Diagnostic value of cardiac 64-slice computed tomography: Importance of coronary calcium
- 1 January 2009
- journal article
- research article
- Published by Taylor & Francis Ltd in Scandinavian Cardiovascular Journal
- Vol. 43 (5), 337-344
- https://doi.org/10.1080/14017430902785501
Abstract
Objectives. Coronary computed tomography angiography (CTA) has proven clinically useful for non-invasive assessment of coronary pathology. However, coronary calcium can reduce its diagnostic value. The objective of this study was to define a calcium score above which CTA appears less reliable. Design. We prospectively investigated 109 patients referred for elective coronary angiography (CA). With a 64-slice CT-scanner, coronary calcium was determined and expressed in Agatston unit (AU). A significant coronary stenosis was defined as ≥50% luminal diameter reduction. Following blinded interpretation, diagnostic values of CTA at different levels of AU were calculated using quantitative CA as reference. Results. A strong association with stent and the severity of coronary calcium was observed. In patients without stents (n = 91) sensitivity, specificity and positive and negative predictive value for presence of significant stenosis were: 100%, 91%, 74%, and 100% in patients with a calcium score ≤400 AU versus 100%, 17%, 75%, and 100% in patients with a score >400 AU. Conclusions. The diagnostic accuracy of CTA in patients with no or little coronary calcium is excellent. However, in patients with an Agatston score >400 specificity declines and therefore, these patients should not go on to CTA, but be referred to CA instead.Keywords
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