J Korean Soc Radiol.  2010 Sep;63(3):205-215. 10.3348/jksr.2010.63.3.205.

Diagnostic Accuracy of 64-slice Dual-source Computed Tomography in the Detection of Coronary Artery Stenosis based on Patient Heart Rate and Calcium Scores

• Kim EY
• Jin GY
• Han YM
• Kwak HS
• Chae JK
• Lee SR
• Kwon KS

• KMID: 2097894
• DOI: http://doi.org/10.3348/jksr.2010.63.3.205

Abstract

PURPOSE: To assess the diagnostic accuracy of dual-source computed tomography (DSCT) in the detection of coronary artery stenosis (CAS) based on patient heart rate and calcium scores.
MATERIALS AND METHODS
This study included 102 patients (46 male, 56 female; mean age 64.1 +/- 10.6 years; age range 37-92 years) with chest pain and who underwent DSCT as well as invasive coronary angiography. Patients were classified into three groups according to mean heart rate (<70 bpm, 70-90 bpm, and >90 bpm) and also classified in three groups according to Agatston calcium scores (<100, 100-400, and >400).
RESULTS
For patients with a mean heart rate <70 bpm, the sensitivity, specificity, PPV, NPV, and diagnostic accuracy of DSCT on a per-vessel basis were 98.5%, 98.2%, 93.6%, 99.1%, and 97.9%, respectively, 99.2%, 99.2%, 97.4%, 99.5%, and 99%, respectively, for 70-90 bpm; and 91.7%, 97.9%, 88.5%, 96.7%, and 95.7%, respectively, for >90 bpm. For calcium scores <100, the sensitivity, specificity, PPV, NPV, and diagnostic accuracy of DSCT on a per-vessel basis were 97.2%, 99.0%, 97.0%, 99.3%, and 98.6%, respectively, 98.5%, 99.5%, 96.2%, 99.4%, and 99.0%, respectively, for calcium scores 100-400, and 95.8%, 97.0%, 87.4%, 97.2%, and 95.6%, respectively, for calcium scores >400.
CONCLUSION
DSCT showed a high diagnostic accuracy and negative predictive value, regardless of heart rate and calcium score.

MeSH Terms

Calcium
Chest Pain
Coronary Angiography
Coronary Artery Disease
Coronary Stenosis
Coronary Vessels
Heart
Heart Rate
Humans
Male
Mustard Compounds
Sensitivity and Specificity
Tomography, X-Ray Computed
Calcium
Mustard Compounds

Figure

• 

  Fig. 1 A 53-year-old female patient with substernal chest pain (mean heart rate during scanning: 61 bpm, Agatston score 0). A-C. Coronary CT angiography (CCTA) using DSCT. Left anterior descending coronary artery (LAD) shows a diffuse, moderate (>50%) stenosis in the mid segment (arrow). D. Invasive coronary angiography (ICA). The mid segment of the LAD shows a significant stenosis in the left anterior oblique projection (arrow). The detection and grade of coronary artery stenosis is the same between coronary CTA and ICA.

• 

  Fig. 2 A 49-year-old male patient with dyspnea (mean heart rate during scanning of 78 bpm and an Agatston score of 0). A-C. CTA using DSCT. The LAD shows discrete, severe stenosis in the mid segment (arrow), due to non-calcified plaque. D. ICA. The mid segment of the LAD shows significant stenosis in a left anterior oblique projection. The detection and grade of coronary artery stenosis is the same between coronary CTA and ICA (arrow).

• 

  Fig. 3 A 73-year-old male patient with chest discomfort (mean heart rate during scanning of 106 bpm and an Agatston score of 280.3). A-C. CTA using DSCT. A curved multiplanar reformation (cMPR) and the coronary tree of the RCA shows diffuse, moderate (>50%) stenosis in the proximal segment due to mixed plaque (arrow). Tracing the axial view of cMPR shows moderate (>50%) stenosis of the coronary artery due to ellipsoidal calcified plaque. D. ICA in left anterior oblique projection confirms significant stenosis (arrow).

• 

  Fig. 4 A 51-year-old male patient with dyspnea (mean heart rate during scanning of 90 bpm and an Agatston Score of 2594.5). A. Maximum intensity projection image shows diffuse calcification on coronary arteries which cannot detect and grade a stenotic site of coronary artery. B. cMPR image of the LAD, LCX, and RCA shows diffuse, severe stenosis, due to extensive calcified plaques. Axial tracing of a cMPR image shows severe stenosis of the proximal LAD, due to a horseshoe-shaped calcification (arrow) and diagnosed triple vessels disease. C. ICA in a left anterior oblique profection confirms sinificant stenosis in proximal LAD of the same site with Fig. B (arrow) and triple vessel disease, consequently.

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