MULTISLICE COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY IN PATIENTS WITH ANGINA PECTORIS

Abstract

Aim. Multislice computed tomography (MSCT) is a non-invasive method for the heart and coronary arteries imaging. The aim of the research was to establish the diagnostic exactness of MSCT in the revelation of significant coronary artery disease in patients with angina pectoris, using digital subtraction angiography (DSA) of coronary arteries as the gold standard. Material and methods. In 78 (56 men, 22 women; average age 64,3±11 years), patients with clinical signs of angina pectoris were done examination of the coronary arteries on 64-slice MSCT in order to detect significant stenoses (>50% luminal narrowing). MSCT of coronary arteries was compared with the invasive coronary angiography. Results. In 78 patients, 864 segments of coronary arteries were available for evaluation. In all segments of coronary arteries, invasive coronary angiography identified 51 lesions. Forty-five lesions were detected by MSCT. The matching sensitivity and specificity were 88% and 97%. Sensitivity, specificity and positive and negative predictive values in a patient-per-patient analysis were 93%, 93%, 90%, and 96%, respectively. False-negative results — Seventeen segments of coronary arteries with diameter reduction in range 51% to 75% were missed on the MSCT scan. The major of the missed lesions were located in the left anterior descedenting artery and the left circumflex artery (small side branches). Four segments were missed because of severe calcifications and five because of motion artifacts. False-positive results — Thirty nine segments were incorrectly classified as significantly because of overestimation. Conclusion. MSCT coronary angiography is an effective, fast, reliable and noninvasive method for the analysis of the coronary arteries. The best results were obtained in patients with healthy coronary arteries (high percentage of negative predictive value), which can significantly reduce the number of invasive coronary angiography. With the improvement of technical characteristics, CT is gaining more importance in the analysis of coronary stenoses and analysis of atherosclerotic plaque.