Meta-analysis of 40- and 64-MDCT angiography for assessing coronary artery stenosis

AJR Am J Roentgenol. 2008 Dec;191(6):1667-75. doi: 10.2214/AJR.07.4022.

Abstract

Objective: The purpose of our study was to assess the diagnostic performance of thin-slice (< or = 0.625 mm) MDCT coronary angiography compared with invasive coronary angiography for the detection of significant (> or = 50%) stenosis.

Materials and methods: Twenty-two articles on 40- and 64-MDCT coronary angiography were included. Sensitivity and specificity were calculated on a per-patient and per-segment basis; in addition, proximal versus distal segments were evaluated. The effect of nonevaluable patients, nonevaluable segments, and disease prevalence on diagnostic performance was assessed.

Results: Pooled sensitivity on a patient level was 97.7% ([95% CI] 96.2-98.7%) and specificity 91.0% (88.5-93.1%). Pooled sensitivity on a segmental level was 90.8% (89.0-92.4%) and specificity 95.7% (95.2-96.1%); for proximal segments, respectively, 94.2% (92.3-95.7%) and 94.1% (93.4-94.8%), and for distal segments 84.8% (81.1-88.0%) and 96.9% (96.4-97.4%). If nonevaluable MDCT investigations were included, the per-patient specificity was reduced from 91.0% to 89.1% (p > 0.05) when allocating excluded patients as having significant coronary artery stenosis, and the sensitivity was reduced from 97.7% to 96.2% (p > 0.05) when allocating excluded patients as not having significant stenosis. The per-patient prevalence of coronary artery stenosis had no significant influence on the sensitivity for detecting significant stenosis.

Conclusion: Forty- and 64-MDCT provide good-to-excellent performance in detecting or ruling out significant coronary artery stenosis, with better results for proximal than for distal coronary artery segments.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Coronary Angiography / methods*
  • Coronary Stenosis / diagnostic imaging*
  • Coronary Stenosis / epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / statistics & numerical data*