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

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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

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Authors and Affiliations

  1. Institute for Diagnostic and Interventional Radiology, J.W. Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany

    Christopher Herzog, Joern O. Balzer, M. G. Mack, Stefan Zangos & Thomas J. Vogl

  2. Department of Cardiology, J.W. Goethe University, Frankfurt/Main, Germany

    Martina Britten & Volker Schaechinger

  3. Department of Epidemiology and Medical Statistics, J.W. Goethe University, Frankfurt/Main, Germany

    Hanns Ackermann

  4. Division of CT, Siemens Medical Inc., Forchheim, Germany

    Stefan Schaller & Thomas Flohr

Authors
  1. Christopher Herzog
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  2. Martina Britten
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  3. Joern O. Balzer
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  4. M. G. Mack
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  5. Stefan Zangos
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  6. Hanns Ackermann
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  7. Volker Schaechinger
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  8. Stefan Schaller
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  9. Thomas Flohr
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  10. Thomas J. Vogl
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Corresponding author

Correspondence to Christopher Herzog.

Additional information

M. Britten and C. Herzog contributed equally to this study

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Herzog, C., Britten, M., Balzer, J.O. et al. Multidetector-row cardiac CT: diagnostic value of calcium scoring and CT coronary angiography in patients with symptomatic, but atypical, chest pain. Eur Radiol 14, 169–177 (2004). https://doi.org/10.1007/s00330-003-2197-9

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  • DOI: https://doi.org/10.1007/s00330-003-2197-9

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