VOLUME

ACCURACY OF THE 256 MULTI-DETECTOR COMPUTERIZED TOMOGRAPHY IN DETECTING CORONARY ARTERY STENOSIS EXPERIENCE FROM BANGKOK HEART HOSPITAL

FEBRUARY 2011 - VOL.1 | ORIGINAL ARTICLE

OBJECTIVE.

To study the accuracy of the 256 Multi-detector Computerized Tomography (MDCT) in detecting coronary artery stenosis.

MATERIALS AND METHODS.

We retrospectively analyzed angiographic findings of patients who underwent both 256 MDCT and invasive coronary angiography (ICA). All epicardial arteries, regardless of calcium burden, were segmented into proximal, mid and distal part for comparative analysis. Significant coronary artery stenosis was defined as the reduction of luminal diameter being equal to or more than 50%. The diagnostic accuracy of 256 MDCT in coronary artery stenosis evaluation was assessed by comparing its’ sensitivity, specificity, positive and negative predictive values to the gold standard ICA.

RESULTS.

From January to December 2009, a total of 147 consecutive patients (124 male, 23 female, mean age of 60 ±12 years) underwent both MDCT and ICA were enrolled. Of total 1470 coronary segments (147 segments of LMA, 441 segments of the LAD, 441 segments of the LCx, 441 segments of the RCA), 98.9% were eligible to be assessed and only 1.1% (15/1470) were ineligible due to very high calcium clumps and severe motion artifacts. Compared to the ICA, the overall sensitivity of the 256 MDCT in detecting coronary stenosis was 88.3 %, specificity was 96.1%, positive predic- tive value was 88.1 % and the negative predictive value was 96.2% with an overall accuracy of 94.2% (p=0.20). In massive calcium scoring cases (calcium scoring ≥400 U), the sensitivity of 256 MDCT in detecting coronary artery stenosis was 90.3%, specificity was 96.1%, positive predictive value was 87.5% and the negative predictive value was 95.5%; the overall accuracy was 92.9%. In nonmassive calcium scoring cases (calcium scoring

CONCLUSION.

The 256 MDCT, regardless of calcium burden, offers a reliable diagnostic accuracy in assessing coronary artery stenosis.

Keywords:

256 MDCT angiography, Invasive coronary angiography (ICA), Calcium scoring, Coronary arterystenosis

DOI

10.31524/bkkmedj.2011.02.001

MEDIA

Table 1:

Distribution of coronary artery stenosis evaluation result using the gold standard ICA

Table 2:

Correlative findings of coronary artery stenosis between the CTA and ICA

Table 3:

Overall diagnostic accuracy of the 256 MDCT in diagnosing coronary artery stenosis comparing to the gold standard ICA

Table 4.1:

Correlative findings of coronary stenosis between the CTA and ICA in massive calcium score (CAC>400 U) subgroups

Table 4.2:

Diagnostic accuracy of the 256 MDCT in diagnosing significant coronary artery stenosis comparing to the gold standard ICA in subgroup with massive calcium score (>400)

Table 5.1:

Correlative findings of coronary stenosis between the CTA and ICA in non massive calcium score (CAC<400 U) subgroups

Table 5.2:

Diagnostic accuracy of the 256 MDCT in diagnosing coronary arterystenosis comparing to the gold standard ICA in subgroup with non massivecalcium score (<400)

Figure 1:

The images of 256 MDCT coronary angiography and ICA of a 78 year old man with history of coronary bypass graft, who came to the hospital with chest pain. The CT scan showed the total calcium volume to be more than 400 (539.8).

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