[Coronary CT-angiography]. / Koronar CT-angiografi.

BACKGROUND: Recent advances in computed tomography (CT) has made noninvasive imaging of the coronary arteries possible. Multidetector-CT (MDCT)-scanners capable of visualizing the coronary arteries will be available in most Norwegian hospitals within a few years. If the examinations have acceptable quality, diagnostics of coronary pathology could to some extent be decentralized. MATERIAL AND METHODS: Our overview is based on non-systematic review of relevant literature, as well as our own experience. RESULTS AND DISCUSSION: Good results have been shown for 16 and especially for 64 detector scanners in several comparative studies with invasive coronary angiography. The predictive value of a negative test is impressive in all the published studies. Significant coronary pathology is unlikely with a normal MDCT investigation of good quality, but MDCT's imprecise assessment of stenoses generates too many false positive findings. CT-technology is evolving rapidly. Yet, variable image quality and a high radiation dose are still challenging, even with modern CT-scanners. INTERPRETATION: We advocate against uncritical use of the method, however, there is reason for optimism regarding the method's future contribution to coronary diagnostics.

Limited usefulness of non-invasive coronary angiography with 16-detector multislice computer tomography at a community hospital.

OBJECTIVES: To evaluate the usefulness of coronary angiography by 16-detector multislice spiral computed tomography (MSCT) in community hospital outpatients. DESIGN: MSCT was performed at the community hospital in 157 of 218 consecutive outpatients with suspected significant coronary disease, before referral for invasive coronary angiography. RESULTS: 101 patients had interpretable MSCT angiograms (64 men, age 62+/-10 years, calcium score 373+/-678, heart rate 56+/-7 beats/min, beta-blocker used by 91%). Coronary stenoses >50% were identified by invasive angiography in 49 patients. Only 79% of all segments could be assessed by MSCT due to heavy coronary calcification (12%) and blurred images (9%) in the remaining. By interpreting non-assessable segments as negative results 79 patients were correctly classified by MSCT. Sensitivity, specificity, positive and negative predictive values at patient level was 82%, 75%, 75% and 81%. By interpreting non-assessable segments as positive findings, the corresponding values were 100%, 29%, 57% and 100%, with correct diagnoses in 63% of patients. CONCLUSIONS: Limited diagnostic accuracy, non-interpretable scans and radiation exposure restrict the usefulness of coronary MSCT in a community hospital setting.