Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease: Patient- versus segment-based analysis

Udo Hoffmann, Fabian Moselewski, Ricardo C. Cury, Maros Ferencik, Ik Kyung Jang, Larry J. Diaz, Suhny Abbara, Thomas J. Brady, Stephan Achenbach

Research output: Contribution to journalArticle

383 Citations (Scopus)

Abstract

Background-In this study, we investigated the diagnostic value and limitations of multidetector computed tomography (MDCT)-based noninvasive detection of significant obstructive coronary artery disease (CAD) in a consecutive high-risk patient population with inclusion of all coronary segments. Methods and Results-In a prospective, blinded, standard cross-sectional technology assessment, a cohort of 33 consecutive patients with a positive stress test result underwent 16-slice MDCT and selective coronary angiography for the detection of significant obstructive CAD. We assessed the diagnostic accuracy of MDCT in a segment-based and a patient-based model and determined the impact of stenosis location and the presence of calcification on diagnostic accuracy in both models. Analysis of all 530 coronary segments demonstrated moderate sensitivity (63%) and excellent specificity (96%) with a moderate positive predictive value of 64% and an excellent negative predictive value (NPV) of 96% for the detection of significant coronary stenoses. Assessment restricted to either proximal coronary segments or segments with excellent image quality (83% of all segments) led to an increase in sensitivity (70% and 82%, respectively), and high specificities were maintained (94% and 93%, respectively). In a patient-based model, the NPV of MDCT for significant CAD was limited to 75%. Coronary calcification was the major cause of false-positive findings (94%). Conclusions-For all coronary segments included, 16-slice MDCT has moderate diagnostic value for the detection of significant obstructive coronary artery stenosis in a population with a high prevalence of CAD. The moderate NPV of patient-based detection of CAD suggests a limited impact on clinical decision-making in high-risk populations.

Original languageEnglish (US)
Pages (from-to)2638-2643
Number of pages6
JournalCirculation
Volume110
Issue number17
DOIs
StatePublished - Oct 26 2004

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Multidetector Computed Tomography
Spiral Computed Tomography
Coronary Artery Disease
Coronary Stenosis
Population
Biomedical Technology Assessment
Coronary Angiography
Exercise Test
Pathologic Constriction

Keywords

  • Atherosclerosis
  • Coronary disease
  • Tomography

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease : Patient- versus segment-based analysis. / Hoffmann, Udo; Moselewski, Fabian; Cury, Ricardo C.; Ferencik, Maros; Jang, Ik Kyung; Diaz, Larry J.; Abbara, Suhny; Brady, Thomas J.; Achenbach, Stephan.

In: Circulation, Vol. 110, No. 17, 26.10.2004, p. 2638-2643.

Research output: Contribution to journalArticle

Hoffmann, Udo ; Moselewski, Fabian ; Cury, Ricardo C. ; Ferencik, Maros ; Jang, Ik Kyung ; Diaz, Larry J. ; Abbara, Suhny ; Brady, Thomas J. ; Achenbach, Stephan. / Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease : Patient- versus segment-based analysis. In: Circulation. 2004 ; Vol. 110, No. 17. pp. 2638-2643.
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abstract = "Background-In this study, we investigated the diagnostic value and limitations of multidetector computed tomography (MDCT)-based noninvasive detection of significant obstructive coronary artery disease (CAD) in a consecutive high-risk patient population with inclusion of all coronary segments. Methods and Results-In a prospective, blinded, standard cross-sectional technology assessment, a cohort of 33 consecutive patients with a positive stress test result underwent 16-slice MDCT and selective coronary angiography for the detection of significant obstructive CAD. We assessed the diagnostic accuracy of MDCT in a segment-based and a patient-based model and determined the impact of stenosis location and the presence of calcification on diagnostic accuracy in both models. Analysis of all 530 coronary segments demonstrated moderate sensitivity (63{\%}) and excellent specificity (96{\%}) with a moderate positive predictive value of 64{\%} and an excellent negative predictive value (NPV) of 96{\%} for the detection of significant coronary stenoses. Assessment restricted to either proximal coronary segments or segments with excellent image quality (83{\%} of all segments) led to an increase in sensitivity (70{\%} and 82{\%}, respectively), and high specificities were maintained (94{\%} and 93{\%}, respectively). In a patient-based model, the NPV of MDCT for significant CAD was limited to 75{\%}. Coronary calcification was the major cause of false-positive findings (94{\%}). Conclusions-For all coronary segments included, 16-slice MDCT has moderate diagnostic value for the detection of significant obstructive coronary artery stenosis in a population with a high prevalence of CAD. The moderate NPV of patient-based detection of CAD suggests a limited impact on clinical decision-making in high-risk populations.",
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T1 - Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease

