Clinical value of 16-slice multi-detector CT compared to invasive coronary angiography.

BACKGROUND: Multi-detector row spiral CT (MDCT) can be applied as a noninvasive tool for the assessment of coronary artery stenoses. Few, confounding reports have been published using 16 detector rows. The aim of the present study was to determine the accuracy of 16-detector row MDCT for the detection of significant stenoses in the coronary arteries, in comparison to conventional invasive coronary angiography.

METHODS: Twenty-two patients with suspected coronary artery disease, were prospectively evaluated by 16-slice retrospectively ECG-gated CT coronary angiography and quantitative invasive coronary angiography. The findings were compared for the detection of significant coronary artery stenoses (>50%) in all segments with diameter >1.5 mm.

RESULTS: MDCT correctly classified all 14 patients (100%) that were found to have significant coronary artery disease on conventional angiography. Overall, 288 segments were included in the analysis, regardless of their image quality. Significant stenoses were detected in 24 segments by CT and in 28 segments by conventional angiography. Out of 260 segments that were negative for significant stenoses on conventional angiography, 255 were correctly identified on CT. The sensitivity, specificity, positive and negative predictive values were 86, 98, 83 and 98%, respectively. MDCT also revealed supplementary findings that invasive angiography was unable to visualize, including anomalous vessel course, the course of vessels filling via collaterals, intramyocardial course of vessels and non-stenotic plaques.

CONCLUSIONS: MDCT coronary angiography utilizing 16-detector rows shows promising results for reliable detection of coronary artery stenoses and particularly for ruling out significant disease.