Diagnostic accuracy of prospective ECG gated coronary computed tomography on a 256 slices scanner: Daily practice experience

Abstract

To determine the accuracy of prospective ECG-gated computed tomography coronary angiography (CTCA) using 256-slice scanner for detecting significant coronary artery disease (CAD) and to quantitatively estimate lumen narrowing with CTCA in comparison to invasive coronary angiography (ICA). Methods: This study included 109 consecutive patients who had ICA on the basis of a previous CTCA (within 60 days) for clinical suspicious of CAD. All CTCA scans were performed with a 256-slice scanner using prospective ECG-gated image acquisition. The presence of stenosis ⩾50%, measured by QCA for ICA and Visual assessment for CTCA, was considered significant stenosis. Results: Obstructive CAD was present in 73.4% of patients. On patient-based analysis, the sensitivity of CTCA was 98%, specificity 83%, PPV 94% and NPV 92%. For segment-based analysis, a total of 1584 segments were analyzed with a sensitivity of 89%, specificity 98%, PPV 85% and NPV 99%. High correlation was observed between degrees of luminal stenosis assessed by CTCA in comparison to QCA in all segments (r2 = 0.961). There was high agreement between observers regarding the presence of significant luminal stenosis (k = 0.78) and good correlation for percentage of luminal stenosis (r = 0.68, p < 0.001) between both readers. Conclusions: In a highly prevalence diseased population, prospective ECG-gated CTCA using 256-slice scanner is highly accurate for detection and quantification of the degree of coronary luminal stenosis in comparison to ICA.

Keywords

• CT coronary angiography
• Prospective ECG-gating
• Diagnostic accuracy