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European Radiology

, Volume 14, Issue 2, pp 169–177 | Cite as

Multidetector-row cardiac CT: diagnostic value of calcium scoring and CT coronary angiography in patients with symptomatic, but atypical, chest pain

  • Christopher HerzogEmail author
  • Martina Britten
  • Joern O. Balzer
  • M. G. Mack
  • Stefan Zangos
  • Hanns Ackermann
  • Volker Schaechinger
  • Stefan Schaller
  • Thomas Flohr
  • Thomas J. Vogl
Cardiac

Abstract

The aim of this study was to investigate the accuracy of multidetector-row cardiac CT (MDCT), calcium scoring (Ca-Sc), and MDCT coronary angiography (MD CTA) in the assessment of coronary atherosclerosis. Thirty-eight patients underwent invasive coronary angiography (CA) and MDCT (collimation 4×1 mm, pitch 1.5 mm, TI 500 ms, 120 kV, 300 mAs, and retrospective ECG-gating). Calcium scoring was calculated for the total coronary artery territory and for RCA, LCA, and LCX separately. The MD CTA served to assess the degree and the localization of stenoses. All findings were compared to invasive coronary angiography. Approximately 68.4% (390 of 570) of all coronary segments could be visualized by MDCT. Correlation coefficient for MD CTA and CA amounted to r=0.58, showing distinct differences for the individual segments. Proximal segments generally showed better correlation (range 0.81–0.77) than medial segments (range 0.91–0.20), distal segments (range 0.55–0.04), or side branches (range 0.76–0.00). Patients with hemodynamically relevant (>75%) stenoses were detected by MD CTA with 72.2% sensitivity (13 of 18) and 100% specificity (20 of 20). For Ca-Sc sensitivity ranged between 94.7% (17 of 18) and 66.7% (12 of 18), specificity between 20% (4 of 20) and 80% (16 of 20) respectively, depending on the prevailing cutoff value. Combination of both methods led to 83.3% sensitivity (15 of 18) and 100% specificity (20 of 20), reaching no level of significance as compared with Ca-Sc (p=0.73) or MD CTA (p=0.23) alone. Calcium scoring as a single method showed highest sensitivity in the detection of coronary atherosclerosis but at the expense of low specificity. In patients with no or moderate calcifications, combination with MD CTA helped to distinctly increase specificity and NPV

Keywords

Multislice CT Coronary angiography Calcium scoring Coronary atherosclerosis Coronary arteries 

