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Published on: August 28, 2018
Multi-Detector Coronary CT Imaging for the Identification of Coronary Artery Stenoses in a "Real-World" Population
Amgad N Makaryus1, Sonia Henry2, Lee Loewinger2
1North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, New York, USA. ; Department of Cardiology, NuHealth, Nassau University Medical Center, East Meadow, NY, USA.
Insights
64-detector computed tomography (CT) accurately assesses coronary artery disease in real-world patients. This non-invasive tool shows high diagnostic accuracy for significant coronary stenoses, comparable to conventional angiography.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Multi-detector computed tomography (CT) is a key non-invasive tool for assessing coronary artery disease (CAD).
- Previous studies often excluded diverse "real-world" patient populations, limiting applicability.
- This study addresses the diagnostic accuracy of 64-detector CT (64-CT) in a broad clinical setting.
Purpose of the Study:
- To compare the accuracy of 64-detector CT (64-CT) against conventional coronary angiography (CA).
- To evaluate 64-CT's effectiveness in diagnosing significant coronary stenoses within a typical clinical patient group.
Main Methods:
- 1,818 consecutive patients referred for 64-CT were analyzed.
- CT angiography was performed using GE LightSpeed VCT.
- Forty-one patients with significant stenoses on 64-CT subsequently underwent CA for direct comparison.
Main Results:
- Analysis included 164 coronary arteries and 410 segments from 41 patients.
- Per-vessel analysis at 50% stenosis: 86% sensitivity, 84% specificity, 85% accuracy.
- Per-segment analysis at 50% stenosis: 77% sensitivity, 93% specificity, 91% accuracy.
Conclusions:
- 64-detector CT (64-CT) demonstrates high diagnostic accuracy for significant coronary artery disease in a real-world clinical population.
- While sensitivity and specificity may be lower than in select prior studies, the results reflect typical clinical practice.
- 64-CT is a valuable non-invasive imaging modality for assessing significant CAD in everyday practice.
Background:
Multi-detector computed tomography (CT) has emerged as a modality for the non-invasive assessment of coronary artery disease (CAD). Prior studies have selected patients for evaluation and have excluded many of the "real-world" patients commonly encountered in daily practice. We compared 64-detector-CT (64-CT) to conventional coronary angiography (CA) to investigate the accuracy of 64-CT in determining significant coronary stenoses in a "real-world" clinical population.
Methods:
A total of 1,818 consecutive patients referred for 64-CT were evaluated. CT angiography was performed using the GE LightSpeed VCT (GE(®) Healthcare). Forty-one patients in whom 64-CT results prompted CA investigation were further evaluated, and results of the two diagnostic modalities were compared.
Results:
A total of 164 coronary arteries and 410 coronary segments were evaluated in 41 patients (30 men, 11 women, age 39-85 years) who were identified by 64-CT to have significant coronary stenoses and who thereafter underwent CA. The overall per-vessel sensitivity, specificity, positive predictive value, negative predictive value, and accuracy at the 50% stenosis level were 86%, 84%, 65%, 95%, and 85%, respectively, and 77%, 93%, 61%, 97%, and 91%, respectively, in the per-segment analysis at the 50% stenosis level.
Conclusion:
64-CT is an accurate imaging tool that allows a non-invasive assessment of significant CAD with a high diagnostic accuracy in a "real-world" population of patients. The sensitivity and specificity that we noted are not as high as those in prior reports, but we evaluated a population of patients that is typically encountered in clinical practice and therefore see more "real-world" results.
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