Transitioning from 16-slice to 64-slice multidetector computed tomography for the assessment of coronary artery disease: are we really making progress?

Abstract

BACKGROUND:

Multidetector computed tomography (MDCT) has demonstrated promise in the noninvasive evaluation of coronary artery disease.

OBJECTIVE:

To systematically review the literature regarding the improved diagnostic accuracy of 64-slice MDCT.

METHODS:

An EMBASE, OVID, PubMed and Cochrane Library database search was performed using the key words 'computed tomography' matched with the terms 'coronary artery' or 'coronary angiography' to identify English-language articles examining MDCT cardiac imaging. Studies that compared 16-slice or 64-slice MDCT with catheter-based coronary angiography for the detection of coronary artery disease in nonrevascularized, poststent and post-coronary artery bypass graft patients were included. Data were pooled to obtain a weighted sensitivity, specificity and diagnostic accuracy for MDCT. Negative and positive predictive values, and likelihood ratios were calculated based on sensitivity and specificity.

RESULTS:

Currently, 15 studies involving 1008 patients have examined the efficacy of 64-slice MDCT in the assessment of coronary artery stenosis (more than 50% luminal narrowing). In these studies, 64-slice MDCT has demonstrated a sensitivity (89%), specificity (96%) and diagnostic accuracy (95%) similar to that of 16-slice MDCT. However, 64-slice MDCT was able to assess 5% more coronary artery segments than 16-slice MDCT. In revascularized patients, MDCT can accurately assess both bypass graft occlusion and stenosis. The 64-slice MDCT is also capable of adequately detecting in-stent restenosis. Improvements in spatial and temporal resolution with 64-slice technology have decreased the occurrence of high attenuation and motion artefacts that plagued the previous generation of MDCT scanners.

CONCLUSION:

MDCT offers an accurate assessment of the coronary arteries, stented arteries and bypass grafts. The improved accuracy and safety of MDCT may reduce the need for catheter-based coronary angiography.

• Authors: Razi Khan, Sapna Rawal, Mark J Eisenberg
• Journal: The Canadian journal of cardiology (Can J Cardiol) Vol. 25 Issue 9 Pg. 533-42 (Sep 2009) ISSN: 1916-7075 [Electronic] England
• PMID: 19746244 (Publication Type: Journal Article, Review)

Topics

• Coronary Angiography (methods)
• Coronary Artery Disease (diagnostic imaging)
• Equipment Design
• Humans
• Reproducibility of Results
• Tomography, X-Ray Computed (trends)