Feasibility and diagnostic accuracy of 16-slice multidetector computed tomography coronary angiography in 500 consecutive patients: critical role of heart rate

  • Daniele Andreini
  • Gianluca Pontone
  • Giovanni Ballerini
  • Carlo Quaglia
  • Enrica Nobili
  • Alessandra Magini
  • Erika Bertella
  • Mauro Pepi
Original Paper



To evaluate the feasibility and diagnostic accuracy of multidetector computed tomography coronary (MDCT) angiography applied to an unselected heart-disease population, to identify all causes of unfeasibility of exams, the distribution of artifacts in every coronary segment and their influence on diagnostic accuracy of examination.

Materials and methods

We evaluated 500 patients with different indications for invasive coronary angiography. All underwent coronary MDCT and ICA. 215 patients were pre-treated with metoprolol intravenously. In the whole population we studied native coronary arteries and in 141 cases the patency of coronary artery bypass grafts (CABG). The quality of MDCT images was graded as good, sufficient and insufficient.


We were able to evaluate the patency of all grafts, with the exception of 4 cases. Diagnostic accuracy of CABG evaluation was very high (sensitivity 100%, specificity 98.4%). In native coronary arteries the overall feasibility was 97.9%. The middle left circumflex artery, right coronary artery and posterior descending artery were the segments most often poorly visualized. The first cause of artifacts was misalignment related to high heart rate, followed by premature heart beats and calcified plaque. The population was separated into 3 groups: group 1: heart rate <55 bpm, group 2: 55–65 bpm, group 3: >65 bpm. In group 1, misalignment was significantly lower than in groups 2 and 3. On a segment-based analysis, overall feasibility was therefore significantly higher in group 1 vs group 2 and vs group 3. Images of good quality were significantly higher in group 1 (95.4%) than in group 2 (87%) and group 3 (71.8%). The higher image quality in group 1 impacts on the overall diagnostic accuracy of the exam. Indeed overall sensitivity is significantly higher in group 1 (89.5%) than in group 2 (86%) and group 3 (82.8%) and overall specificity is significantly higher in group 1 than in group 3.


Multidetector computed tomography has a high feasibility and diagnostic accuracy for the evaluation of coronary artery disease in an unselected population. Good patient preparation (optimized beta-blocker therapy, correct breathing instructions) is essential for evaluating native coronary arteries while preparation with a beta-blocker is less relevant in bypass graft patients.


