Cardiac

European Radiology

, Volume 20, Issue 1, pp 81-87

First online:

Diagnostic accuracy of computed tomography coronary angiography in patients with a zero calcium score

  • Filippo CademartiriAffiliated withDepartment of Radiology and Cardiology, Azienda Ospedaliero-Universitaria di ParmaDepartment of Radiology and Cardiology, Erasmus Medical CenterDepartment of Radiology, Azienda Ospedaliero-Universitaria—Parma Email author 
  • , Erica MaffeiAffiliated withDepartment of Radiology and Cardiology, Azienda Ospedaliero-Universitaria di Parma
  • , Alessandro PalumboAffiliated withDepartment of Radiology and Cardiology, Azienda Ospedaliero-Universitaria di ParmaDepartment of Radiology and Cardiology, Erasmus Medical Center
  • , Chiara MartiniAffiliated withDepartment of Radiology and Cardiology, Azienda Ospedaliero-Universitaria di ParmaDepartment of Radiology and Cardiology, Erasmus Medical Center
  • , Sara SeitunAffiliated withDepartment of Radiology and Cardiology, Azienda Ospedaliero-Universitaria di Parma
  • , Carlo TedeschiAffiliated withDepartment of Radiology and Cardiology, Ospedale San Gennaro
  • , Roberto De RosaAffiliated withDepartment of Radiology and Cardiology, Ospedale San Gennaro
  • , Teresa ArcadiAffiliated withDepartment of Radiology, University Hospital
  • , Ignazio SalamoneAffiliated withDepartment of Radiology, University Hospital
    • , Alfredo BlandinoAffiliated withDepartment of Radiology, University Hospital
    • , Annick C. WeustinkAffiliated withDepartment of Radiology and Cardiology, Erasmus Medical Center
    • , Nico R. MolletAffiliated withDepartment of Radiology and Cardiology, Erasmus Medical Center
    • , Pim J. De FeyterAffiliated withDepartment of Radiology and Cardiology, Erasmus Medical Center
    • , Gabriel P. KrestinAffiliated withDepartment of Radiology and Cardiology, Erasmus Medical Center

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Abstract

To evaluate the diagnostic accuracy of 64-slice CT coronary angiography (CT-CA) for the detection of significant coronary artery stenosis in patients with zero on the Agatston Calcium Score (CACS). We enrolled 279 consecutive patients (96 male, mean age 48 ± 12 years) with suspected coronary artery disease. Patients were symptomatic (n = 208) or asymptomatic (n = 71), and underwent conventional coronary angiography (CAG). For CT-CA we administered an IV bolus of 100 ml of iodinated contrast material. CT-CA was compared to CAG using a threshold for significant stenosis of ≥50%. The prevalence of disease demonstrated at CAG was 15% (1.4% in asymptomatic). The population at CAG showed no or non-significant disease in 85% (238/279), single vessel disease in 9% (25/279), and multi-vessel disease in 6% (16/279). Sensitivity, specificity, and positive and negative predictive values of CT-CA vs. CAG on the patient level were 100%, 95%, 76%, and 100% in the overall population and 100%, 100%, 100%, and 100% in asymptomatic patients, respectively. CT-CA proves high diagnostic performance in patients with or without symptoms and with zero CACS. The prevalence of significant disease detected by CT-CA was not negligible in asymptomatic patients. The role of CT-CA in asymptomatic patients remains uncertain.

Keywords

Multidetector computed tomography Conventional coronary angiography Coronary artery disease Calcium score Asymptomatic