Accuracy of 64-MDCT in the diagnosis of ischemic heart disease

OBJECTIVE. The aim of this study was to evaluate the potential clinical value of a new generation of 64-MDCT systems with that of invasive coronary angiography in the diagnosis of coronary artery disease (CAD). SUBJECTS AND METHODS. Seventy-two consecutive patients with known or suspected CAD underwent both 64-MDCT and quantitative coronary angiography (QCA). A CT system with acquisition of 64 slices per gantry rotation was used with a spatial resolution of 0.4 x 0.4 x 0.4 mm and a gantry rotation time of 330 milliseconds. Sensitivity, specificity, and diagnostic accuracy of 64-MDCT in the detection or exclusion of CAD were evaluated on both a per patient and a per segment basis. RESULTS. Sixty-eight of 72 coronary CT angiograms (CTAs) (94%) were of diagnostic image quality. QCA showed significant CAD (i.e., one or more stenoses in > 50%) in 57% (39/68) and nonsignificant disease or healthy CTAs in 43% (29/68) of the patients. Sensitivity, specificity, and the negative predictive value (NPV) of 64-MDCT per patient were 97%, 79%, and 96%, respectively. Per segment, 923 of 1,020 coronary artery segments were assessable (90%). For the detection of stenoses of more than 50% and more than 75% per segment, 64-MDCT showed a sensitivity of 82% and 86%, respectively. Per segment, specificity and NPV were as high as 95% and 97%, respectively. CONCLUSION. In clinical routine, coronary CTA will primarily be used for risk stratification on a per patient basis. In the present study, coronary 64-MDCT showed a high diagnostic accuracy on both per patient and per segment analyses.