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Dual-source computed tomography angiography for diagnosis and assessment of coronary artery disease: systematic
Ali Salavati1, Farid Radmanesh, Kazem Heidari
1Department of Nuclear Medicine, Center for PET/CT, Zentralklinik Bad Berka, Bad Berka 99437, Germany. salavati@gmail.com
Insights
Dual-source computed tomography coronary angiography (DSCT-CA) offers high accuracy for diagnosing coronary artery disease (CAD). This noninvasive test shows excellent sensitivity and specificity, making it a valuable tool for patient assessment.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Accuracy Studies
- Medical Technology Assessment
Background:
- Accurate noninvasive assessment of coronary arteries is crucial for diagnosing coronary artery disease (CAD).
- Traditional diagnostic methods can be invasive and carry risks.
Purpose of the Study:
- To systematically review the diagnostic accuracy of dual-source computed tomography (DSCT) for diagnosing CAD.
- To evaluate the effectiveness of DSCT coronary angiography (DSCT-CA) compared to invasive coronary angiography.
Main Methods:
- A systematic literature search was conducted across eight databases for studies published between January 2005 and March 2011.
- Studies comparing DSCT-CA with invasive coronary angiography in patients with suspected or known CAD were included.
- Meta-regression was used to analyze diagnostic performance and the impact of covariates.
Main Results:
- Twenty-five studies involving 2303 patients (per-patient analysis) showed 99% sensitivity and 89% specificity for DSCT-CA.
- Per-segment analysis (32,615 segments) yielded 94% sensitivity and 97% specificity.
- Summary likelihood ratios indicated strong diagnostic performance for DSCT-CA.
Conclusions:
- DSCT-CA demonstrates robust diagnostic performance in identifying coronary artery disease.
- The accuracy of DSCT-CA is maintained even at elevated heart rates.
- DSCT-CA is a reliable noninvasive option for CAD assessment.
Background:
Development of an accurate test for noninvasive assessment of coronary arteries has been highly desirable.
Objectives:
We performed a systematic review of diagnostic accuracy of the dual-source computed tomography (DSCT) in the diagnosis of coronary artery disease (CAD).
Methods:
Eight medical databases were searched for articles published from January 2005 through March 2011. Studies compared DSCT coronary angiography (DSCT-CA) and invasive coronary angiography, as the reference standard, in consecutive patients with suspected or known CAD, and relevant data were extracted by 2 independent reviewers. Summary diagnostic accuracies were calculated, and the effect of covariates on the diagnostic performance was evaluated by meta-regression.
Results:
Twenty-five studies were included. In per-patient analysis (n = 2303), pooled sensitivity was 99% [95% confidence interval (CI), 97%-99%] with specificity of 89% (95% CI, 84%-92%). The summary positive (+LR) and negative (-LR) likelihood ratios were 8.6 (95% CI, 6.4-11.6) and 0.02 (95% CI, 0.01-0.03), respectively. In per-segment analysis (n = 32,615), pooled sensitivity was 94% (95% CI, 92%-96%) with specificity of 97% (95% CI, 96%--98%). Summary +LR and -LR were 30.2 (95% CI, 22.1-43.5) and 0.06 (95% CI, 0.04-0.08), respectively.
Conclusions:
DSCT-CA seems to be robust to elevate heart rates while maintaining a high level of diagnostic performance.
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