Ct Coronary Angiography in Clinical Practice

0 B J E C T IV E S: Our objective was to prospectively evaluate the diagnostic performance of the high-speed dual-source computed tomography scanner (DSCT), with an increased temporal resolution (83 ms), for the detection of significant coronary lesions (2": 50% lumen diameter reduction) in a clinically wide range of patients. BACK G R 0 UN D: Cardiac motion artifacts may decrease coronary image quality with use of earlier computed tomography scanners that have a lim'1ted temporal resolut'1on. METHODS: We prospectively studied I 00 symptomatic patients (79 men, 21 women, mean age 61 ±I I years) with atypical ( 18%) or typical (55%) angina pectoris, or unstable coronary artery disease (27%) scheduled for conventional coronary angiography. Mean scan time was 8.58 ± 1.52 s. Mean heart rate was 68 ± I I beats/min. Quantitat'1ve coronary angiography was used as the standard of reference. Irrespective of image quality or vessel size, all segments were included for analysis. RESULTS: Invasive coronary angiography demonstrated no significant disease in 23%, singlevessel disease in 31%, and multivessel disease in 46% of patients; I ,489 coronary segments, containing 220 significant ( 14.8%) stenoses, were available for analysis. Sensitivity, specificity, and positive and negative predictive values of DSCT coronary angiography for the detection of significant lesions on a segment-by-segment analysis were 95% (95% confidence interval [CI] 90 to 97), 95% (95% Cl 93 to 96), 75% (95% Cl 69 to 80), 99% (95% Cl 98 to 99), respectively, and on a patient-based analysis 99% (95% Cl 92 to I 00), 87% (95% Cl 65 to 97), 96% (95% Cl 89 to 99), and 95% (95% Cl 74 to I 00), respectively. CONCL U 5 I ON S: Noninvasive DSCT coronary angiography is h1ghly sensitive to detect and to reliably rule out the presence of a significant coronary stenosis in patients presenting with atypical or typical angina pectoris, or unstable coronary artery disease.