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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.

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.

journal_name

Acad Radiol

journal_title

Academic radiology

authors

Husmann L,Herzog BA,Burger IA,Buechel RR,Pazhenkottil AP,von Schulthess P,Wyss CA,Gaemperli O,Landmesser U,Kaufmann PA

doi

10.1016/j.acra.2009.09.007

subject

Has Abstract

pub_date

2010-02-01 00:00:00

pages

201-6

issue

eissn

1076-6332

issn

1878-4046

pii

S1076-6332(09)00499-1

journal_volume

pub_type

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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.