Skip to main content
Top
Published in: European Radiology 9/2011

01-09-2011 | Cardiac

Accuracy of coronary artery stenosis detection with CT versus conventional coronary angiography compared with composite findings from both tests as an enhanced reference standard

Authors: J. Matthias Kerl, U. Joseph Schoepf, Peter L. Zwerner, Ralf W. Bauer, Joseph A. Abro, Christian Thilo, Thomas J. Vogl, Christopher Herzog

Published in: European Radiology | Issue 9/2011

Login to get access

Abstract

Objective

To prospectively compare the accuracy of coronary CT angiography (CCTA) and conventional coronary angiography (CCA) for stenosis detection using composite findings from both tests as an enhanced reference standard.

Methods

One hundred thirteen patients underwent CCTA and CCA. Per-segment and per-patient accuracy of CCTA compared with initial CCA interpretation were determined. Angiographers were then unblinded to the CCTA results and re-evaluation of the CCA studies was performed with knowledge of CCTA findings, which was used as an enhanced reference standard to compare the diagnostic accuracy of CCTA versus CCA.

Results

When using the enhanced reference standard instead of initial CCA interpretation, CCTA accuracy for identifying segments (patients) with ≥50% stenosis increased from 97.7% (96.5%) to 98.1% (98.2%), sensitivity from 90.5% (100%) to 90.8% (100%), and specificity from 98.4% (94.3%) to 98.9% (97.1%). CCTA identified six segments and two patients with stenoses ≥50% missed on initial CCA interpretation. Compared with the enhanced reference standard the accuracies of CCTA and of initial CCA interpretation were not different (p = 0.87).

