The Diagnotic Value Of Multi-slice Spiral CT To Coronary Artherosclerotic Heart Disease

ObjectiveMultislice spiral computed tomography ( MSCT) with retrospectively ECG-gated image reconstruction permits coronary artery visualization. We evaluate the primary clinical value of sixteen-slice spiral CT coronary angiography to i-dentify coronary artery stenoses( > 50% diameter stenosis) and occlusions.MethodsA total of 46 consecutive patients were studied including 37 man and 9 woman , average age 56 years. 46 patients were referred for invasive coronary angiography and MSCTA to detect coronary disease in 2 weeks. All patients in sinus rhythm, without contraindication to the administrtion of iodinated contrast a-gent, without implanted pacemakers or valve prostheses, and without severe respiratory or heart failure. 16-slice spiral CT with improved spatial and temporal resolution, as well as routine premedication with 12. 5-25mg Betaloc for detection of coronary stenoses 30 minutes before the scan if the heart rate was more than 70 bmp.MSCT scan :We use a 16-slice spiral CT scanner( Philips Mx8000-IDT) to covering the distance from the carina to the diaphragmal face of the heart. Plain scan image and MPR, MIP,VR and CTVR reconstruction with enhanced scan image were wade in all cases. The images were analyzed by one or two cardiologist experienced in tomographic coronary imaging using the original axialimage and multiplanar reconstructions. By visual estimation , coronary arteries were classified as evaluable or unevaluable, and in evaluable arteries, the stenosis of exceeding 50% diameter reduction was assassed. Side branches were includedin the analysis of the respective main coronary artery. Results were compared with quantitative coronary angiography as gold standard for stenosis detection.ResultsOf 184 coronary arteries (left main, left anterior descending, left circumflex and right coronary artery, including their respective side branches) , 15 coronary could not be evaluated (8.2% ). Artifacts caused by coronary motion and severe vessel calcification were the most frequent reason for unevaluable arteries. 31 of 39 stenoses and occlusions were detected by MSCT (79.5% ). In 169 evaluable arteries, 28 of 33 arteries of lesions were detected, and the absence of stenosis was correctly identified in 130 of 136 arteries (sensitivity 84.8% ; specificity, 95. 6% ; positive predictive value 82.4% ;negative predictive value 96. 3%).ConclusionsMSCT with retrospective ECG gating permits the detection of coronary arter-y stenoses with high accuracy if image quality is sufficient, but its clinical use may presently be limited due to image quality in a substantial number of cases, mainly due to coronary motion artifacts and severe vessel calcification.