Diagnostic value of 16-slice multidetector computed tomography in symptomatic patients with suspected significant obstructive coronary artery disease

Abstract

We investigated the diagnostic value and limitations of 16-slice multidetector computed tomography (MDCT) to detect significant obstructive coronary artery disease in symptomatic patients. A total of 43 symptomatic patients underwent conventional coronary angiography and 16-slice multidetector computed tomography for the detection of significant obstructive coronary artery disease. The diagnostic value and limitations of 16-slice multidetector computed tomography to detect significant coronary stenoses were determined by analyzing all coronary arteries and proximal segments, both including and excluding unevaluable segments. Analysis of all 592 coronary artery segments demonstrated moderate sensitivity (67%) and positive predictive value (69%), with a high specificity (95%) and negative predictive value (94%) for the detection of significant coronary artery stenoses. When the unevaluable segments had been excluded, with the analysis of all evaluable segments, proximal segments, and evaluable proximal segments, sensitivity increased (71%, 77%, and 83%, respectively), and high specificity (95%, 96%, and 96%, respectively) and negative predictive value (95%) were maintained. When we repeated the analysis taking only the patients into account, 16-slice MDCT correctly diagnosed 88% of all patients but a moderate negative predictive value (63%) was obtained. Artifacts caused by cardiac motion were the most frequent reason for unevaluable segments. Calcification was the leading cause of degraded image quality and incorrect diagnosis. Our results demonstrated that 16-slice MDCT has a moderate diagnostic value for the correct diagnosis of symptomatic patients with significant coronary artery disease. This result suggests that 16-slice MDCT may not be able to exclude significant coronary artery disease reliably in patients at high risk.