TY - JOUR
T1 - Predictors of disagreement between prospectively ECG-triggered dual-source coronary computed tomography angiography and conventional coronary angiography
AU - Muzzarelli, Stefano
AU - Suerder, Daniel
AU - Murzilli, Romina
AU - Donato, Lucia
AU - Pedrazzini, Giovanni
AU - Pasotti, Elena
AU - Moccetti, Tiziano
AU - Klersy, Catherine
AU - Faletra, Francesco Fulvio
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Aims To identify causes of misinterpretation in second generation, dual-source coronary computed tomography angiography (CCTA). Methods A retrospective re-interpretation was performed on 100 consecutive CCTA studies, previously performed with a 2 × 128 slice dual-source CT. Results were compared with coronary angiography (CA). CCTA and CA images were interpreted by 2 independent readers. At CCTA vessel diameter, image quality, plaque characteristics and localization (bifurcation vs. non) were described for all segments. Finally, aortic contrast-to-noise ratio (CNR) and the total Agatston calcium score were quantified. Agreement between CCTA and CA was assessed with the Kappa statistic after categorizing the stenosis severity at significant (≥50%) and critical (≥70%) cut-offs, and independent predictors of disagreement were determined by multivariable logistic regression, including patient characteristics such as body mass index (BMI), heart rate (HR), age and gender. Results Per-segment sensitivity and specificity at ≥50% and ≥70% stenosis was of 83-95%, and 73-97%, respectively. There was a substantial agreement between CCTA and CA (kappa-50% = 0.78, SE = 0.03; kappa-70% = 0.72, SE = 0.03). Worse motion-related quality score, smaller vessel diameter, calcification within the segment of interest and LAD location were independent predictors of disagreement at 50% stenosis. The same factors, excluded LAD location, in addition to bifurcation-location of the coronary lesion predicted misdiagnosis at 70% stenosis. HR per se and BMI did not predict disagreement. Conclusion According to the literature a substantial agreement between CCTA and CA was found. However, discrepancies exist and are mainly related with motion-related degradation of image quality, specific vessel anatomy and plaque characteristics. Awareness of such potential limitations may help guiding interpretation of CCTA.
AB - Aims To identify causes of misinterpretation in second generation, dual-source coronary computed tomography angiography (CCTA). Methods A retrospective re-interpretation was performed on 100 consecutive CCTA studies, previously performed with a 2 × 128 slice dual-source CT. Results were compared with coronary angiography (CA). CCTA and CA images were interpreted by 2 independent readers. At CCTA vessel diameter, image quality, plaque characteristics and localization (bifurcation vs. non) were described for all segments. Finally, aortic contrast-to-noise ratio (CNR) and the total Agatston calcium score were quantified. Agreement between CCTA and CA was assessed with the Kappa statistic after categorizing the stenosis severity at significant (≥50%) and critical (≥70%) cut-offs, and independent predictors of disagreement were determined by multivariable logistic regression, including patient characteristics such as body mass index (BMI), heart rate (HR), age and gender. Results Per-segment sensitivity and specificity at ≥50% and ≥70% stenosis was of 83-95%, and 73-97%, respectively. There was a substantial agreement between CCTA and CA (kappa-50% = 0.78, SE = 0.03; kappa-70% = 0.72, SE = 0.03). Worse motion-related quality score, smaller vessel diameter, calcification within the segment of interest and LAD location were independent predictors of disagreement at 50% stenosis. The same factors, excluded LAD location, in addition to bifurcation-location of the coronary lesion predicted misdiagnosis at 70% stenosis. HR per se and BMI did not predict disagreement. Conclusion According to the literature a substantial agreement between CCTA and CA was found. However, discrepancies exist and are mainly related with motion-related degradation of image quality, specific vessel anatomy and plaque characteristics. Awareness of such potential limitations may help guiding interpretation of CCTA.
KW - Coronary angiography
KW - Coronary computed tomography angiography
KW - Diagnostic accuracy
KW - False negative
KW - False positive
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U2 - 10.1016/j.ejrad.2016.03.021
DO - 10.1016/j.ejrad.2016.03.021
M3 - Article
AN - SCOPUS:84962907347
SN - 0720-048X
VL - 85
SP - 1138
EP - 1146
JO - European Journal of Radiology
JF - European Journal of Radiology
IS - 6
ER -