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. 2005 Nov;91(11):1423-7.
doi: 10.1136/hrt.2004.049817. Epub 2005 Mar 10.

Clinical use of multislice spiral computed tomography in 210 highly preselected patients: experience with 4 and 16 slice technology

T Beck  1 , C Burgstahler, A Kuettner, A F Kopp, M Heuschmid, C D Claussen, S Schroeder
Affiliations

Clinical use of multislice spiral computed tomography in 210 highly preselected patients: experience with 4 and 16 slice technology

T Beck et al. Heart. 2005 Nov.

Abstract

Objective: To report an initial experience with multislice spiral computed tomography (MSCT) coronary imaging, as well as differences in diagnostic accuracy between 4 slice and 16 slice MSCT technology.

Methods and results: 210 patients underwent MSCT coronary angiography (4 slices, n = 120; 16 slices, n = 90; suspicion of coronary artery disease, n = 158; suspicion of restenosis, n = 52). Recommendations for further diagnostic tests were based on the MSCT results. Patients were interviewed by telephone after a mean (SD) of 449 (169) days to evaluate their further clinical course. MSCT detected significant lesions in 90 of 210 (43%) patients and invasive coronary angiography (ICA) was recommended. MSCT excluded significant lesions in 120 of 210 (57%) patients. ICA was actually performed in 44 of 210 (21%) patients (corresponding results, 27 of 44 (61%); false positive, 11 of 44 (25%); false negative, 6 of 44 (14%)). No significant differences were found between 4 and 16 slice imaging. No major cardiac event occurred during follow up.

Conclusions: MSCT was found to be useful to evaluate the need for invasive diagnostic procedures. However, the false negative results underline that further improvements of image quality are required before MSCT can replace ICA in carefully selected patients.

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Figures

Figure 1
Figure 1
Left coronary artery of an asymptomatic 65 year old male patient. (A) Axial view of the left anterior descending artery (LAD) with mixed plaque in the proximal LAD (arrow). No contrast enhanced lumen is visible within the stenotic area, indicating either a severe subtotal stenosis or chronic total occlusion with retrograde vessel perfusion. (B) Lateral view of the LAD. Mixed plaque with stenotic area (arrow). (C) Three dimensional reconstruction. No contrast enhanced lumen is visible within the plaque area (arrow). After multislice spiral computed tomography (MSCT) coronary angiography was performed the patient was advised to undergo invasive coronary angiography (ICA). (D and E) ICA verified the MSCT findings. The LAD has a proximal chronic occlusion with bridging collaterals (arrow). ICA in right anterior oblique before (D) and after (E) percutaneous coronary intervention. For MSCT coronary angiography it is difficult to differentiate a subtotal stenosis from a chronic occlusion with retrograde vessel perfusion. RCA, right coronary artery; RCX, right circumflex artery.
See this image and copyright information in PMC

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