OBJECTIVES: Coronary computed tomography angiography (CTA) has proven clinically useful for non-invasive assessment of coronary pathology. However, coronary calcium can reduce its diagnostic value. The objective of this study was to define a calcium score above which CTA appears less reliable. DESIGN: We prospectively investigated 109 patients referred for elective coronary angiography (CA). With a 64-slice CT-scanner, coronary calcium was determined and expressed in Agatston unit (AU). A significant coronary stenosis was defined as > or =50% luminal diameter reduction. Following blinded interpretation, diagnostic values of CTA at different levels of AU were calculated using quantitative CA as reference. RESULTS: A strong association with stent and the severity of coronary calcium was observed. In patients without stents (n = 91) sensitivity, specificity and positive and negative predictive value for presence of significant stenosis were: 100%, 91%, 74%, and 100% in patients with a calcium score < or =400 AU versus 100%, 17%, 75%, and 100% in patients with a score >400 AU. CONCLUSIONS: The diagnostic accuracy of CTA in patients with no or little coronary calcium is excellent. However, in patients with an Agatston score >400 specificity declines and therefore, these patients should not go on to CTA, but be referred to CA instead.
OBJECTIVES: Coronary computed tomography angiography (CTA) has proven clinically useful for non-invasive assessment of coronary pathology. However, coronary calcium can reduce its diagnostic value. The objective of this study was to define a calcium score above which CTA appears less reliable. DESIGN: We prospectively investigated 109 patients referred for elective coronary angiography (CA). With a 64-slice CT-scanner, coronary calcium was determined and expressed in Agatston unit (AU). A significant coronary stenosis was defined as > or =50% luminal diameter reduction. Following blinded interpretation, diagnostic values of CTA at different levels of AU were calculated using quantitative CA as reference. RESULTS: A strong association with stent and the severity of coronary calcium was observed. In patients without stents (n = 91) sensitivity, specificity and positive and negative predictive value for presence of significant stenosis were: 100%, 91%, 74%, and 100% in patients with a calcium score < or =400 AU versus 100%, 17%, 75%, and 100% in patients with a score >400 AU. CONCLUSIONS: The diagnostic accuracy of CTA in patients with no or little coronary calcium is excellent. However, in patients with an Agatston score >400 specificity declines and therefore, these patients should not go on to CTA, but be referred to CA instead.
Authors: Anders Thomassen; Henrik Petersen; Axel C P Diederichsen; Hans Mickley; Lisette O Jensen; Allan Johansen; Oke Gerke; Poul-Erik Braad; Per Thayssen; Mette M Høilund-Carlsen; Werner Vach; Juhani Knuuti; Poul F Høilund-Carlsen Journal: Eur J Nucl Med Mol Imaging Date: 2013-08-28 Impact factor: 9.236
Authors: Martijn A M den Dekker; Kristof de Smet; Geertruida H de Bock; Rene A Tio; Matthijs Oudkerk; Rozemarijn Vliegenthart Journal: Eur Radiol Date: 2012-07-15 Impact factor: 5.315
Authors: Viktoria Wieske; Mario Walther; Benjamin Dubourg; Hatem Alkadhi; Bjarne L Nørgaard; Matthijs F L Meijs; Axel C P Diederichsen; Yung-Liang Wan; Hans Mickley; Konstantin Nikolaou; Abbas A Shabestari; Bjørn A Halvorsen; Eugenio Martuscelli; Kai Sun; Bernhard A Herzog; Roy P Marcus; Sebastian Leschka; Mario J Garcia; Kristian A Ovrehus; Juhani Knuuti; Vladymir Mendoza-Rodriguez; Nuno Bettencourt; Simone Muraglia; Ronny R Buechel; Philipp A Kaufmann; Elke Zimmermann; Jean-Claude Tardif; Matthew J Budoff; Peter Schlattmann; Marc Dewey Journal: Eur Radiol Date: 2022-03-10 Impact factor: 7.034