Clinical research study
64-Slice CT for Diagnosis of Coronary Artery Disease: A Systematic Review

https://doi.org/10.1016/j.amjmed.2008.02.039Get rights and content

Abstract

Purpose

The purpose of this systematic review was to assess the accuracy of 64-slice CT coronary angiography for the diagnosis of coronary artery disease.

Methods

We attempted to identify all published trials in all languages that used 64-slice CT to diagnose coronary artery disease. Results of 64-slice CT coronary angiography were compared with invasive coronary angiography or intravascular ultrasound.

Results

Sensitivity of 64-slice CT for significant (≥50%) stenosis, based on pooled data from all studies, was ≥90% in patient-based evaluations, named vessels, segments, and coronary artery bypass grafts, except the left circumflex (sensitivity 88%), distal segments (80%), and stents (88%). Specificity was 88% in patient-based evaluations, and ≥90% at individual sites. Positive predictive values for patient-based evaluations, left main coronary artery, and coronary artery bypass grafts ranged from 91% to 93%, but elsewhere ranged from 69% to 84%. Negative predictive values were 96% to 100%. Positive likelihood ratios for patient-based evaluations were 8.0 and, at specific sites, were ≥9.7. Negative likelihood ratios, except for distal segments, were <0.1.

Conclusion

Negative 64-slice CT reliably excluded significant coronary disease. However, the data suggest that stenoses shown on 64-slice CT require confirmation. Combining the results of 64-slice CT with a pre-CT clinical probability assessment would strengthen the diagnosis. Due to the risk of radiation-induced cancer, patients should be selected carefully for this test, and scan protocols should be optimized to minimize risk.

Section snippets

Methods

We used several sources to guide our review process, including recommendations by Lijmer et al concerning avoidance of bias in studies of diagnostic tests,2 review of methods of systematic review,3 and the Standards for Reporting Diagnostic Accuracy statement for reporting studies of diagnostic accuracy.4

Results

All but 3 investigators5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 25, 26, 27, 28, 29, 30, 31, 33, 34, 35, 36, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49 used a Siemens Somatom 64 (Siemens Medical Solutions, Erlangen, Germany) exclusively. Cademartiri et al used both a Siemens Sensation 64 and an Aquilion 64 (Toshiba Medical Systems, Tochigi Prefecture, Japan).24 An Aquilion 64 was used exclusively by 2 groups.32, 37 Reasons for the individual investigations were

Discussion

Sensitivity of 64-slice CT coronary angiography, for significant stenosis, based on pooled data from all studies, was ≥90% in patient-based evaluations, named vessels, and segments, except the left circumflex (sensitivity 88%), distal segments (80%), and stents (88%). Specificity was 88% in patient-based evaluations, and ≥90% for all individual sites.

Compared with 16-slice CT, the sensitivity of 64-slice CT coronary angiography for significant stenosis was higher in patient-based analyses, 98%

Conclusion

Sixty-four-slice CT coronary angiography in most vessels and segments of vessels is sensitive and specific. A positive 64-slice CT in the left main coronary artery and in coronary artery bypass grafts showed few false positives. At other sites, positive predictive values, due to the low prevalence of disease at any specific site, suggest that stenoses shown on 64-slice CT require confirmation. A negative 64-slice CT coronary angiogram reliably excluded significant coronary artery disease.

References (56)

  • C. Caussin et al.

    Comparison of coronary minimal lumen area quantification by sixty-four-slice computed tomography versus intravascular ultrasound for intermediate stenosis

    Am J Cardiol

    (2006)
  • W.B. Meijboom et al.

    Comparison of diagnostic accuracy of 64-slice computed tomography coronary angiography in women versus men with angina pectoris

    Am J Cardiol

    (2007)
  • D. Oncel et al.

    Detection of significant coronary artery stenosis with 64-section MDCT angiography

    Eur J Radiol

    (2007)
  • A.A. Shabestari et al.

    Diagnostic performance of 64-channel multislice computed tomography in assessment of significant coronary artery disease in symptomatic subjects

    Am J Cardiol

    (2007)
  • T.K. Ong et al.

    Accuracy of 64-row multidetector computed tomography in detecting coronary artery disease in 134 symptomatic patients: influence of calcification

    Am Heart J

    (2006)
  • R. Jabara et al.

    Comparison of multidetector 64-slice computed tomographic angiography to coronary angiography to assess the patency of coronary artery bypass grafts

    Am J Cardiol

    (2007)
  • J.D. Schuijf et al.

    Diagnostic accuracy of 64-slice multislice computed tomography in the noninvasive evaluation of significant coronary artery disease

    Am J Cardiol

    (2006)
  • J.J. Fine et al.

    Comparison of accuracy of 64-slice cardiovascular computed tomography with coronary angiography in patients with suspected coronary artery disease

    Am J Cardiol

    (2006)
  • S. Ghostine et al.

    Non-invasive detection of coronary artery disease in patients with left bundle branch block using 64-slice computed tomography

    J Am Coll Cardiol

    (2006)
  • W.B. Meijboom et al.

    Pre-operative computed tomography coronary angiography to detect significant coronary artery disease in patients referred for cardiac valve surgery

    J Am Coll Cardiol

    (2006)
  • H. Scheffel et al.

    Accuracy of 64-slice computed tomography for the preoperative detection of coronary artery disease in patients with chronic aortic regurgitation

    Am J Cardiol

    (2007)
  • P.D. Stein et al.

    Multidetector CT for the diagnosis of coronary artery disease: a systematic review

    Am J Med

    (2006)
  • P.D. Stein et al.

    Usefulness of 4-, 8-, and 16-slice computed tomography for detection of graft occlusion or patency after coronary artery bypass grafting

    Am J Cardiol

    (2005)
  • J.G. Lijmer et al.

    Empirical evidence of design-related bias in studies of diagnostic tests

    JAMA

    (1999)
  • D.J. Cook et al.

    Systematic reviews: synthesis of best evidence for clinical decisions

    Ann Intern Med

    (1997)
  • P.M. Bossuyt et al.

    The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration

    Ann Intern Med

    (2003)
  • N.R. Mollet et al.

    High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography

    Circulation

    (2005)
  • F. Pugliese et al.

    Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris

    Eur Radiol

    (2006)
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