Multidetector Computed Tomography for the Diagnosis of Coronary Artery Disease: A Systematic Review

Stein, Paul D.; Beemath, Afzal; Kayali, Fadi; Skaf, Elias; Sanchez, Julia; Olson, Ronald E.

doi:10.1016/j.amjmed.2005.06.071

« Previous Next »The American Journal of Medicine
Volume 119, Issue 3 , Pages 203-216, March 2006

Multidetector Computed Tomography for the Diagnosis of Coronary Artery Disease: A Systematic Review

Paul D. Stein, MD
- Department of Research, St. Joseph Mercy Oakland Hospital, Pontiac, Mich.
- Department of Internal Medicine, Wayne State University, Detroit, Mich.
- Requests for reprints should be addressed to Paul D. Stein, MD, Saint Joseph Mercy Oakland, 44405 Woodward Avenue, Pontiac, MI 48341-2985.
Afzal Beemath, MD
- Department of Research, St. Joseph Mercy Oakland Hospital, Pontiac, Mich.
Fadi Kayali, MD
- Department of Research, St. Joseph Mercy Oakland Hospital, Pontiac, Mich.
Elias Skaf, MD
- Department of Research, St. Joseph Mercy Oakland Hospital, Pontiac, Mich.
Julia Sanchez, MD
- Department of Research, St. Joseph Mercy Oakland Hospital, Pontiac, Mich.
Ronald E. Olson, PhD
- Office of Grants, Contracts and Sponsored Research, Oakland University, Rochester, Mich.

Received in revised form 30 June 2005; accepted 30 June 2005.

Abstract

Purpose

The study’s purpose was to determine the sensitivity and specificity of contrast-enhanced multidetector computed tomography (CT) for the detection of coronary artery disease.

Subjects and methods

A search of the literature in all languages was performed incorporating both electronic and manual components. Manual reference checks of recent reviews and all original investigations supplemented the electronic searches.

Results

Average sensitivity for patient-based detection of significant (>50% or ≥50%) stenosis was 61 of 64 (95%) with 4-slice CT, 276 of 292 (95%) with 16-slice CT, and 47 of 47 (100%) with 64-slice CT. Average specificity was 84% for 4-slice CT, 84% for 16-slice CT, and 100% for 64-slice CT. The sensitivity for a significant stenosis in evaluable segments was 307 of 372 (83%) with 4-slice CT, 1023 of 1160 (88%) with 16-slice CT, and 165 of 176 (94%) with 64-slice CT. Average specificity was 93% or greater with all multidetector CT. Seventy-eight percent of segments were evaluable with 4-slice CT, 91% with 16-slice CT, and 100% with 64-slice CT. Stenoses in proximal and mid-segments were shown with a higher sensitivity than distal segments. Left main stenosis was identified with high sensitivity with all multidetector CT, but sensitivity in other vessels increased with an increasing number of detectors.

Conclusion

Multidetector CT has the potential to be used as a screening test in appropriate patients. Contrast-enhanced 16-slice CT seems to be reasonably sensitive and specific for the detection of significant coronary artery disease but has shortcomings. Preliminary data with 64-slice CT suggest that it is more sensitive and specific.

Keywords: Coronary artery disease , Coronary angiography , Computed tomography