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Hoffmann MHK, Shi H, Schmitz BL, et al. Noninvasive Coronary Angiography With Multislice Computed Tomography. JAMA. 2005;293(20):2471–2478. doi:https://doi.org/10.1001/jama.293.20.2471
Author Affiliations: Department of Diagnostic
Radiology, University Hospital, Ulm, Germany (Drs Hoffmann, Shi, Schmitz,
Schmid, Brambs, and Aschoff); and Department of Cardiology, Heart-Center,
Ulm (Drs Lieberknecht, Schulze, Ludwig, Kroschel, Jahnke, and Haerer).
Context Multislice computed tomography (MSCT) has recently evolved as a modality
for noninvasive coronary imaging.
Objective To assess the accuracy and robustness of MSCT vs the criterion standard
of invasive coronary angiography for detection of obstructive coronary artery
Design, Setting, and Patients Prospective, single-center study conducted in a referral center setting
in Germany and enrolling 103 consecutive patients (mean age, 61.5 [SD, 9.7]
years) from November 2003–August 2004 who were undergoing both invasive
coronary angiography and MSCT using a scanner with 16 detector rows.
Main Outcome Measures Blinded results for both modalities compared using the patient as the
primary unit of analysis, with supplementary segment- and vessel-based analyses.
Results One thousand three hundred eighty-four segments (≥1.5 mm diameter)
were identified by invasive coronary angiography; nondiagnostic image quality
of MSCT was identified for only 88 (6.4%) of these segments, mainly due to
faster heart rates. Compared with invasive coronary angiography for detection
of significant lesions (>50% stenosis), segment-based sensitivity, specificity,
and positive and negative predictive values of MSCT were 95%, 98%, 87%, and
99%, respectively. Quantitative comparison of MSCT and invasive coronary angiography
showed good correlation (r = 0.87, P<.001), with MSCT systematically measuring greater-percentage
stenoses (bias, +12%). In the patient-based analysis, the area under the receiver
operating characteristic curve was 0.97 (95% confidence interval, 0.90-1.00),
indicating high discriminative power to identify patients who might be candidates
for revascularization (>50% left main artery stenosis and/or >70% stenosis
in any other epicardial vessel). Threshold optimization allowed either detection
of these patients with 100% sensitivity at a reasonable false-positive rate
(specificity, 76.5%; MSCT stenosis, >66%) or optimization of both the sensitivity
and specificity (>90%; MSCT stenosis, >76%).
Conclusions Multislice computed tomography provides high accuracy for noninvasive
detection of suspected obstructive coronary artery disease. This promising
technology has potential to complement diagnostic invasive coronary angiography
in routine clinical care.
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