Accuracy of Detecting Coronary Artery Stenosis Between 64-multislice Spiral CT and Selective Coronary Angiography: A Comparative Study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

BAI Zhixuan , SHI Jun , PENG Yong

Department of Cardiovascular Surgery， West China Hospital of Sichuan University，Chengdu 610041，P. R. China;

Corresponding author：

Keywords：

Coronary artery disease; Computed tomography; Coronary angiography

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Abstract： Objective To evaluate the diagnostic accuracy for the the assessment of coronary artery stenoses
using 64-multislice spiral computed tomography （64-MSCT） scanner compared with selective coronary angiography（SCA）. Methods 64-MSCT and SCA were both performed in 93 patients with 74 males and 19 females at mean age of （58.2±8.5） years in West China Hospital between April 2004 and December 2010. The cardiacrhythm of all the patients was stably sinus. Patients with initial heart rates≥90 time/min were received treatments of β-blockers. All available coronary segments（internal diameter ≥ 2.0 mm）were included in the evaluation. Lesions with ≥ 50％ luminalnarrowing were considered as significant stenosis. According to the image detail of segments and existance of artfacts,the image quality was randed Ⅰ to Ⅳ ,with rank Ⅰ to Ⅲ meeting demands of image evaluation. Evaluations had been done concerning the 64-MSCT scanner for detecting the stenosis of the variant branches or segments of the coronary artery. Results 64-MSCTprovided a full image correspondence(100%,1 238/1 238)of all the segments clearly displayed in the SCA. All of the coronary segments involved （n=1 238） met the quality demands of being evaluated as rankⅠ to Ⅲ. Considering SCA as the golden standard， overall sensitivity for classifying stenosis using 64-MSCT scannerwas 88.8%（427/481）， specificity was 91.7%（694/757）， positive predictive value was 87.1%（427/490），and negative predictive value was 92.8%（ 694/748）.While the stenosis diagnostic accuracy of proximal left circumflexbranch and the first obtuse marginal branch of left coronay artery is lower than other branches： the sensitivity of the proximal left circumflex branch was 68.3%（41/60），specificity was 60.6%（20/33），positive predictive value was 75.9%（41/54），negative predictive value was 51.3%（20/39）；the sensitivity of the first obtuse marginalbranch was 58.8%（10/17），specificity was 93.5%（58/62），positive predictive value was 71.4%（10/14），negative predictive value was 89.2%（58/65）. Arterial wall calcification and false image of cardiac movements were the maininfluence factors for accuracy of the the assessment of coronary artery stenosis with 64-MSCT scanner. Conclusion 64-MSCT scanner provids a high diagnostic accuracy in assessing stenosis of the coronary artery. The anatomical location and luminal area of coronary artery were the main influence factors of diagnostic accuracy. Thus the diagnostic accuracy in proximal left circumflex branch and the first obtuse marginal branch of left coronary artery was lower than other coronary
segments.

Citation： BAI Zhixuan,SHI Jun,PENG Yong,et al .. Accuracy of Detecting Coronary Artery Stenosis Between 64-multislice Spiral CT and Selective Coronary Angiography: A Comparative Study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(1): 8-14. doi: Copy

