Abstract
PurposeTo comprehensively investigate the diagnostic performance of coronary artery angiography with 64-MDCT and post 64-MDCT.Materials and MethodsPubMed was searched for all published studies that evaluated coronary arteries with 64-MDCT and post 64-MDCT. The clinical diagnostic role was evaluated by applying the likelihood ratios (LRs) to calculate the post-test probability based on Bayes' theorem.Results91 studies that met our inclusion criteria were ultimately included in the analysis. The pooled positive and negative LRs at patient level were 8.91 (95% CI, 7.53, 10.54) and 0.02 (CI, 0.01, 0.03), respectively. For studies that did not claim that non-evaluable segments were included, the pooled positive and negative LRs were 11.16 (CI, 8.90, 14.00) and 0.01 (CI, 0.01, 0.03), respectively. For studies including uninterruptable results, the diagnostic performance decreased, with the pooled positive LR 7.40 (CI, 6.00, 9.13) and negative LR 0.02 (CI, 0.01, 0.03). The areas under the summary ROC curve were 0.98 (CI, 0.97 to 0.99) for 64-MDCT and 0.96 (CI, 0.94 to 0.98) for post 64-MDCT, respectively. For references explicitly stating that the non-assessable segments were included during analysis, a post-test probability of negative results >95% and a positive post-test probability <95% could be obtained for patients with a pre-test probability of <73% for coronary artery disease (CAD). On the other hand, when the pre-test probability of CAD was >73%, the diagnostic role was reversed, with a positive post-test probability of CAD >95% and a negative post-test probability of CAD <95%.ConclusionThe diagnostic performance of post 64-MDCT does not increase as compared with 64-MDCT. CTA, overall, is a test of exclusion for patients with a pre-test probability of CAD<73%, while for patients with a pre-test probability of CAD>73%, CTA is a test used to confirm the presence of CAD.
Highlights
Coronary artery disease (CAD) is the leading illness threating human health in developed countries and it is increasingly becoming a significant public health problem in developing countries [1]
With the development of the 16-multi-detector CT (MDCT), a non-invasive approach of coronary CT angiography (CTA), it has been applied widely to avoid the complications of invasive coronary angiography (ICA), which is generally believed to be the gold standard in evaluating CAD [2]
Since there are already a number of risk algorithms available to evaluate the detailed pre-test probability [9–12], we evaluated the diagnostic role of CTA based on the diagnostic performance of CTA and the precise pre-test probability to provide a more practical patient-relevant utility of CTA
Summary
Coronary artery disease (CAD) is the leading illness threating human health in developed countries and it is increasingly becoming a significant public health problem in developing countries [1]. Several meta-analysis studies have proven that single source 64MDCT with improved parameters has a better ability to predict the stenosis of coronary artery lumen than that of 16-MDCT [3– 5]. With the emergence and wider application of dual source 64-, 128-, 256-, and 320-MDCT it is hoped that the improvement will lead to a greater diagnostic accuracy than 64-MDCT. The pre-test probability categorization is important because of its significant impact on the post-test probability of disease and the selection of a diagnostic test [8]. Appropriate application of CTA may improve patients’ clinical outcomes, while the inappropriate utilization of CTA may generate extra radiation exposure to patients and unwarranted costs. Since there are already a number of risk algorithms available to evaluate the detailed pre-test probability [9–12], we evaluated the diagnostic role of CTA based on the diagnostic performance of CTA and the precise pre-test probability to provide a more practical patient-relevant utility of CTA
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