Accuracy of MSCT Coronary Angiography with 64 Row CT Scanner—Facing the Facts

Improvements in multislice computed tomography (MSCT) angiography of the coronary vessels have enabled the minimally invasive detection of coronary artery stenoses, while quantitative coronary angiography (QCA) is the accepted reference standard for evaluation thereof. Sixteen-slice MSCT showed promising diagnostic accuracy in detecting coronary artery stenoses haemodynamically and the subsequent introduction of 64-slice scanners promised excellent and fast results for coronary artery studies. This prompted us to evaluate the diagnostic accuracy, sensitivity, specificity, and the negative und positive predictive value of 64-slice MSCT in the detection of haemodynamically significant coronary artery stenoses. Thirty-seven consecutive subjects with suspected coronary artery disease were evaluated with MSCT angiography and the results compared with QCA. All vessels were considered for the assessment of significant coronary artery stenosis (diameter reduction ≥ 50%). Thirteen patients (35%) were identified as having significant coronary artery stenoses on QCA with 6.3% (35/555) affected segments. None of the coronary segments were excluded from analysis. Overall sensitivity for classifying stenoses of 64-slice MSCT was 69%, specificity was 92%, positive predictive value was 38% and negative predictive value was 98%. The interobserver variability for detection of significant lesions had a κ-value of 0.43. Sixty-four-slice MSCT offers the diagnostic potential to detect coronary artery disease, to quantify haemodynamically significant coronary artery stenoses and to avoid unnecessary invasive coronary artery examinations.

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Abstract 5803: Optimal Threshold for Multi Detector Computer Tomography to Detect Physiologically Significant Stenosis in Patients with Ischemic Heart Disease

Circulation ◽

10.1161/circ.118.suppl_18.s_106-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Takashi Yamano ◽

Atsushi Tanaka ◽

Takashi Tanimoto ◽

Shigeho Takarada ◽

Hiroki Kitabata ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Optimal Threshold ◽

Fractional Flow ◽

Significant Stenosis ◽

Artery Disease

PURPOSE: Sixty-four multi detector computed tomography angiography (64-MDCT) has emerged as a rapidly developing method for the noninvasive detection of coronary artery disease with high negative predictive value and relatively low positive predictive value, especially in patients with intermediate-severity coronary artery disease (ISCAD). There are, however, few studies regarding with optimal threshold for detection of physiologically significant stenosis in 64-MDCT. The purpose of this study was to investigate the optimal threshold for 64-MDCT to detect physiologically significant stenosis using fractional flow reserve of the myocardium (FFRmyo) in patients with ISCAD. METHODS: We enrolled single lesions detected by 64-MDCT of 64 ISCAD patients (age, 68.3 +/− 10.2 years; 78% male). FFRmyo </= 0.75 measured by a 0.014-inch pressure wire was used as the gold standard for presence of physiologically significant stenosis. The area stenosis (%AS) in 64-MDCT were compared with the results of FFRmyo and percent diameter stenosis (%DS) in quantitative coronary angiography (QCA) during elective coronary angiography. Using receiver operating characteristic (ROC) analysis, the optimum threshold for percent area stenosis (%AS) in 64-MDCT was determined in the prediction of FFRmyo </= 0.75. RESULTS: There was an inverse correlation between %AS in 64-MDCT and FFRmyo (65 +/− 20 % and 0.71 +/− 0.16, respectively; r = −0.67; p < 0.01). Furthermore, there was a positive correlation between %AS in 64-MDCT and %DS in QCA (65 +/− 20 % and 63 +/− 19 %, respectively; r = 0.69; p < 0.01). Using a cutoff of 62 %AS in 64-MDCT, ROC curve analysis shows 79 % sensitivity, 85 % specificity, 82% positive predictive value, 83% negative predictive value and 83% accuracy for detecting physiologically significant stenosis. CONCLUSION: > 62 %AS in 64-MDCT could predict the physiologically significant coronary stenosis in patients with ISCAD. Applying an alternative threshold to detect physiologically significant stenosis might contribute to improve the diagnostic accuracy for 64-MDCT in patients with ISCAD.

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Retraction Note: Diagnostic accuracy of 320-row computed tomography as compared with invasive coronary angiography in unselected, consecutive patients with suspected coronary artery disease

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-014-0400-5 ◽

2014 ◽

Vol 30 (4) ◽

pp. 833-833

Author(s):

F. Pelliccia ◽

V. Pasceri ◽

A. Evangelista ◽

A. Pergolini ◽

F. Barillà ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Diagnostic Accuracy ◽

Invasive Coronary Angiography ◽

Suspected Coronary Artery Disease ◽

Artery Disease

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Abstract 15233: The Lesion Length Gives a Better Effect on the Fractional Flow Reserve Than the Minimal Luminal Area in the Intermediate Coronary Artery Lesion

Circulation ◽

10.1161/circ.132.suppl_3.15233 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Yoon Juneyoung ◽

Xiongjie Jin ◽

Kyong-Woo Seo ◽

Jin-sun Park ◽

Hyoung-Mo Yang ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Area Under The Curve ◽

Lesion Length ◽

Visual Estimation ◽

Luminal Area ◽

Artery Disease

Introduction: The pressure gradient of the circulation fluid in a stenosis area depends on minimal luminal area (MLA) of the stenosis, lesion length (LL), and the fluid velocity. However, the correlation of the LL and the MLA; the cutoff values are uncertain. Hypothesis: LL and MLA differently influences the FFR. Methods: We studied 117 patients with intermediate coronary artery disease who underwent FFR and IVUS measurement out of 302 patients in FAVOR study. This study was a prospective, 1:1 randomized, open label multicenter trial to demonstrate the clinical outcomes between FFR and IVUS-guided PCI. Inclusion criteria were as follows: 1)Angina or documented silent ischemia 2) De novo intermediate coronary artery disease (30-70% diameter stenosis) by visual estimation, 3) Reference vessel diameter ≥ 3.0mm by visual estimation. We excluded left main disease, MI, EF< 40%, and graft vessel. There were no significant differences in baseline clinical characteristics. The mean values are the QCA (54.3±14.0 %), MLA (3.6±1.4 mm2) and LL (20.6±1.4mm), respectively. We were performed the path analysis using AMOS 18, and estimated the ROC curve in SPSS 18. Results: Standardized estimates were the LL -0.47,QCA -0.28 and MLA -0.21 (R2=0.594, p<0.000) in path analysis. The model is recursive and statistically significant. The FFR was ≤0.80 in 47 lesions (31%). The optimal LL for an FFR of ≤0.80 was 15.8mm (90% sensitivity, 50% specificity, 44% positive predictive value, 87% negative predictive value, area under the curve: 0.75, 95% CI: 0.66 to 0.85; p < 0.001) and MLA 3.9mm (sensitivity 86%, specificity 59%, 35% positive predictive value , 94% negative predictive value, area under the curve: 0.78, 95% CI: 0.67 to 0.85; p < 0.001) Conclusions: The lesion length influenced more the FFR than MLA. The lesion length ≥ 15.8mm and MLA ≤ 3.9mm are risk zones, which need to be confirm the functional status with FFR because of the low positive predictive value

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