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The diagnostic performance of coronary artery angiography with 64-MSCT and post 64-MSCT: systematic review and
Min Li1, Xiang-Min Du2, Zhi-Tao Jin3
1Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China.
Insights
Coronary artery computed tomography angiography (CTA) with 64-MDCT and post 64-MDCT show comparable diagnostic performance. CTA is effective for excluding coronary artery disease (CAD) in low-risk patients and confirming it in high-risk patients.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Diagnostic Performance Evaluation
Background:
- Coronary artery disease (CAD) diagnosis relies on accurate imaging techniques.
- Multi-detector computed tomography (MDCT) has advanced coronary angiography.
- Evaluating the diagnostic utility of 64-MDCT and post-processing techniques is crucial.
Purpose of the Study:
- To comprehensively assess the diagnostic performance of 64-MDCT coronary artery angiography.
- To compare the diagnostic performance of 64-MDCT with post-processed 64-MDCT.
- To determine the clinical role of coronary artery computed tomography angiography (CTA) across different pre-test probabilities of CAD.
Main Methods:
- Systematic literature search of PubMed for studies evaluating coronary arteries with 64-MDCT and post 64-MDCT.
- Meta-analysis of 91 studies using likelihood ratios (LRs) to calculate post-test probabilities based on Bayes' theorem.
- Evaluation of diagnostic performance stratified by the inclusion of non-evaluable segments and interruptible results.
Main Results:
- Pooled positive and negative LRs at the patient level were 8.91 and 0.02, respectively.
- Areas under the summary ROC curve were 0.98 for 64-MDCT and 0.96 for post 64-MDCT.
- CTA demonstrated high diagnostic accuracy, serving as a test of exclusion for pre-test CAD probability <73% and a confirmatory test for pre-test CAD probability >73%.
Conclusions:
- The diagnostic performance of post 64-MDCT is not significantly superior to standard 64-MDCT.
- Coronary artery computed tomography angiography (CTA) is a valuable tool for both ruling out and confirming coronary artery disease.
- The interpretation of CTA results should consider the pre-test probability of coronary artery disease.
Purpose:
To comprehensively investigate the diagnostic performance of coronary artery angiography with 64-MDCT and post 64-MDCT.
Materials And Methods:
PubMed was searched for all published studies that evaluated coronary arteries with 64-MDCT and post 64-MDCT. The clinical diagnostic role was evaluated by applying the likelihood ratios (LRs) to calculate the post-test probability based on Bayes' theorem.
Results:
91 studies that met our inclusion criteria were ultimately included in the analysis. The pooled positive and negative LRs at patient level were 8.91 (95% CI, 7.53, 10.54) and 0.02 (CI, 0.01, 0.03), respectively. For studies that did not claim that non-evaluable segments were included, the pooled positive and negative LRs were 11.16 (CI, 8.90, 14.00) and 0.01 (CI, 0.01, 0.03), respectively. For studies including uninterruptable results, the diagnostic performance decreased, with the pooled positive LR 7.40 (CI, 6.00, 9.13) and negative LR 0.02 (CI, 0.01, 0.03). The areas under the summary ROC curve were 0.98 (CI, 0.97 to 0.99) for 64-MDCT and 0.96 (CI, 0.94 to 0.98) for post 64-MDCT, respectively. For references explicitly stating that the non-assessable segments were included during analysis, a post-test probability of negative results >95% and a positive post-test probability <95% could be obtained for patients with a pre-test probability of <73% for coronary artery disease (CAD). On the other hand, when the pre-test probability of CAD was >73%, the diagnostic role was reversed, with a positive post-test probability of CAD >95% and a negative post-test probability of CAD <95%.
Conclusion:
The diagnostic performance of post 64-MDCT does not increase as compared with 64-MDCT. CTA, overall, is a test of exclusion for patients with a pre-test probability of CAD<73%, while for patients with a pre-test probability of CAD>73%, CTA is a test used to confirm the presence of CAD.
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