Conclusion

CCTA compares favourably with CCA for stenosis detection. Use of a composite reference standard combining findings from both tests can control for the effect of false-negative CCA results when evaluating the accuracy of CCTA.
Literature
1.
go back to reference Budoff MJ, Dowe D, Jollis JG et al (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive coronary angiography) trial. J Am Coll Cardiol 52:1724–1732PubMedCrossRef Budoff MJ, Dowe D, Jollis JG et al (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive coronary angiography) trial. J Am Coll Cardiol 52:1724–1732PubMedCrossRef
2.
go back to reference Miller JM, Rochitte CE, Dewey M et al (2008) Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 359:2324–2336PubMedCrossRef Miller JM, Rochitte CE, Dewey M et al (2008) Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 359:2324–2336PubMedCrossRef
3.
go back to reference Becker CR, Knez A, Leber A et al (2002) Detection of coronary artery stenoses with multislice helical CT angiography. J Comput Assist Tomogr 26:750–755PubMedCrossRef Becker CR, Knez A, Leber A et al (2002) Detection of coronary artery stenoses with multislice helical CT angiography. J Comput Assist Tomogr 26:750–755PubMedCrossRef
4.
go back to reference Hoffmann MH, Shi H, Schmitz BL et al (2005) Noninvasive coronary angiography with multislice computed tomography. JAMA 293:2471–2478PubMedCrossRef Hoffmann MH, Shi H, Schmitz BL et al (2005) Noninvasive coronary angiography with multislice computed tomography. JAMA 293:2471–2478PubMedCrossRef
5.
go back to reference Nieman K, Cademartiri F, Lemos PA, Raaijmakers R, Pattynama PM, de Feyter PJ (2002) Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography. Circulation 106:2051–2054PubMedCrossRef Nieman K, Cademartiri F, Lemos PA, Raaijmakers R, Pattynama PM, de Feyter PJ (2002) Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography. Circulation 106:2051–2054PubMedCrossRef
6.
go back to reference Stein PD, Yaekoub AY, Matta F, Sostman HD (2008) 64-slice CT for diagnosis of coronary artery disease: a systematic review. Am J Med 121:715–725PubMedCrossRef Stein PD, Yaekoub AY, Matta F, Sostman HD (2008) 64-slice CT for diagnosis of coronary artery disease: a systematic review. Am J Med 121:715–725PubMedCrossRef
7.
go back to reference Mowatt G, Cook JA, Hillis GS et al (2008) 64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart 94:1386–1393PubMedCrossRef Mowatt G, Cook JA, Hillis GS et al (2008) 64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart 94:1386–1393PubMedCrossRef
8.
go back to reference De Scheerder I, De Man F, Herregods MC et al (1994) Intravascular ultrasound versus angiography for measurement of luminal diameters in normal and diseased coronary arteries. Am Heart J 127:243–251PubMedCrossRef De Scheerder I, De Man F, Herregods MC et al (1994) Intravascular ultrasound versus angiography for measurement of luminal diameters in normal and diseased coronary arteries. Am Heart J 127:243–251PubMedCrossRef
9.
go back to reference Grondin CM, Dyrda I, Pasternac A, Campeau L, Bourassa MG, Lesperance J (1974) Discrepancies between cineangiographic and postmortem findings in patients with coronary artery disease and recent myocardial revascularization. Circulation 49:703–708PubMed Grondin CM, Dyrda I, Pasternac A, Campeau L, Bourassa MG, Lesperance J (1974) Discrepancies between cineangiographic and postmortem findings in patients with coronary artery disease and recent myocardial revascularization. Circulation 49:703–708PubMed
10.
go back to reference Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA (2009) ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: a report by the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 53:530–553PubMedCrossRef Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA (2009) ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: a report by the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 53:530–553PubMedCrossRef
11.
go back to reference Diamond GA, Forrester JS (1979) Analysis of probability as an aid in the clinical diagnosis of coronary artery disease. N Engl J Med 300:1350–1358PubMedCrossRef Diamond GA, Forrester JS (1979) Analysis of probability as an aid in the clinical diagnosis of coronary artery disease. N Engl J Med 300:1350–1358PubMedCrossRef
12.
go back to reference Schoepf UJ, Zwerner PL, Savino G, Herzog C, Kerl JM, Costello P (2007) Coronary CT Angiography. Radiology 244:48–63PubMedCrossRef Schoepf UJ, Zwerner PL, Savino G, Herzog C, Kerl JM, Costello P (2007) Coronary CT Angiography. Radiology 244:48–63PubMedCrossRef
13.
go back to reference American College of Cardiology/American Heart Association Ad Hoc Task Force on Cardiac Catheterization (1991) American College of Cardiology/American Heart Association. Guidelines for cardiac catheterization and cardiac catheterization laboratories. J Am Coll Cardiol 84:1149–1182 American College of Cardiology/American Heart Association Ad Hoc Task Force on Cardiac Catheterization (1991) American College of Cardiology/American Heart Association. Guidelines for cardiac catheterization and cardiac catheterization laboratories. J Am Coll Cardiol 84:1149–1182
14.
15.
go back to reference Boden WE, O'Rourke RA, Teo KK et al (2007) Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 356:1503–1516PubMedCrossRef Boden WE, O'Rourke RA, Teo KK et al (2007) Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 356:1503–1516PubMedCrossRef
16.
17.