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12.	Tunstall-Pedoe H， Kuulasmaa K， Mähönen M， et al. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality： 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet， 1999，353（9164）：1547-1557.
13.	Ueshima H， Sekikawa A， Miura K， et al. Cardiovascular disease and risk factors in Asia： a selected review. Circulation， 2008，118（25）：2702-2709.
14.	Wu ZS， Yao CH， Zhao D， et al. Sino-MONICA project： a collaborative study on trends and determinants in cardiovascular diseases in China， Part i： morbidity and mortality monitoring. Circulation， 2001，103（3）：462-468.
15.	Wu ZS， Yao CH， Zhao D， et al. Cardiovascular disease risk factor levels and their relations to CVD rates in China—results of Sino-MONICA project. Eur J Cardiovasc Prev Rehabil， 2004，11（4）：275-283.
16.	Schroeder S， Kopp AF， Kuettner A，et al. Influence of heart rate on vessel visibility in noninvasive coronary angiography using new multi-slice computed tomography： experience in 94 patients. J Clin Imaging， 2002， 26 （2）： 106-111.
17.	Nieman K， Rensing BJ， van Geuns RJ， et al. Non-invasive coronary angiography with multislice spiral computed tomography： impact of heart rate. Heart， 2002，88（5）：470-474.
18.	Martuscelli E， Romagnoli A， D’Eliseo A， et al. Accuracy of thin-slice computed tomography in the detection of coronary stenosis．Eur Heart J， 2004， 25 （7）：1043–1048.
19.	Vogl TJ， Abolmaali ND， Diebold T， et al. Techniques for the detection of coronary atherosclerosis： multi-detector row CT coronary angiography. Radiology， 2002，223（1）：212-220.
20.	Hong C， Becker CR， Huber A， et al. ECG-gated reconstructed multi-detector row CT coronary angiography： effect of varying trigger delay on image quality. Radiology，2001，220（3）：712-717.
21.	Kopp AF， Schroeder S， Kuettner A， et al. Coronary arteries： retrospectively ecg-gated multi–detector row CT angiography with selective optimization of the image reconstruction window. Radiology， 2001，221（3）： 683-688.
22.	Giesler M， Baum U， Ropers D， et al. Noninvasive visualization of coronary arteries using contrast-enhanced multidetector CT： influence of heart rate on image quality and stenosis detection. Am J Roentgenol， 2002，179（4）：911-916.
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1. 　Scanlon PJ， Faxon DP， Audet AM， et al. ACC/AHA Guidelines for Coronary Angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines （Committee on Coronary Angiography）. Developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol， 1999， 33（6），1758-1824.
2. 　Flohr TG， Schoepf UJ， Ohnesorge BM. Chasing the heart：new developments for cardiac CT. J Thorac Imaging， 2007，22（1）：4-16.
3. 　Raff GL， Gallagher MJ， O’Neill WW， et al. Diagnostic accuracy of noninvasive coronar angiography using 64-slice spiral computer tomography. J Am Coll Cardiol， 2005， 46（3）：552-557.
4. 　Austen WG， Edwards JE， Frye RL，et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease， Council on Cardiovascular Surgery， American Heart Association. Circulation， 1975， 51（4 Suppl）：5-40.
5. 　Mollet NR， Cademartiri F， Nieman K， et al. Multislice spiral computed tomography coronary angiography in patients with stable angina pectoris. J Am Coll Cardiol， 2004，43（12）：2265-2270.
6. 　Achenbach S， Giesler T， Ropers D， et al. Detection of coronary artery stenoses by contrast-enhanced， retrospectively electrocardiographically-gated， multislice spiral computed tomography. Circulation， 2001，103（21）：2535-2538.
7. 　Mark DB， Berman DS， Budoff MJ， et al. ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography： a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol， 2010， 55（23）：2663-2699.
8. 　Ropers D， Baum U， Pohle K， et al. Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction. Circulation， 2003，10 （7）：664-668.
9. 　Becker CR， Ohnesorge BM， Schoepf UJ， et al. Current development of cardiac imaging with multidetector row CT. Eur J Radiol， 2000，36（2）：97-103.
10. 　Leschka S， Alkadhi H， Plass A， et al. Accuracy of MSCT coronary angiography with 64-slice technology： first experience. Eur Heart J， 2005，26 （11）：1482-1487.
11. 　Nieman K， Oudkerk M， Rensing BJ， et al. Coronary angiography with multi-slice computed tomography. Lancet，2001，357（9258）：599-603.
12. 　Tunstall-Pedoe H， Kuulasmaa K， Mähönen M， et al. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality： 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet， 1999，353（9164）：1547-1557.
13. 　Ueshima H， Sekikawa A， Miura K， et al. Cardiovascular disease and risk factors in Asia： a selected review. Circulation， 2008，118（25）：2702-2709.
14. 　Wu ZS， Yao CH， Zhao D， et al. Sino-MONICA project： a collaborative study on trends and determinants in cardiovascular diseases in China， Part i： morbidity and mortality monitoring. Circulation， 2001，103（3）：462-468.
15. 　Wu ZS， Yao CH， Zhao D， et al. Cardiovascular disease risk factor levels and their relations to CVD rates in China—results of Sino-MONICA project. Eur J Cardiovasc Prev Rehabil， 2004，11（4）：275-283.
16. 　Schroeder S， Kopp AF， Kuettner A，et al. Influence of heart rate on vessel visibility in noninvasive coronary angiography using new multi-slice computed tomography： experience in 94 patients. J Clin Imaging， 2002， 26 （2）： 106-111.
17. 　Nieman K， Rensing BJ， van Geuns RJ， et al. Non-invasive coronary angiography with multislice spiral computed tomography： impact of heart rate. Heart， 2002，88（5）：470-474.
18. 　Martuscelli E， Romagnoli A， D’Eliseo A， et al. Accuracy of thin-slice computed tomography in the detection of coronary stenosis．Eur Heart J， 2004， 25 （7）：1043–1048.
19. 　Vogl TJ， Abolmaali ND， Diebold T， et al. Techniques for the detection of coronary atherosclerosis： multi-detector row CT coronary angiography. Radiology， 2002，223（1）：212-220.
20. 　Hong C， Becker CR， Huber A， et al. ECG-gated reconstructed multi-detector row CT coronary angiography： effect of varying trigger delay on image quality. Radiology，2001，220（3）：712-717.
21. 　Kopp AF， Schroeder S， Kuettner A， et al. Coronary arteries： retrospectively ecg-gated multi–detector row CT angiography with selective optimization of the image reconstruction window. Radiology， 2001，221（3）： 683-688.
22. 　Giesler M， Baum U， Ropers D， et al. Noninvasive visualization of coronary arteries using contrast-enhanced multidetector CT： influence of heart rate on image quality and stenosis detection. Am J Roentgenol， 2002，179（4）：911-916.
23. 　Hoffmann MH， Shi H， Schmize BL， et al. Noninvasive coronary angiography with multislice computed tomography. JAMA，2005，29（3）：2471-2478.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Accuracy of Detecting Coronary Artery Stenosis Between 64-multislice Spiral CT and Selective Coronary Angiography: A Comparative Study

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