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Usefulness of additional coronary calcium scoring in low-dose CT coronary angiography with prospective ECG-triggering impact on total effective radiation dose and diagnostic accuracy


Husmann, L; Herzog, B A; Burger, I A; Buechel, R R; Pazhenkottil, A P; von Schulthess, P; Wyss, C A; Gaemperli, O; Landmesser, U; Kaufmann, P A (2010). Usefulness of additional coronary calcium scoring in low-dose CT coronary angiography with prospective ECG-triggering impact on total effective radiation dose and diagnostic accuracy. Academic Radiology, 17(2):201-206.

Abstract

RATIONALE AND OBJECTIVES: To determine the impact of additional coronary calcium scoring on total effective radiation dose and diagnostic accuracy of low-dose computed tomography coronary angiography (CTCA) with prospective electrocardiogram (ECG) triggering. MATERIALS AND METHODS: Sixty-one consecutive patients underwent 64-slice CTCA using prospective ECG triggering, calcium scoring, and invasive quantitative coronary angiography, the latter served as standard of reference. Diagnostic accuracy was calculated for CTCA, calcium scoring, and for the combination of both. Receiver operator characteristic analyses were performed to determine cutoffs for prediction of significant coronary artery stenoses. RESULTS: Mean effective radiation dose was 2.1 + or - 0.7 mSv (range, 1.0-3.3 mSv) for CTCA and 1.1 + or - 0.1 mSv (range, 0.9-1.4 mSv) for calcium scoring. Per-patient sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 85.7%, 89.2%, and 100% for CTCA, and 72.7%, 82.1%, 82.8%, and 71.9% for calcium scoring. Adding calcium-scoring with a cutoff at 133 in patients aged >50.7 years with nondiagnostic CTCA improved the respective values of diagnostic accuracy of the entire study population to 100%, 96.4%, 97.1%, and 100%; the added value of calcium scoring was confined to only three patients (5%), who were reclassified from false positive to true negative. CONCLUSION: Specificity and PPV of low-dose CTCA may be further improved by combining it with coronary calcium scoring. However, only a fraction of patient may benefit, whereas exposing the entire population to more than 50% increase in effective radiation dose.

RATIONALE AND OBJECTIVES: To determine the impact of additional coronary calcium scoring on total effective radiation dose and diagnostic accuracy of low-dose computed tomography coronary angiography (CTCA) with prospective electrocardiogram (ECG) triggering. MATERIALS AND METHODS: Sixty-one consecutive patients underwent 64-slice CTCA using prospective ECG triggering, calcium scoring, and invasive quantitative coronary angiography, the latter served as standard of reference. Diagnostic accuracy was calculated for CTCA, calcium scoring, and for the combination of both. Receiver operator characteristic analyses were performed to determine cutoffs for prediction of significant coronary artery stenoses. RESULTS: Mean effective radiation dose was 2.1 + or - 0.7 mSv (range, 1.0-3.3 mSv) for CTCA and 1.1 + or - 0.1 mSv (range, 0.9-1.4 mSv) for calcium scoring. Per-patient sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 85.7%, 89.2%, and 100% for CTCA, and 72.7%, 82.1%, 82.8%, and 71.9% for calcium scoring. Adding calcium-scoring with a cutoff at 133 in patients aged >50.7 years with nondiagnostic CTCA improved the respective values of diagnostic accuracy of the entire study population to 100%, 96.4%, 97.1%, and 100%; the added value of calcium scoring was confined to only three patients (5%), who were reclassified from false positive to true negative. CONCLUSION: Specificity and PPV of low-dose CTCA may be further improved by combining it with coronary calcium scoring. However, only a fraction of patient may benefit, whereas exposing the entire population to more than 50% increase in effective radiation dose.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
04 Faculty of Medicine > Center for Integrative Human Physiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:570 Life sciences; biology
610 Medicine & health
Language:English
Date:February 2010
Deposited On:05 Mar 2010 07:18
Last Modified:05 Apr 2016 14:01
Publisher:Elsevier
ISSN:1076-6332
Publisher DOI:10.1016/j.acra.2009.09.007
PubMed ID:19944630
Permanent URL: http://doi.org/10.5167/uzh-32279

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