References

  1. 1.
    Wexler L, Brundage B, Crouse J, Detrano R, Fuster V, Maddahi J et al. (1996) Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications: a statement for health professionals from the American Heart Association. Circulation 94:1175–1192PubMedGoogle Scholar
  2. 2.
    Becker CR, Schoepf UJ, Reiser MF (2001) Methods for quantification of coronary artery calcifications with electron-beam and conventional CT and pushing the spiral CT envelope: new cardiac applications. Int J Cardiovasc Imaging 17:203–211CrossRefPubMedGoogle Scholar
  3. 3.
    Becker CR, Knez A, Leber A, Treede H, Ohnesorge B, Schoepf UJ et al. (2002) Detection of coronary artery stenoses with multislice helical CT angiography. J Comput Assist Tomogr 26:750–755CrossRefPubMedGoogle Scholar
  4. 4.
    Fischbach R, Heindel W (2000) Detection and quantification of coronary calcification: an update. Fortschr Rontgenstr 172:407–414CrossRefGoogle Scholar
  5. 5.
    Hong C, Becker CR, Schoepf UJ, Ohnesorge B, Bruening R, Reiser M (2002) Coronary artery calcium: absolute quantification in non-enhanced and contrast-enhanced multi-detector row CT studies. Radiology 223:474–480PubMedGoogle Scholar
  6. 6.
    Kopp AF, Ohnesorge B, Becker C, Schroder S, Heuschmid M, Kuttner A et al. (2002) Reproducibility and accuracy of coronary calcium measurements with multi-detector row versus electron-beam CT. Radiology 225:113–119PubMedGoogle Scholar
  7. 7.
    Ohnesorge B, Flohr T, Fischbach R, Kopp AF, Knez A, Schroder S et al. (2002) Reproducibility of coronary calcium quantification in repeat examinations with retrospectively ECG-gated multisection spiral CT. Eur Radiol 12:1532–1540CrossRefPubMedGoogle Scholar
  8. 8.
    Stanford W, Thompson BH (1999) Imaging of coronary artery calcification: its importance in assessing atherosclerotic disease. Radiol Clin North Am 37:257–272PubMedGoogle Scholar
  9. 9.
    American College of Cardiology/American Heart Association (2000) Expert consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery diseaese. Circulation 102:126–140PubMedGoogle Scholar
  10. 10.
    Bormann JL, Stanford W, Stenberg RG (1992) Ultrafast tomographic detection of coronary artery calcification as an indicator of stenosis. Am J Card Imaging 6:191–196Google Scholar
  11. 11.
    Falk E (1983) Plaque rupture with severe pre-existing stenosis precipitating coronary thrombosis: characteristics of coronary atherosclerotic plaques underlying fatal occlusive thrombi. Br Heart J 50:127–134PubMedGoogle Scholar
  12. 12.
    Schmermund A, Baumgart D, Gorge G, Seibel R, Gronemeyer D, Ge J et al. (1997) Coronary artery calcium in acute coronary syndromes: a comparative study of electron-beam computed tomography, coronary angiography, and intracoronary ultrasound in survivors of acute myocardial infarction and unstable angina. Circulation 96:1461–1469PubMedGoogle Scholar
  13. 13.
    Flohr T, Ohnesorge B (2001) Heart-rate-adaptive optimization of spatial and temporal resolution for electrocardiogram-gated multislice spiral CT of the heart. J Comput Assist Tomogr 25:907–923CrossRefPubMedGoogle Scholar
  14. 14.
    Fuchs T, Krause J, Schaller S, Flohr T, Kalender WA (2000) Spiral interpolation algorithms for multislice spiral CT. Part II: Measurement and evaluation of slice sensitivity profiles and noise at a clinical multislice system. IEEE Trans Med Imaging 19:835–847PubMedGoogle Scholar
  15. 15.
    Ohnesorge B, Flohr T, Becker C, Kopp AF, Schoepf UJ, Baum U et al. (2000) Cardiac imaging by means of electrocardiographically gated multisection spiral CT: initial experience. Radiology 217:564–571PubMedGoogle Scholar
  16. 16.
    Kopp AF, Schroeder S, Baumbach A, Kuettner A, Georg C, Ohnesorge B et al. (2001) Non-invasive characterisation of coronary lesion morphology and composition by multislice CT: first results in comparison with intracoronary ultrasound. Eur Radiol 11:1607–1611CrossRefPubMedGoogle Scholar
  17. 17.
    Becker CR, Knez A, Leber A, Hong C, Treede H, Wildhirt S et al. (2000) Initial experiences with multi-slice detector spiral CT in diagnosis of arteriosclerosis of coronary vessels. Radiologe 40:118–122PubMedGoogle Scholar
  18. 18.
    Vogl TJ, Abolmaali ND, Diebold T, Engelmann K, Ay M, Dogan S et al. (2002) Techniques for the detection of coronary atherosclerosis: multi-detector row CT coronary angiography. Radiology 223:212–220PubMedGoogle Scholar
