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Severity of Coronary Artery Stenosis on CTA
Degree of StenosisDiameter Reduction (%)normalnone minimal1-25 mild26-50 moderate51-70 moderate71-99 occlusion100 Sundaram B, Kazerooni EA et al
AJR 2009;192:574-583 "Multidetector CT angiography accurately identifies the presence and severity of obstructive coronary artery disease and subsequent revascularization in symptomatic patients. The negative and positive predictive values indicate that multidetector CT angiography cannot replace conventional coronary angiography at present."
Diagnostic Performance of Coronary Angiography by 64-Row CT
Miller JM et al.
N Engl J Med 2008 Nov 27;359(22):2309-2311"Importantly the 99% negative predictive value at the patient and vessel level establishes CCTA as an effective noninvasive alternative to ICA to rule out obstructive coronary artery stenosis."
Diagnostic Performance of 64-Multidetector Row CCTA for Evaluation of Coronary Artery Stenosis in Individuals Without Known Coronary Artery Disease: Results from the Perspective Multicenter ACCURACY trial
Budoff MJ et al.
J Am Coll Cardiol 2008 Nov 18;52(21):1724-1732"In this prospective multicenter trial of chest pain patients without known CAD, 64 multidetector row CCTA possesses high diagnostic accuracy for detection of obstructive coronary stenosis at both thresholds of 50% and 70% stenosis."
Diagnostic Performance of 64-Multidetector Row CCTA for Evaluation of Coronary Artery Stenosis in Individuals Without Known Coronary Artery Disease: Results from the Perspective Multicenter ACCURACY trial
Budoff MJ et al.
J Am Coll Cardiol 2008 Nov 18;52(21):1724-1732Objective: The purpose of our study was to assess the diagnostic performance of thin slice (≤ 0.625 mm) MDCT coronary angiography compared with invasive coronary angiography for the detection of significant stenosis (≥50%).
Material and Methods: 22 articles on 40 and 64 MDCT coronary angiography were included.Meta-Analysis of 40 and 64-MDCT Angiography for Assessing Coronary Artery StenosisMeijer AB et al.AJR 2008; 191:1667-1675Results: Pooled sensitivity on a patient level was 97.7% and specificity 91.0%. Pooled sensitivity on a segmental level was 90.8% and specificity 95.7%; for proximal segments respectively, 94.2% and 94.1%, and for distal segments 84.8% and 96.9%.
Meta-Analysis of 40 and 64-MDCT Angiography for Assessing Coronary Artery StenosisMeijer AB et al.AJR 2008; 191:1667-1675“ In conclusion, dual-source coronary CTA with prospective ECG triggering performs accuarately in the assessment of CAD at low radiation doses. Diagnostic accuracy remains similarly high despite the presence of heavy calcifications but is associated with an increased rate of nondiagnostic segments.”
Influence of Calcifications on Diagnostic Accuracy of Coronary CT Angiography Using Prospective ECG TriggeringStolzmann P et al.AJR 2008; 191:1684-1689"Dual-source CT coronary angiography with use of prospective ECG triggering performs accurately in the assessment of coronary artery disease at low radiation doses. Diagnostic accuracy remains high despite the presence of heavy calcifications but is associated with an increased rate of nondiagnostic segments."
Influence of Calcifications on Diagnostic Accuracy of Coronary CT Angiography Using Prospective ECG TriggeringStolzmann P et al.AJR 2008; 191:1684-1689" This limitation of CTA is particularly true in light of blooming and beam hardning artifacts that calcium causes."
Accuracy of MDCT in Assessing the Degree of Stenosis Caused by Calcified Coronary Artery PlaquesZhang S et al.AJR 2008;191:1676-1683“ In detecting obstructive lesions caused by the 43 large calcified coronary artery plaques, coronary CTA had a sensitivity of 100%, specificity of 44%, positive predictive value of 56%, negative predictive value of 100%, and accuracy of 67%.”
Accuracy of MDCT in Assessing the Degree of Stenosis Caused by Calcified Coronary Artery PlaqusZhang S et al.AJR 2008;191:1676-1683"Coronary CTA can be used to accurately predict the presence of obstructive disease in >90% of small and moderate-sized calcified coronary artery plaques. With large calcified coronary artery plaques, CTA correctly predicts the presence of obstructive disease in approximately two thirds of cases. When errors occur, they are usually due to overestimation of the degree of stenosis."
Accuracy of MDCT in Assessing the Degree of Stenosis Caused by Calcified Coronary Artery PlaqusZhang S et al.AJR 2008;191:1676-1683- "The main artifacts that hamper MDCT coronary angiography image interpretation are motion artifacts that cause blurring and incorrect diagnosis due to coronary artery calcifications."
Artifacts in ECG-Synchronized MDCT Coronary Angiography
Kroft LJM et al.
AJR 2007; 189:581-591
- Artifacts in Cardiac CTA
- Blooming artifacts
- Blurring artifacts
- Streak artifacts
- Subtle discontinuities and missing data
- Stairstep artifacts
- Windmill artifacts
- Poor contrast in lumen of coronary artery
- Incomplete coverage
- Artifacts in Cardiac CTA
"Artifacts may be grouped in technical (physics based, scanner based, and reconstruction based), operator and patient related causes."
Artifacts in ECG-Synchronized MDCT Coronary Angiography
Kroft LJM et al.
AJR 2007; 189:581-591
- "With the newer generations of multidetector CT scanners, the diagnostic performance for the assessment of significant coronary arterial stenoses (>50% diameter stenosis) has significantly improved, and the proportion of nonassessable segments has decreased."
Diagnostic Performance of Multidetector CT Angiography for Assessment of Coronary Artery Disease: Meta-analysis
Vanhoenacker PK et al
Radiology 2007; 244:419-428