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European Radiology
Published in: European Radiology 12/2012

01-12-2012 | Cardiac

Diagnostic performance of coronary CT angiography for stenosis detection according to calcium score: systematic review and meta-analysis

Authors: Martijn A. M. den Dekker, Kristof de Smet, Geertruida H. de Bock, Rene A. Tio, Matthijs Oudkerk, Rozemarijn Vliegenthart

Published in: European Radiology | Issue 12/2012

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Abstract

Objectives

A systematic review and meta-analysis to assess sensitivity and specificity of coronary CT angiography (CCTA) for significant stenosis at different degrees of coronary calcification.

Methods

A literature search was performed including studies describing test characteristics of CCTA for significant stenosis, performed with at least 16-MDCT and according to calcium score (CS). Invasive coronary angiography was the reference standard. Pooled sensitivity and specificity of CCTA by CS categories and CT equipment were calculated.

Results

Of 14,121 articles, 51 studies reported on the impact of calcium scoring on diagnostic performance of CCTA and could be included in the systematic review. Twenty-seven of these studies (5,203 participants) were suitable for meta-analysis. On a patient-basis, sensitivity of CCTA for significant stenosis was 95.8, 95.6, 97.6 and 99.0% for CS 0–100, 101–400, 401–1,000 and >1,000 respectively. Specificity was 91.2, 88.2, 50.6 and 84.0% respectively. Specificity of CCTA was significantly lower for CS 401–1,000 due to lack of patients without significant stenosis. Sensitivity and specificity of 16-MDCT were significantly lower compared to more modern CT systems.

Conclusions

Even in cases of severe coronary calcification, sensitivity and specificity of CCTA for significant stenosis are high. With 64-MDCT and newer CT systems, a CS cut-off for performing CCTA no longer seems indicated.

Key Points

• Decisions about performing coronary CT angiography (CCTA) sometimes depend on calcium scoring.
• CCTA is highly sensitive for coronary stenosis.
• With 16-MDCT, however, heavy calcification reduces specificity for significant stenosis.
• For 64-MDCT (and above), CCTA has high specificity, even with severe coronary calcification.
Appendix
Available only for authorised users
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Metadata
Title
Diagnostic performance of coronary CT angiography for stenosis detection according to calcium score: systematic review and meta-analysis
Authors
Martijn A. M. den Dekker
Kristof de Smet
Geertruida H. de Bock
Rene A. Tio
Matthijs Oudkerk
Rozemarijn Vliegenthart
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
European Radiology / Issue 12/2012
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-012-2551-x

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