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Clinical Value of MDCT in the Diagnosis of Coronary Artery Disease in Patients with a Low Pretest Likelihood of Significant Disease

¹ Department of Clinical Radiology, University Hospitals-Grosshadern, Ludwig-Maximilians University of Munich, Grosshadern Campus, Marchioninistr. 15, Munich 81377, Germany.
² Bracco Altana Pharma GmbH, Konstanz, Germany.
³ Worldwide Medical Affairs, Bracco Imaging SpA, Milan, Italy.
⁴ Department of Cardiology, University Hospitals-Grosshadern, Ludwig-Maximilians University of Munich, Munich, Germany.

OBJECTIVE. The aim of this study was to evaluate the clinical value of MDCT in the diagnosis of coronary artery disease in a population having a low pretest likelihood of significant disease.

SUBJECTS AND METHODS. Sixty-four patients with suspected coronary artery disease and a low pretest likelihood of significant disease according to the criteria of the American Heart Association underwent both MDCT of the heart and quantitative conventional coronary angiography (QCA). MDCT examinations were performed on a 16-MDCT scanner. CT data sets were evaluated on a per-patient basis and a per-segment basis and were classified as indicating no disease, nonsignificant disease (stenoses 50%), or significant disease (stenoses > 50%). Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 16-MDCT in the detection or exclusion of significant and nonsignificant coronary artery disease were evaluated on both per-patient and per-segment bases.

RESULTS. Regarding the success rate of 16-MDCT, 94% (60/64) of patients and 92% (388/420) of vessel segments were of sufficient quality for diagnosis. In the remaining 60 patients evaluated, QCA revealed significant coronary artery disease, nonsignificant disease, and no disease in 8.3% (5/60), 75.0% (45/60), and 16.7% (10/60) of cases, respectively, on a per-patient basis, and in 1.3% (5/388), 23.2% (90/388), and 75.5% (293/388) of cases, respectively, on a per-segment basis. The sensitivity, specificity, NPV, and PPV of 16-MDCT for the detection of significant coronary artery disease were 80.0%, 94.5%, 98.1%, and 57.1%, respectively, on a per-patient basis, and 80.0%, 99.2%, 99.7%, and 57.1% on a per-segment basis.

CONCLUSION. In a population having a low pretest likelihood of significant coronary artery disease, 16-MDCT shows a moderate to high sensitivity and high NPV for the detection or exclusion of significant disease, but has a somewhat reduced PPV compared with QCA.

Keywords: angiography • atherosclerosis • coronary artery disease • MDCT

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