FP/one FN) and motion artifacts in two segments (one FP/one FN). Overall sensitivity, specificity, positive and negative predictive value for evaluating CAD were 96.4, 97.5, 85.7, and 99.4%, respectively. First experience indicates that DSCT coronary angiography provides high diagnostic accuracy for assessment of CAD in a high pre-test probability population with extensive coronary calcifications and without heart rate control.

Keywords

Dual-source computed tomography Coronary angiography Coronary stenosis