Noninvasive evaluation of coronary artery stenosis by multi-slice spiral CT with standardized reconstruction images

Objective: To determine the diagnostic accuracy of multi-slice spiral computed tomography(MSCT) for the assessment of coronary artery stenosis with standardized reconstruction images. Methods: Fifty-five patients (37 male, aged 59 years) with suspected coronary artery disease were studied by ECG-gated MSCT. Patients with a heart rate above 65/min received β-blockers before the scan. Contrast-enhanced scan (80-100 ml contrast agent IV at 3.5 mL/s) was performed during an approximately 20 s breath hold for detection of stenosis. In axial MSCT images, 7 MIP and 9 VRT reconstruction images, coronary arteries were assessed concerning the presence of stenosis exceeding 50% diameter reduction and the results were compared with conventional coronary angiography (CAG). The display of coronary arteries with different orientations of reconstruction images was evaluated. Results: CAG detected 62 out of the 220 evaluated branches (left main, left anterior descending, left circumflex, and right coronary artery in 55 patients) significantly diseased. On the 7 MIP and 9 VRT reconstruction images, CTA correctly detected 58 of the 62 stenosis (5 at left main, 21 at left anterior descending, 14 at left circumflex, and 18 at right coronary artery). Without exclusion of branches, the sensitivity, specificity, accuracy, positive and negative predictive value of CT angiography (CTA) to identify ≥50% stenosis was 94% (58/62), 92% (146/158), 93% (204/220), 83% (58/70), and 97% (146/150) respectively. Conclusions: Improvements in MSCT technology allow noninvasive detection of coronary artery stenosis with high accuracy. The establishment of CTA standard orientations is helpful for evaluation of coronary artery lesions in comparison with the conventional coronary angiography, and will promote cooperations of multiple centers and multiple departments. (authors)