European Radiology

, Volume 22, Issue 12, pp 2688–2698 | Cite as

Diagnostic performance of coronary CT angiography for stenosis detection according to calcium score: systematic review and meta-analysis

  • Martijn A. M. den Dekker
  • Kristof de Smet
  • Geertruida H. de Bock
  • Rene A. Tio
  • Matthijs Oudkerk
  • Rozemarijn Vliegenthart



A systematic review and meta-analysis to assess sensitivity and specificity of coronary CT angiography (CCTA) for significant stenosis at different degrees of coronary calcification.


A literature search was performed including studies describing test characteristics of CCTA for significant stenosis, performed with at least 16-MDCT and according to calcium score (CS). Invasive coronary angiography was the reference standard. Pooled sensitivity and specificity of CCTA by CS categories and CT equipment were calculated.


Of 14,121 articles, 51 studies reported on the impact of calcium scoring on diagnostic performance of CCTA and could be included in the systematic review. Twenty-seven of these studies (5,203 participants) were suitable for meta-analysis. On a patient-basis, sensitivity of CCTA for significant stenosis was 95.8, 95.6, 97.6 and 99.0% for CS 0–100, 101–400, 401–1,000 and >1,000 respectively. Specificity was 91.2, 88.2, 50.6 and 84.0% respectively. Specificity of CCTA was significantly lower for CS 401–1,000 due to lack of patients without significant stenosis. Sensitivity and specificity of 16-MDCT were significantly lower compared to more modern CT systems.


Even in cases of severe coronary calcification, sensitivity and specificity of CCTA for significant stenosis are high. With 64-MDCT and newer CT systems, a CS cut-off for performing CCTA no longer seems indicated.

Key Points

Decisions about performing coronary CT angiography (CCTA) sometimes depend on calcium scoring.

CCTA is highly sensitive for coronary stenosis.

With 16-MDCT, however, heavy calcification reduces specificity for significant stenosis.

For 64-MDCT (and above), CCTA has high specificity, even with severe coronary calcification.


Computed tomography angiography Calcium score Coronary artery disease Meta-analysis Systematic review 



Coronary artery disease


Coronary CT angiography


Calcium score


Dual-source CT


Multidetector CT


Quality assessment of diagnostic accuracy studies

Supplementary material

330_2012_2551_MOESM1_ESM.doc (352 kb)
Supplementary Material(DOC 351 kb)


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Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Martijn A. M. den Dekker
    • 1
  • Kristof de Smet
    • 4
  • Geertruida H. de Bock
    • 2
  • Rene A. Tio
    • 3
  • Matthijs Oudkerk
    • 1
  • Rozemarijn Vliegenthart
    • 1
  1. 1.Center for Medical Imaging – North East Netherlands, Department of RadiologyUniversity of Groningen / University Medical Center GroningenGroningenThe Netherlands
  2. 2.Center for Medical Imaging – North East Netherlands, Department of EpidemiologyUniversity of Groningen / University Medical Center GroningenGroningenThe Netherlands
  3. 3.Department of CardiologyUniversity of Groningen / University Medical Center GroningenGroningenThe Netherlands
  4. 4.Department of RadiologyUniversity of BrusselsBrusselsBelgium

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