go back to reference Marano R, De Cobelli F, Floriani I et al (2009) Italian multicenter, prospective study to evaluate the negative predictive value of 16- and 64-slice MDCT imaging in patients scheduled for coronary angiography (NIMISCAD-Non Invasive Multicenter Italian Study for Coronary Artery Disease). Eur Radiol 19:1114–1123PubMedCrossRef Marano R, De Cobelli F, Floriani I et al (2009) Italian multicenter, prospective study to evaluate the negative predictive value of 16- and 64-slice MDCT imaging in patients scheduled for coronary angiography (NIMISCAD-Non Invasive Multicenter Italian Study for Coronary Artery Disease). Eur Radiol 19:1114–1123PubMedCrossRef
18.
go back to reference Pugliese F, Mollet NR, Runza G et al (2006) Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris. Eur Radiol 16:575–582PubMedCrossRef Pugliese F, Mollet NR, Runza G et al (2006) Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris. Eur Radiol 16:575–582PubMedCrossRef
19.
go back to reference Husmann L, Herzog BA, Gaemperli O et al (2009) Diagnostic accuracy of computed tomography coronary angiography and evaluation of stress-only single-photon emission computed tomography/computed tomography hybrid imaging: comparison of prospective electrocardiogram triggering vs. retrospective gating. Eur Heart J 30:600–607PubMedCrossRef Husmann L, Herzog BA, Gaemperli O et al (2009) Diagnostic accuracy of computed tomography coronary angiography and evaluation of stress-only single-photon emission computed tomography/computed tomography hybrid imaging: comparison of prospective electrocardiogram triggering vs. retrospective gating. Eur Heart J 30:600–607PubMedCrossRef
20.
go back to reference Flohr TG, McCollough CH, Bruder H et al (2006) First performance evaluation of a dual-source CT (DSCT) system. Eur Radiol 16:256–268PubMedCrossRef Flohr TG, McCollough CH, Bruder H et al (2006) First performance evaluation of a dual-source CT (DSCT) system. Eur Radiol 16:256–268PubMedCrossRef
21.
go back to reference Johnson TR, Nikolaou K, Busch S et al (2007) Diagnostic accuracy of dual-source computed tomography in the diagnosis of coronary artery disease. Invest Radiol 42:684–691PubMedCrossRef Johnson TR, Nikolaou K, Busch S et al (2007) Diagnostic accuracy of dual-source computed tomography in the diagnosis of coronary artery disease. Invest Radiol 42:684–691PubMedCrossRef
22.
go back to reference Ropers U, Ropers D, Pflederer T et al (2007) Influence of heart rate on the diagnostic accuracy of dual-source computed tomography coronary angiography. J Am Coll Cardiol 50:2393–2398PubMedCrossRef Ropers U, Ropers D, Pflederer T et al (2007) Influence of heart rate on the diagnostic accuracy of dual-source computed tomography coronary angiography. J Am Coll Cardiol 50:2393–2398PubMedCrossRef
23.
go back to reference Alkadhi H, Scheffel H, Desbiolles L et al (2008) Dual-source computed tomography coronary angiography: influence of obesity, calcium load, and heart rate on diagnostic accuracy. Eur Heart J 29:766–776PubMedCrossRef Alkadhi H, Scheffel H, Desbiolles L et al (2008) Dual-source computed tomography coronary angiography: influence of obesity, calcium load, and heart rate on diagnostic accuracy. Eur Heart J 29:766–776PubMedCrossRef
24.
go back to reference Husmann L, Schepis T, Scheffel H et al (2008) Comparison of diagnostic accuracy of 64-slice computed tomography coronary angiography in patients with low, intermediate, and high cardiovascular risk. Acad Radiol 15:452–461PubMedCrossRef Husmann L, Schepis T, Scheffel H et al (2008) Comparison of diagnostic accuracy of 64-slice computed tomography coronary angiography in patients with low, intermediate, and high cardiovascular risk. Acad Radiol 15:452–461PubMedCrossRef
25.
go back to reference Pickhardt PJ, Choi JR, Hwang I et al (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349:2191–2200PubMedCrossRef Pickhardt PJ, Choi JR, Hwang I et al (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349:2191–2200PubMedCrossRef
26.
go back to reference Topol E, Nissen S (1995) Our preoccupation with coronary luminology. The dissociation between clinical and angiographic findings in ischemic heart disease. Circulation 92:2333–2342PubMed Topol E, Nissen S (1995) Our preoccupation with coronary luminology. The dissociation between clinical and angiographic findings in ischemic heart disease. Circulation 92:2333–2342PubMed
27.
go back to reference Sones FM Jr (1958) Cine-cardio-angiography. Pediatr Clin N Am 5:945–979 Sones FM Jr (1958) Cine-cardio-angiography. Pediatr Clin N Am 5:945–979
28.
go back to reference Leber AW, Becker A, Knez A et al (2006) Accuracy of 64-slice computed tomography to classify and quantify plaque volumes in the proximal coronary system: a comparative study using intravascular ultrasound. J Am Coll Cardiol 47:672–677PubMedCrossRef Leber AW, Becker A, Knez A et al (2006) Accuracy of 64-slice computed tomography to classify and quantify plaque volumes in the proximal coronary system: a comparative study using intravascular ultrasound. J Am Coll Cardiol 47:672–677PubMedCrossRef
29.
go back to reference Zir LM, Miller SW, Dinsmore RE, Gilbert JP, Harthorne JW (1976) Interobserver variability in coronary angiography. Circulation 53:627–632PubMed Zir LM, Miller SW, Dinsmore RE, Gilbert JP, Harthorne JW (1976) Interobserver variability in coronary angiography. Circulation 53:627–632PubMed
Metadata
Title
Accuracy of coronary artery stenosis detection with CT versus conventional coronary angiography compared with composite findings from both tests as an enhanced reference standard
Authors
J. Matthias Kerl
U. Joseph Schoepf
Peter L. Zwerner
Ralf W. Bauer
Joseph A. Abro
Christian Thilo
Thomas J. Vogl
Christopher Herzog
Publication date
01-09-2011
Publisher
Springer-Verlag
Published in
European Radiology / Issue 9/2011
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-011-2134-2

Other articles of this Issue 9/2011

European Radiology 9/2011 Go to the issue