News | December 16, 2009

CT Calcium Detection Aids in Ruling Out Obstructive Coronary Disease

December 16, 2009 - Non-enhanced CT for calcium detection is a reliable way to exclude obstructive coronary artery disease in patients with chest pain, according to a study published in the December issue of the American Journal of Cardiology.

While is a well established option for , particularly when stress tests are inconclusive or not feasible, Concerns surrounding radiation and contrast exposure prompted researchers, led by Dr. Koen Nieman and colleagues from Erasmus Medical Center, Rotterdam, The Netherlands, to investigate alternative diagnostic techniques for evaluating patients with chest pain other than CT angiography (CTA).

To compare the effectiveness of coronary calcium scores (CCS), CTA, and exercise electrocardiography (XECG) for detecting obstructive coronary disease, researchers evaluated 471 patients with new stable chest pain.

In eight patients (1.7 percent), neither CCS nor CTA was possible. In an additional eight, CTA could not be performed for various reasons. All of the calcium scans were successful, while three CTAs failed. XECG was not possible in 48 patients (10.2 percent) and was inconclusive in 140 of 423 patients (33 percent). Ninety-eight patients underwent catheter angiography, with 57 found to have at least 50 percent diameter obstruction.

Overall, 175 patients (37 percent) had a negative CCS. Three of these (2 percent) had significant CAD on CT angiograms, only one of which was confirmed by quantitative angiography.

In patients with a high CCS (Agatston of more than 400; n = 65), CTA could exclude obstructive CAD in no more than four (6 percent). CT was more often diagnostic in patients with a low-intermediate CCS (10 to 400; n = 175), and could rule out obstructive CAD in 56 percent of patients.

Few cases of obstructive disease were detected in patients with a low CCS (less than 10; n = 48), although these patients had evidence of atherosclerotic disease.

Overall, 42 percent of patients had positive CT angiograms. These patients had significant stenosis on quantitative angiogram more often when exercise electrocardiogram was also positive.

For patients with diagnostic results for all tests, the sensitivity and specificity to detect significant coronary stenosis were 100 percent and 16 percent for CCS of more than zero, 82 percent and 64 percent for CCS of more than 100, 97 percent and 36 percent for CTA, and 70 percent and 76 percent for XECG, respectively.

The type of tests preferred for the workup of suspected CAD - functional, or anatomical - is still up for debate. "Although XECG is considered more cost effective, it has poor diagnostic performance," the researchers noted.

The researchers concluded, similar to a negative stress test result, a negative CCS also has an excellent prognosis. This suggests that a negative CCS could suffice to rule out obstructive CAD without the need for further testing.

For more information:www.ajconline.org

Related Content

Achenbach to Receive Inaugural 2019 Stephan Achenbach Pioneer Award in Cardiovascular CT
News | Computed Tomography (CT) | July 10, 2019
The Society of Cardiovascular Computed Tomography (SCCT) will present Stephan Achenbach, M.D., FSCCT with the inaugural...
New Type of Cardiac Care to Cut Imaging Wait Times and Unnecessary Hospital Admissions
News | Computed Tomography (CT) | June 20, 2019
A new type of care for cardiac patients at St. Paul’s Hospital, Vancouver, has the potential to reduce heart imaging...
Canon Medical Receives FDA Clearance for AiCE Reconstruction Technology for CT
Technology | Computed Tomography (CT) | June 18, 2019
Canon Medical Systems USA Inc. has received 510(k) clearance on its new deep convolutional neural network (DCNN) image...
SCCT Announces 2019 Gold Medal Award Recipients

Jonathon Leipsic, M.D., (left) and Gilbert Raff, M.D., (right)

News | Computed Tomography (CT) | June 05, 2019
The Society of Cardiovascular Computed Tomography (SCCT) will present the 2019 Gold Medal Award to Jonathon Leipsic, M....
Johns Hopkins Medicine First in U.S. to Install Canon Medical's Aquilion Precision
News | Computed Tomography (CT) | March 26, 2019
Johns Hopkins Medicine now has access to the first Ultra-High Resolution computed tomography (UHR CT) system for...
Siemens Healthineers Debuts Cardiovascular Edition of Somatom go.Top CT
News | Computed Tomography (CT) | March 14, 2019
Siemens Healthineers will introduce the Somatom go.Top Cardiovascular Edition, a new version of its established...
Canon Medical Introduces Deep Learning-Based CT Image Reconstruction
News | Computed Tomography (CT) | February 27, 2019
Canon Medical Systems recently introduced AiCE (Advanced intelligent Clear IQ Engine), a deep convolutional neural...
SCCT Releases New Guideline for CT Use During TAVR
News | Computed Tomography (CT) | January 08, 2019
The Society of Cardiovascular Computed Tomography (SCCT) has released a new expert consensus document for computed...
Overlay Init