Razi Khan1, Sapna Rawal, Mark J Eisenberg. 1. Division of Cardiology and Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada. razi.khan@gmail.com
Abstract
BACKGROUND: Multidetector computed tomography (MDCT) has demonstrated promise in the noninvasive evaluation of coronary artery disease. OBJECTIVE: To systematically review the literature regarding the improved diagnostic accuracy of 64-slice MDCT. METHODS: An EMBASE, OVID, PubMed and Cochrane Library database search was performed using the key words 'computed tomography' matched with the terms 'coronary artery' or 'coronary angiography' to identify English-language articles examining MDCT cardiac imaging. Studies that compared 16-slice or 64-slice MDCT with catheter-based coronary angiography for the detection of coronary artery disease in nonrevascularized, poststent and post-coronary artery bypass graft patients were included. Data were pooled to obtain a weighted sensitivity, specificity and diagnostic accuracy for MDCT. Negative and positive predictive values, and likelihood ratios were calculated based on sensitivity and specificity. RESULTS: Currently, 15 studies involving 1008 patients have examined the efficacy of 64-slice MDCT in the assessment of coronary artery stenosis (more than 50% luminal narrowing). In these studies, 64-slice MDCT has demonstrated a sensitivity (89%), specificity (96%) and diagnostic accuracy (95%) similar to that of 16-slice MDCT. However, 64-slice MDCT was able to assess 5% more coronary artery segments than 16-slice MDCT. In revascularized patients, MDCT can accurately assess both bypass graft occlusion and stenosis. The 64-slice MDCT is also capable of adequately detecting in-stent restenosis. Improvements in spatial and temporal resolution with 64-slice technology have decreased the occurrence of high attenuation and motion artefacts that plagued the previous generation of MDCT scanners. CONCLUSION: MDCT offers an accurate assessment of the coronary arteries, stented arteries and bypass grafts. The improved accuracy and safety of MDCT may reduce the need for catheter-based coronary angiography.
BACKGROUND: Multidetector computed tomography (MDCT) has demonstrated promise in the noninvasive evaluation of coronary artery disease. OBJECTIVE: To systematically review the literature regarding the improved diagnostic accuracy of 64-slice MDCT. METHODS: An EMBASE, OVID, PubMed and Cochrane Library database search was performed using the key words 'computed tomography' matched with the terms 'coronary artery' or 'coronary angiography' to identify English-language articles examining MDCT cardiac imaging. Studies that compared 16-slice or 64-slice MDCT with catheter-based coronary angiography for the detection of coronary artery disease in nonrevascularized, poststent and post-coronary artery bypass graft patients were included. Data were pooled to obtain a weighted sensitivity, specificity and diagnostic accuracy for MDCT. Negative and positive predictive values, and likelihood ratios were calculated based on sensitivity and specificity. RESULTS: Currently, 15 studies involving 1008 patients have examined the efficacy of 64-slice MDCT in the assessment of coronary artery stenosis (more than 50% luminal narrowing). In these studies, 64-slice MDCT has demonstrated a sensitivity (89%), specificity (96%) and diagnostic accuracy (95%) similar to that of 16-slice MDCT. However, 64-slice MDCT was able to assess 5% more coronary artery segments than 16-slice MDCT. In revascularized patients, MDCT can accurately assess both bypass graft occlusion and stenosis. The 64-slice MDCT is also capable of adequately detecting in-stent restenosis. Improvements in spatial and temporal resolution with 64-slice technology have decreased the occurrence of high attenuation and motion artefacts that plagued the previous generation of MDCT scanners. CONCLUSION: MDCT offers an accurate assessment of the coronary arteries, stented arteries and bypass grafts. The improved accuracy and safety of MDCT may reduce the need for catheter-based coronary angiography.
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