Academic Radiology
Volume 17, Issue 2 , Pages 201-206, February 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

  • Lars Husmann, MD

      Affiliations

    • Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
    • ,
  • Bernhard A. Herzog, MD

      Affiliations

    • Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
    • ,
  • Irene A. Burger, MD

      Affiliations

    • Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
    • ,
  • Ronny R. Buechel, MD

      Affiliations

    • Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
    • ,
  • Aju P. Pazhenkottil, MD

      Affiliations

    • Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
    • ,
  • Patrick von Schulthess

      Affiliations

    • Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
    • ,
  • Christophe A. Wyss, MD

      Affiliations

    • Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
    • ,
  • Oliver Gaemperli, MD

      Affiliations

    • Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
    • ,
  • Ulf Landmesser, MD

      Affiliations

    • Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
    • ,
  • Philipp A. Kaufmann, MD

      Affiliations

    • Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
    • Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Switzerland
    • Corresponding Author InformationAddress correspondence to: P.A.K.

Received 17 June 2009; accepted 5 September 2009. published online 30 November 2009.

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 ± 0.7 mSv (range, 1.0–3.3 mSv) for CTCA and 1.1 ± 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.

Key Words: Prospective ECG-triggering, coronary calcium-scoring, computed tomography coronary angiography, effective radiation dose, diagnostic accuracy

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 Supported by a grant from the Swiss National Science Foundation and by the ZIHP (Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland).

PII: S1076-6332(09)00499-1

doi:10.1016/j.acra.2009.09.007

Academic Radiology
Volume 17, Issue 2 , Pages 201-206, February 2010

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