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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Diagnostic accuracy of computed tomography coronary angiography utilizing recent advances in technology in patients
Gordon T W Mander1,2, Karen Dobeli3, Caitlin Steffensen4,2
1Department of Medical Imaging, Toowoomba Hospital, Darling Downs Hospital and Health Service, Toowoomba, Australia.
Insights
This review assesses computed tomography coronary angiography (CTCA) for diagnosing coronary artery disease (CAD) in adults with high heart rates. Recent CTCA technologies show promise for improving diagnostic accuracy in this patient group.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Accuracy Studies
- Medical Technology Assessment
Background:
- Invasive coronary angiography is the gold standard for diagnosing coronary artery disease (CAD), but it is invasive and costly.
- Computed tomography coronary angiography (CTCA) offers a non-invasive alternative but can be limited by image quality in patients with elevated heart rates.
- Advancements in CT scanner technology may enhance CTCA's diagnostic performance, particularly in challenging patient populations.
Purpose of the Study:
- To evaluate the diagnostic accuracy of contemporary computed tomography coronary angiography (CTCA) technologies for detecting coronary artery disease (CAD).
- To specifically assess CTCA performance in adults experiencing elevated heart rates (greater than 65 beats per minute).
- To determine if recent technological improvements in CT scanners enhance CTCA's accuracy for CAD diagnosis.
Main Methods:
- Systematic review and meta-analysis of diagnostic test accuracy studies.
- Inclusion of studies published from 2007 onwards, in English, focusing on adults (≥18 years) with heart rates >65 bpm.
- Comparison of CTCA against invasive coronary angiography as the reference standard, utilizing CT scanners with ≥128 detector-rows and prospective ECG-gated acquisition.
Main Results:
- Data extraction and quality assessment performed independently by two reviewers.
- Meta-analysis will be conducted where feasible to synthesize findings.
- A GRADE Summary of Findings will be presented to assess the certainty of evidence.
Conclusions:
- This review will provide crucial insights into the diagnostic utility of modern CTCA for CAD detection in patients with high heart rates.
- Findings will inform clinical decision-making regarding the appropriate use of CTCA in this demographic.
- The study aims to clarify the role of advanced CTCA technology in non-invasively diagnosing coronary artery disease.
Objective:
The objective of this review is to determine the diagnostic accuracy of computed tomography coronary angiography (CTCA) using recent scan technologies for detecting coronary artery disease (CAD) in adults with high heart rates.
Introduction:
Invasive coronary angiography is the gold standard for detecting significant CAD, but it is costly and carries risks of complications. Computed tomography coronary angiography has a high sensitivity for diagnosing CAD, although image quality may be affected by elevated heart rates. Recent technological advances in scanner design may increase the diagnostic accuracy of CTCA.
Inclusion Criteria:
This review will consider diagnostic test accuracy studies that include adults 18 years and older with a heart rate greater than 65 beats per minute who have undergone CTCA to diagnose CAD (greater than 50% stenosis). Eligible studies will compare invasive coronary angiography with computed tomography scanner technologies that use either single- or dual-source scanner configuration in prospective electrocardiogram scan acquisition mode, and with a total scanner coverage equal to or greater than 128 detector-rows. Studies published in English from 2007 will be considered.
Methods:
PubMed, Embase, CINAHL and Scopus will be searched, along with Google Scholar, the NIHR-HTA register, computed tomography vendors and conference abstracts. Screening of potential titles and abstracts, retrieval of full-text studies, assessment of methodological quality and data extraction will be performed independently by two reviewers. Meta-analyses will be performed, if possible, and a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Summary of Findings presented.
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