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Systematic review of the accuracy of dual-source cardiac CT for detection of arterial stenosis in difficult to image patient groups.
Westwood, Marie E; Raatz, Heike D I; Misso, Kate; Burgers, Laura; Redekop, Ken; Lhachimi, Stefan K; Armstrong, Nigel; Kleijnen, Jos.
Afiliação
  • Westwood ME; Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York YO19 6FD, England.
Radiology ; 267(2): 387-95, 2013 May.
Article em En | MEDLINE | ID: mdl-23392425
ABSTRACT

PURPOSE:

To assess the diagnostic performance of dual-source cardiac (DSC) computed tomography (CT) newer-generation CT instruments for identifying anatomically significant coronary artery disease (CAD) in patients who are difficult to image by using 64-section CT. MATERIALS AND

METHODS:

A literature search comprised bibliographic databases (January 1, 2000, to March 22, 2011, with a pragmatic update on September 6, 2012), trial registries, and conference proceedings. Only studies using invasive coronary angiography as reference standard were included. Risk of bias was assessed (QUADAS-2). Results were stratified according to patient group on the basis of clinical characteristics. Summary estimates of sensitivity and specificity of DSC CT for detecting 50% or greater arterial stenosis were calculated by using a bivariate summary receiver operating characteristic or random-effects model.

RESULTS:

Twenty-five studies reported accuracy of DSC CT for diagnosing CAD in difficult to image patients; in 22 studies, one of two CT units of the same manufacturer (Somatom Definition or Somatom Definition Flash) was used, and in the remaining three, a different CT unit of another manufacturer (Aquilion One) was used. The pooled, per-patient estimates of sensitivity were 97.7% (95% confidence interval [CI] 88.0%, 99.9%) and 97.7% (95% CI 93.2%, 99.3%) for patients with arrhythmias and high heart rates, respectively. The corresponding pooled estimates of specificity were 81.7% (95% CI 71.6%, 89.4%) and 86.3% (95% CI 80.2%, 90.7%), respectively. All data were acquired by using Somatom Definition. In two studies with Somatom and one study with Aquilion One, sensitivity estimates of 90% or greater were reported in patients with previous stent implantations; specificities were 81.7% and 89.5% for Somatom and 81.0% for Aquilion One. In patients with high coronary calcium scores, previous bypass grafts, or obesity, only per-segment or per-artery data were available. Sensitivity estimates remained high (>90% in all but one study), and specificities ranged from 79.1% to 100%. All data were acquired by using Somatom Definition.

CONCLUSION:

DSC CT may be sufficiently accurate to diagnose clinically significant CAD in some or all difficult to image patients. SUPPLEMENTAL

MATERIAL:

http//radiology.rsna.org/lookup/suppl/doi10.1148/radiol.13121136/-/DC1.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Tomografia Computadorizada por Raios X / Angiografia Coronária Idioma: En Ano de publicação: 2013 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Tomografia Computadorizada por Raios X / Angiografia Coronária Idioma: En Ano de publicação: 2013 Tipo de documento: Article