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Meta-Analysis of 40- and 64-MDCT Angiography for Assessing Coronary Artery Stenosis

¹ All authors: Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.

OBJECTIVE. The purpose of our study was to assess the diagnostic performance of thin-slice ( 0.625 mm) MDCT coronary angiography compared with invasive coronary angiography for the detection of significant ( 50%) stenosis.

MATERIALS AND METHODS. Twenty-two articles on 40- and 64-MDCT coronary angiography were included. Sensitivity and specificity were calculated on a per-patient and per-segment basis; in addition, proximal versus distal segments were evaluated. The effect of nonevaluable patients, nonevaluable segments, and disease prevalence on diagnostic performance was assessed.

RESULTS. Pooled sensitivity on a patient level was 97.7% ([95% CI] 96.2–98.7%) and specificity 91.0% (88.5–93.1%). Pooled sensitivity on a segmental level was 90.8% (89.0–92.4%) and specificity 95.7% (95.2–96.1%); for proximal segments, respectively, 94.2% (92.3–95.7%) and 94.1% (93.4–94.8%), and for distal segments 84.8% (81.1–88.0%) and 96.9% (96.4–97.4%). If nonevaluable MDCT investigations were included, the per-patient specificity was reduced from 91.0% to 89.1% (p > 0.05) when allocating excluded patients as having significant coronary artery stenosis, and the sensitivity was reduced from 97.7% to 96.2% (p > 0.05) when allocating excluded patients as not having significant stenosis. The per-patient prevalence of coronary artery stenosis had no significant influence on the sensitivity for detecting significant stenosis.

CONCLUSION. Forty- and 64-MDCT provide good-to-excellent performance in detecting or ruling out significant coronary artery stenosis, with better results for proximal than for distal coronary artery segments.

Keywords: cardiac • coronary angiography • CT • diagnostic imaging • stenoses

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