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Published on: September 22, 2023
64-slice CT for diagnosis of coronary artery disease: a systematic review
Paul D Stein1, Abdo Y Yaekoub, Fadi Matta
1St. Joseph Mercy Oakland Hospital, Pontiac, MI 48341-5023, USA. steinp@trinity-health.org
Insights
64-slice CT coronary angiography accurately rules out significant coronary artery disease, with high sensitivity and negative predictive values. However, positive findings require confirmation, and careful patient selection is advised due to radiation risks.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Accuracy
- Radiology
Background:
- Coronary artery disease (CAD) diagnosis relies on accurate imaging.
- 64-slice CT coronary angiography offers a non-invasive imaging option.
- Assessing the diagnostic performance of this technology is crucial.
Purpose of the Study:
- To systematically review and assess the diagnostic accuracy of 64-slice CT coronary angiography for CAD.
- To compare 64-slice CT results against invasive coronary angiography and intravascular ultrasound.
Main Methods:
- Systematic literature search for all published trials on 64-slice CT for CAD diagnosis.
- Meta-analysis of pooled data comparing 64-slice CT with gold-standard diagnostic methods.
Main Results:
- High sensitivity (>90%) for significant stenosis in most evaluations, except for specific segments and stents.
- High specificity (>88%) and excellent negative predictive values (96-100%) indicating reliable exclusion of disease.
- Variable positive predictive values (69-93%) suggest potential for false positives, necessitating confirmation.
Conclusions:
- 64-slice CT coronary angiography is effective in reliably excluding significant coronary artery disease.
- Positive findings on 64-slice CT may require confirmation with other diagnostic methods.
- Optimizing scan protocols and careful patient selection are essential to mitigate radiation risks.
Purpose:
The purpose of this systematic review was to assess the accuracy of 64-slice CT coronary angiography for the diagnosis of coronary artery disease.
Methods:
We attempted to identify all published trials in all languages that used 64-slice CT to diagnose coronary artery disease. Results of 64-slice CT coronary angiography were compared with invasive coronary angiography or intravascular ultrasound.
Results:
Sensitivity of 64-slice CT for significant (> or =50%) stenosis, based on pooled data from all studies, was > or =90% in patient-based evaluations, named vessels, segments, and coronary artery bypass grafts, except the left circumflex (sensitivity 88%), distal segments (80%), and stents (88%). Specificity was 88% in patient-based evaluations, and > or =90% at individual sites. Positive predictive values for patient-based evaluations, left main coronary artery, and coronary artery bypass grafts ranged from 91% to 93%, but elsewhere ranged from 69% to 84%. Negative predictive values were 96% to 100%. Positive likelihood ratios for patient-based evaluations were 8.0 and, at specific sites, were > or =9.7. Negative likelihood ratios, except for distal segments, were <0.1.
Conclusion:
Negative 64-slice CT reliably excluded significant coronary disease. However, the data suggest that stenoses shown on 64-slice CT require confirmation. Combining the results of 64-slice CT with a pre-CT clinical probability assessment would strengthen the diagnosis. Due to the risk of radiation-induced cancer, patients should be selected carefully for this test, and scan protocols should be optimized to minimize risk.
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