T2 - Patient- versus segment-based analysis

AU - Hoffmann, Udo

AU - Moselewski, Fabian

AU - Cury, Ricardo C.

AU - Ferencik, Maros

AU - Jang, Ik Kyung

AU - Diaz, Larry J.

AU - Abbara, Suhny

AU - Brady, Thomas J.

AU - Achenbach, Stephan

PY - 2004/10/26

Y1 - 2004/10/26

N2 - Background-In this study, we investigated the diagnostic value and limitations of multidetector computed tomography (MDCT)-based noninvasive detection of significant obstructive coronary artery disease (CAD) in a consecutive high-risk patient population with inclusion of all coronary segments. Methods and Results-In a prospective, blinded, standard cross-sectional technology assessment, a cohort of 33 consecutive patients with a positive stress test result underwent 16-slice MDCT and selective coronary angiography for the detection of significant obstructive CAD. We assessed the diagnostic accuracy of MDCT in a segment-based and a patient-based model and determined the impact of stenosis location and the presence of calcification on diagnostic accuracy in both models. Analysis of all 530 coronary segments demonstrated moderate sensitivity (63%) and excellent specificity (96%) with a moderate positive predictive value of 64% and an excellent negative predictive value (NPV) of 96% for the detection of significant coronary stenoses. Assessment restricted to either proximal coronary segments or segments with excellent image quality (83% of all segments) led to an increase in sensitivity (70% and 82%, respectively), and high specificities were maintained (94% and 93%, respectively). In a patient-based model, the NPV of MDCT for significant CAD was limited to 75%. Coronary calcification was the major cause of false-positive findings (94%). Conclusions-For all coronary segments included, 16-slice MDCT has moderate diagnostic value for the detection of significant obstructive coronary artery stenosis in a population with a high prevalence of CAD. The moderate NPV of patient-based detection of CAD suggests a limited impact on clinical decision-making in high-risk populations.

AB - Background-In this study, we investigated the diagnostic value and limitations of multidetector computed tomography (MDCT)-based noninvasive detection of significant obstructive coronary artery disease (CAD) in a consecutive high-risk patient population with inclusion of all coronary segments. Methods and Results-In a prospective, blinded, standard cross-sectional technology assessment, a cohort of 33 consecutive patients with a positive stress test result underwent 16-slice MDCT and selective coronary angiography for the detection of significant obstructive CAD. We assessed the diagnostic accuracy of MDCT in a segment-based and a patient-based model and determined the impact of stenosis location and the presence of calcification on diagnostic accuracy in both models. Analysis of all 530 coronary segments demonstrated moderate sensitivity (63%) and excellent specificity (96%) with a moderate positive predictive value of 64% and an excellent negative predictive value (NPV) of 96% for the detection of significant coronary stenoses. Assessment restricted to either proximal coronary segments or segments with excellent image quality (83% of all segments) led to an increase in sensitivity (70% and 82%, respectively), and high specificities were maintained (94% and 93%, respectively). In a patient-based model, the NPV of MDCT for significant CAD was limited to 75%. Coronary calcification was the major cause of false-positive findings (94%). Conclusions-For all coronary segments included, 16-slice MDCT has moderate diagnostic value for the detection of significant obstructive coronary artery stenosis in a population with a high prevalence of CAD. The moderate NPV of patient-based detection of CAD suggests a limited impact on clinical decision-making in high-risk populations.

KW - Atherosclerosis

KW - Coronary disease

KW - Tomography

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