Noninvasive Coronary Angiography With Multislice Computed Tomography

Abstract

CONTEXT: Multislice computed tomography (MSCT) has recently evolved as a modality for noninvasive coronary imaging. OBJECTIVE: To assess the accuracy and robustness of MSCT vs the criterion standard of invasive coronary angiography for detection of obstructive coronary artery disease. DESIGN, SETTING, AND PATIENTS: Prospective, single-center study conducted in a referral center setting in Germany and enrolling 103 consecutive patients (mean age, 61.5 [SD, 9.7] years) from November 2003-August 2004 who were undergoing both invasive coronary angiography and MSCT using a scanner with 16 detector rows. MAIN OUTCOME MEASURES: Blinded results for both modalities compared using the patient as the primary unit of analysis, with supplementary segment- and vessel-based analyses. RESULTS: One thousand three hundred eighty-four segments (> or =1.5 mm diameter) were identified by invasive coronary angiography; nondiagnostic image quality of MSCT was identified for only 88 (6.4%) of these segments, mainly due to faster heart rates. Compared with invasive coronary angiography for detection of significant lesions (>50% stenosis), segment-based sensitivity, specificity, and positive and negative predictive values of MSCT were 95%, 98%, 87%, and 99%, respectively. Quantitative comparison of MSCT and invasive coronary angiography showed good correlation (r = 0.87, P<.001), with MSCT systematically measuring greater-percentage stenoses (bias, +12%). In the patient-based analysis, the area under the receiver operating characteristic curve was 0.97 (95% confidence interval, 0.90-1.00), indicating high discriminative power to identify patients who might be candidates for revascularization (>50% left main artery stenosis and/or >70% stenosis in any other epicardial vessel). Threshold optimization allowed either detection of these patients with 100% sensitivity at a reasonable false-positive rate (specificity, 76.5%; MSCT stenosis, >66%) or optimization of both the sensitivity and specificity (>90%; MSCT stenosis, >76%). CONCLUSIONS: Multislice computed tomography provides high accuracy for noninvasive detection of suspected obstructive coronary artery disease. This promising technology has potential to complement diagnostic invasive coronary angiography in routine clinical care.