  19. 19.
    Diamond GA, Forrester JS (1979) Analysis of probability as an aid in the clinical diagnosis of coronary artery disease. N Engl J Med 300:1350–1358PubMedGoogle Scholar
  20. 20.
    Ohnesorge B, Flohr T, Becker C, Knez A, Kopp AF, Fukuda K et al. (2000) Cardiac imaging with rapid, retrospective ECG-synchronized multilevel spiral CT. Radiologe 40:111–117PubMedGoogle Scholar
  21. 21.
    Herzog C, Abolmaali N, Balzer JO, Baunach S, Ackermann H, Dogan S et al. (2002) Heart-rate-adapted image reconstruction in multidetector-row cardiac CT: influence of physiological and technical prerequisite on image quality. Eur Radiol 12:2670–2678PubMedGoogle Scholar
  22. 22.
    American College of Cardiology/American Heart Association (1991) Guidelines for cardiac catheterization and cardiac catheterization laboratories. American College of Cardiology/American Heart Association Ad Hoc Task Force on Cardiac Catheterization. J Am Coll Cardiol 18:1149–1182PubMedGoogle Scholar
  23. 23.
    Bowker A (1948) A test for symmetry in contingency tables. J Am Stat Assoc 43:572–574Google Scholar
  24. 24.
    Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832PubMedGoogle Scholar
  25. 25.
    Rumberger JA, Brundage BH, Rader DJ, Kondos G (1999) Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc 74:243–252PubMedGoogle Scholar
  26. 26.
    Becker CR, Knez A, Ohnesorge B, Schoepf UJ, Flohr T, Bruening R et al. (2000) Visualization and quantification of coronary calcifications with electron beam and spiral computed tomography. Eur Radiol 10:629–635CrossRefPubMedGoogle Scholar
  27. 27.
    Becker CR, Kleffel T, Crispin A, Knez A, Young J, Schoepf UJ et al. (2001) Coronary artery calcium measurement: agreement of multirow detector and electron beam CT. Am J Roentgenol 176:1295–1298Google Scholar
  28. 28.
    Achenbach S, Daniel WG, Moshage W (2001) Recommendations for standardization of EBT and MSCT scanning. Herz 26:273–277PubMedGoogle Scholar
  29. 29.
    Becker CR, Ohnesorge BM, Schoepf UJ, Reiser MF (2000) Current development of cardiac imaging with multidetector-row CT. Eur J Radiol 36:97–103CrossRefPubMedGoogle Scholar
  30. 30.
    Nieman K, Oudkerk M, Rensing BJ, van Ooijen P, Munne A, van Geuns RJ et al. (2001) Coronary angiography with multi-slice computed tomography. Lancet 357:599–603PubMedGoogle Scholar
  31. 31.
    Kopp AF, Schroeder S, Kuettner A (2000) Multidetector-row CT for non-invasive coronary angiography: results in 102 patients. Radiology 217:487PubMedGoogle Scholar
  32. 32.
    Fischbach R, Wichter T, Juergens KU (2001) Multidetector-row spiral CT of the coronary arteries: comparison with coronary angiography. Fortschr Roentgenstr 173:26Google Scholar
  33. 33.
    Jakobs TF, Becker CR, Wintersperger BJ, Herzog P, Ohnesorge B, Flohr T et al. (2002) CT angiography of the coronary arteries with a 16-row spiral tomograph: effect of spatial resolution on image quality. Radiologe 42:733–738Google Scholar
  34. 34.
    Kopp AF, Heuschmid M, Claussen CD (2002) Multidetector helical CT of the liver for tumor detection and characterization. Eur Radiol 12:745–752CrossRefPubMedGoogle Scholar
  35. 35.
    Wintersperger BJ, Herzog P, Jakobs T, Reiser MF, Becker CR (2002) Initial experience with the clinical use of a 16-detector-row CT system. Crit Rev Comput Tomogr 43:283–316PubMedGoogle Scholar
  36. 36.
    Ulzheimer S, Kalender WA (2003) Assessment of calcium scoring performance in cardiac computed tomography. Eur Radiol 13:484–497PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Christopher Herzog
    • 1
    Email author
  • Martina Britten
    • 2
  • Joern O. Balzer
    • 1
  • M. G. Mack
    • 1
  • Stefan Zangos
    • 1
  • Hanns Ackermann
    • 3
  • Volker Schaechinger
    • 2
  • Stefan Schaller
    • 4
  • Thomas Flohr
    • 4
  • Thomas J. Vogl
    • 1
  1. 1.Institute for Diagnostic and Interventional RadiologyJ.W. Goethe University FrankfurtFrankfurt/MainGermany
  2. 2.Department of CardiologyJ.W. Goethe UniversityFrankfurt/MainGermany
  3. 3.Department of Epidemiology and Medical StatisticsJ.W. Goethe UniversityFrankfurt/MainGermany
  4. 4.Division of CTSiemens Medical Inc.ForchheimGermany

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