Predictive Value of 16-Slice Multidetector Spiral Computed Tomography to Detect Significant Obstructive Coronary Artery Disease in Patients at High Risk for Coronary Artery Disease

Abstract

Background— In this study, we investigated the diagnostic value and limitations of multidetector computed tomography (MDCT)–based noninvasive detection of significant obstructive coronary artery disease (CAD) in a consecutive high-risk patient population with inclusion of all coronary segments. Methods and Results— In a prospective, blinded, standard cross-sectional technology assessment, a cohort of 33 consecutive patients with a positive stress test result underwent 16-slice MDCT and selective coronary angiography for the detection of significant obstructive CAD. We assessed the diagnostic accuracy of MDCT in a segment-based and a patient-based model and determined the impact of stenosis location and the presence of calcification on diagnostic accuracy in both models. Analysis of all 530 coronary segments demonstrated moderate sensitivity (63%) and excellent specificity (96%) with a moderate positive predictive value of 64% and an excellent negative predictive value (NPV) of 96% for the detection of sig...