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Newer Generation MDCTs Better for Coronary Evaluation

February 5, 2008
Written by: , Filed in: Cardiac Imaging
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The objective of a recent study was to evaluate four different generations of multidetector CT (MDCT) scanners for detecting significant (>=50%) coronary arterial stenosis at a single institution.

The retrospective study has concluded that the newer generation 16-section and 64-section MDCTs have significantly better diagnostic performance for evaluating significant coronary artery stenoses compared with 4-section MDCT.

Participants
204 patients who underwent CT coronary angiography before conventional coronary angiography. Studies were performed from February 2000 to March 2006.

The first 51 patients underwent a four-section CT, the second 51 underwent a first-generation 16-section CT utilizing 12 sections per rotation, the third 51 underwent a second-generation 16-section CT, and the final 51 underwent a 64-section CT.

Methodology
Patients with heart rates >65 bpm received 100 mg of metoprolol 1 hour before imaging. Images were reconstructed with an ECG-gated algorithm. All of the CTs were evaluated by two radiologists who had experience in cardiac imaging. Significant coronary stenosis >=50% in coronary arteries >=2 mm in diameter was assessed visually using multiplanar and curved multiplanar reconstructions.

Image quality for each coronary segment was graded as good, adequate, poor, and nonevaluable. This was based on the presence of artifact due to motion, calcification, or noise.

All of the conventional coronary angiograms were interpreted by one observer with experience in coronary angiography. A stenosis >=50% as assessed using a quantitative coronary angiographic algorithm was considered significant. A high Agatston calcium score did not exclude patients.

Cardiac CTA: What You Need to Know
 
 University of California San Francisco, Department of Radiology
 Course Director: Gautham P. Reddy, MD, MPH

 
  Coronary artery disease is the leading cause of morbidity and mortality in industrialized countries. With the advent of 64-detector CT scanners, CT has become an essential tool for evaluation of the heart and great vessels, and is a promising technique for assessment of the coronary arteries.
 
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  Cardiac CTA: What You Need to Know

Results of the Study
33.1% of coronary artery segments on 4-section MDCT had poor image quality. This percentage was 14.4%, 6.3%, and 2.6% on first-generation 16-section MDCT, second-generation 16-section MDCT, and 64-section MDCT, respectively.

The sensitivity, specificity, positive predictive value, and negative predictive value for detecting significant coronary artery stenoses of each generation MDCT was:

57%, 91%, 60%, and 90% for 4-section MDCT;
90%, 93%, 65%, and 99% for first-generation 16-section MDCT; 97%, 98%, 87%, and 100% for second-generation 16-section MDCT;
and 99%, 96%, 80%, and 100% for 64-section MDCT.

The diagnostic performance of 4-section MDCT was significantly worse than second-generation 16-section CT and 64-section CT (odds ratio 4.57 and 2.89, respectively).

Conclusions
Four-section MDCT has relatively poor diagnostic performance for the evaluation of coronary artery stenosis compared with the newer generation 16-section and 64-section MDCTs.

Reviewer’s Comments
It is nice to have a single-center comparison of different generation MDCTs being evaluated by the same few physicians.

Author:
vineet R. Jain, MD

Reference:
Pugliese F, Mollet NR, et al. Performance of Coronary CT Angiography by Using Different Generations of Multisection Scanners: Single-Center Experience. Radiology; 2008; 246 (February): 384-393

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