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European Heart Journal Advance Access originally published online on June 21, 2005
European Heart Journal 2005 26(19):1987-1992; doi:10.1093/eurheartj/ehi384
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Limited diagnostic yield of non-invasive coronary angiography by 16-slice multi-detector spiral computed tomography in routine patients referred for evaluation of coronary artery disease

Christoph Kaiser1,*,{dagger}, Jens Bremerich2,{dagger}, Sabine Haller2, Hans Peter Brunner-La Rocca1, Georg Bongartz2, Matthias Pfisterer1 and Peter Buser1

1Division of Cardiology, University Hospital, CH-4031 Basel, Switzerland
2Division of Radiology, University Hospital, CH-4031 Basel, Switzerland

Received 22 September 2004; revised 20 May 2005; accepted 26 May 2005; online publish-ahead-of-print 21 June 2005.

* Corresponding author. Tel: +41 61 265 52 14; fax: +41 61 265 45 98.
E-mail address: ckaiser{at}uhbs.ch

See page 1942 for the editorial comment on this article (doi:10.1093/eurheartj/ehi463)

Aims Multislice spiral computed tomography (MSCT) is a promising non-invasive method to diagnose coronary artery disease (CAD). As no detailed comparative evaluation in consecutive patients referred for evaluation of CAD has been reported, this prospective study evaluating 2384 coronary segments in 149 consecutive patients was performed.

Methods and results The coronary artery tree was analysed in 16 segments both for coronary angiography (CA) and MSCT; a luminal narrowing ≥50% based on visual assessment was considered significant. By MSCT, 77% of 2110 angiographically assessable segments could be evaluated, 94% per patient in proximal and 70% in distal segments (P<0.001). Sensitivity of MSCT to detect significant stenoses was 30% in all, but only 10% in peripheral segments. The main limitations were calcifications in 34% of segments and motion artefacts in 24% of patients. Overall diagnostic sensitivity for the presence of significant CAD was 86% but specificity was only 49%.

Conclusion When compared with invasive CA, 16-slice MSCT is of limited diagnostic value for the diagnosis of CAD in consecutive patients. Despite a clinically useful sensitivity for the overall diagnosis of significant CAD, specificity is low. Thus, relevant decisions regarding the need of and suitability for possible revascularization procedures cannot be based on MSCT findings alone.

Key Words: Multislice computed tomography • Coronary angiography • Coronary artery disease • Diagnosis


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