Abstract
Introduction: Multislice CT has gained acceptance as a noninvasive tool to evaluate coronary arteries but its utility is limited by the occurrence of motion artifacts in patients with heart rates exceeding 70bpm. Furthermore little is known about the accuracy of MSCT in patient populations with an intermediate pretest likelihood for obstructive coronary artery disease. Objectives: The aim of the present study was to assess the clinical performance of a dual x-ray source MSCT with high temporal resolution without using negative chronotropic pretreatment. Methods: Dual source CT angiography (DSCT) (Siemens Definition) was performed in 130 patients with an intermediate likelihood for coronary artery disease, according to the Morise Scoring method, who were referred for invasive coronary angiography. Results: DSCT generated datasets with diagnostic image quality in overall 127/130 patients. In 13 of 15 patients with atrial fibrillation and in 63 of 65 patients with heart rates > 65 bpm image quality was diagnostic. 13/13 patients with at least 1 stenosis > 75% (Sensitivity 100%) were correctly identified and in 110/114 patients (Specificity 96%, positive predictive value 76%) coronary stenosis >75% were correctly excluded. The accuracy to detect patients with coronary stenoses > 75% was not significantly different among patients with heart rates > 65bpm and < 65bpm. Conclusion: This is one of the first studies using Multislice CT to assess the coronary status of patients with an intermediate pretest likelihood for coronary artery disease. We have shown that Dual Source Multislice CT (DSCT) allows to rule out coronary artery stenoses in such patients with excellent sensitivity. Due to a trend to overestimate the stenosis severity the positive predictive value of this technique is moderate in patient cohorts with a low prevalence of coronary stenoses. Fast heart rates and arrhythmias are no limitations for this technique anymore.
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