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Low-dose CT coronary angiography for the prediction of myocardial ischaemia

European Radiology volume 20, pages 56–64 (2010)Cite this article

Abstract

The purpose of this study was to prospectively determine the accuracy of low-dose computed tomography coronary angiography (CTCA) for the diagnosis of functionally relevant coronary artery disease (CAD) using cardiac magnetic resonance (CMR) as a standard of reference. Forty-one consecutive patients (age 64 ± 10 years) underwent k-space and time broad-use linear acquisition speed-up technique accelerated CMR (1.5 T) and dual-source CTCA using prospective electrocardiography gating within 1 day. CTCA lesions were analysed and diameter stenoses of more than 50% and more than 75% were compared with CMR findings taken as the reference standard for assessing the functional relevance of CAD. CMR revealed perfusion defects in 21/41 patients (51%). A total of 569 coronary segments were analysed with low-dose CTCA. The image quality of low-dose CTCA was diagnostic in 566/569 segments (99.5%) in 39/41 patients (95%). Low-dose CTCA revealed stenoses of more than 50% in 58/123 coronary arteries (47.2%) in 24/41 patients (59%) and more than 75% stenoses in 46/123 coronary arteries (37.4%) in 23/41 patients (56%). Using a greater than 50% diameter stenosis, low-dose CTCA yielded the following per artery sensitivity, specificity, positive and negative predictive values, and accuracy for the detection of perfusion defects: 89%, 79%, 72%, 92% and 83%, respectively. Low-dose CTCA is reliable for ruling out functionally relevant CAD, but is a poor predictor of myocardial ischaemia.

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Acknowledgements

H.A. and S.L. are supported by the National Center of Competence in Research, Computer Aided and Image Guided Medical Interventions of the Swiss National Science Foundation.

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Affiliations

  1. Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

    Paul Stolzmann, Olivio F. Donati, Hans Scheffel, Stephan Baumueller, Sebastian Leschka, Borut Marincek & Hatem Alkadhi

  2. Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland

    Naim Azemaj, André Plass & Jürg Grünenfelder

  3. Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland

    Sebastian Kozerke & Peter Boesiger

Authors
  1. Paul Stolzmann
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  2. Olivio F. Donati
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Correspondence to Hatem Alkadhi.

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Stolzmann, P., Donati, O.F., Scheffel, H. et al. Low-dose CT coronary angiography for the prediction of myocardial ischaemia. Eur Radiol 20, 56–64 (2010). https://doi.org/10.1007/s00330-009-1536-x

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  • DOI: https://doi.org/10.1007/s00330-009-1536-x

Keywords

  • Computed tomography
  • Myocardial perfusion imaging
  • Magnetic resonance imaging
  • Coronary artery disease
  • Myocardial ischaemia
  • Low dose