Beta-blocker therapy Heart rate Misalignment of slices 



American heart association


Coronary artery disease


First diagonal branch


Second diagonal branch


Invasive coronary angiography


Internal mammary artery


Left anterior descending artery


Left circumflex artery


Left main artery


First marginal branch


Second marginal branch


Multidetector computed tomography


Multiplanar reconstruction


Negative predictive value


Posterior descending artery


Positive predictive value


Right coronary artery


Vessel analysis


Volume rendering


  1. 1.
    Scanlon P, Faxon D, Audet A et al (1999) Society for Cardiac Angiography and Interventions. ACC/AHA guidelines for coronary angiography: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). J Am Coll Cardiol 33:1756–1824PubMedCrossRefGoogle Scholar
  2. 2.
    Bashore TM, Bates ER, Berger PB et al (2001) American College of Cardiology/Society for Cardiac Angiography and Interventions Clinical Expert Consensus Document on cardiac catheterization laboratory standards: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 37:2170–2214PubMedCrossRefGoogle Scholar
  3. 3.
    Hoffmann U, Hadvar J, Dunn E (2004) Is CT angiography ready for prime time? A meta-analysis. J Am Coll Cardiol 43(suppl A):312ACrossRefGoogle Scholar
  4. 4.
    Traversi E, Bertoli G, Barazzoni G et al (2004) Non-invasive coronary angiography with multislice computer tomography. Technology, methods, preliminary experience and prospects. Ital Heart J 5(2):89–98PubMedGoogle Scholar
  5. 5.
    Nieman K, Cademartiri F, Lemos PA et al (2002) Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography. Circulation 106:2051–2054PubMedCrossRefGoogle Scholar
  6. 6.
    Ropers D, Baum U, Pohle K et al (2003) Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction. Circulation 107: 664–666PubMedCrossRefGoogle Scholar
  7. 7.
    Mollet NR, Cademartiri F, Nieman K et al (2004) Multislice spiral computed tomography coronary angiography in patients with stable angina pectoris. J Am Coll Cardiol 43: 2265–2270PubMedCrossRefGoogle Scholar
  8. 8.
    Kuetter A, Kopp AF, Schroeder S et al (2004) Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with angiographically proven coronary artery disease. J Am Coll Cardiol 43: 831–839CrossRefGoogle Scholar
  9. 9.
    Leber AW, Knez A, Becker A et al (2004) Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques. J Am Coll Cardiol 43: 1241–1247PubMedCrossRefGoogle Scholar
  10. 10.
    Achembach S, Ropers D, Hoffmann U et al (2004) Assessment of coronary remodeling in stenotic and nonstenotic coronary atherosclerotic lesions by multidetector spiral computed tomography. J Am Coll Cardiol 43:842–847CrossRefGoogle Scholar
  11. 11.
    Hoffmann U, Moselewski F, Cury R et al (2004) Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease. Circulation 110:2638–2643PubMedCrossRefGoogle Scholar
  12. 12.
    Cademartiri F, Marano R, Luccichenti G et al (2004) Anatomia normale del circolo coronarico con tomografia computerizzata multistrato a 16 canali. Radiol Med 107:11–23Google Scholar
  13. 13.
    Desjardins B, Kazerooni EA (2004) ECG-gated cardiac CT. AJR 182:993–1010PubMedGoogle Scholar
  14. 14.
    Achamnbach S, Moselewski F, Ropers D et al (2004) Detection of calcified and noncalcified coronary atherosclerotic plaque by contrast-enhanced submillimeter multidetector spiral computed tomography. Circulation 109:14–17CrossRefGoogle Scholar
  15. 15.
    Kopp AF, Schroeder S, Kuettner A et al (2002) Non-invasive coronary angiography with high resolution multidetector-row computed tomography. Results in 102 patients European Heart Journal 23:1714–1725Google Scholar
  16. 16.
    Ferencik M, Moselewski F, Ropers D et al (2003) Quantitative parameters of image quality in multidetector spiral computed tomographic coronary imaging with submillimeter collimation. Am J Cardiol 92:1257–1262PubMedCrossRefGoogle Scholar
  17. 17.
    Schroeder S, Kopp AF, Kuettner A et al (2002) Influence of heart rate on vessel visibility in noninvasive coronary angiography using new multislice computed tomography. Experience in 94 patients. Clin Imaging 26:106PubMedCrossRefGoogle Scholar
  18. 18.
    Cademartiri F, Mollet NR, Runza G et al (2006) Diagnostic accuracy of multislice computed tomography coronary angiography is improved at low heart rates. Int J Cardiovascular Imaging 22:101–105CrossRefGoogle Scholar
  19. 19.
    Austen WG, Edwards JE, Frye RL et al (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for grading of coronary artery disease, Council of Cardiovascular Surgery, American Heart Association. Circulation 51:35–40Google Scholar
  20. 20.
    Yamashita Y, Komohara Y, Takahashi M et al (2000) Abdominal helical CT: evaluation of optimal doses of intravenous contrast material–a prospective randomized study. Radiology 216:718–723PubMedGoogle Scholar
  21. 21.
    Cademartiri F, Mollet N, van der Lugt A et al (2004) Non-invasive 16-row multislice CT coronary angiography: usefulness of saline chaser. Eur Radiol 14:178–183PubMedCrossRefGoogle Scholar
  22. 22.
    Garcia MJ, Lessick J (2006) Hoffmann MHK for the CATSCAN Study Investigators. Accuracy of 16-row multidetector computed tomography for the assessment of coronary artery stenosis. JAMA 296:403–411PubMedCrossRefGoogle Scholar
  23. 23.
    Sung SS, Yookyung K, Soo Mee L (2005) Improvement of image quality with beta-blocker premedication on ECG-gated 16-MDCT coronary angiography. AJR 84:649–654Google Scholar
  24. 24.
    Singh BN (2005) Beta-Adrenergic blockers as antiarrhythmic and antifibrillatory compounds: an overview. J Cardiovasc Pharmacol Ther 10(Suppl 1):S3–S14PubMedCrossRefGoogle Scholar
  25. 25.
    Haverkamp V, Hindriks G, Gulker H (1990) Antiarrhythmic properties of beta-blockers. J Cardiovasc Pharmacol 16(Suppl 5):S29–S32, ReviewPubMedGoogle Scholar
  26. 26.
    Achenbach S, Ropers D, Kuettner A et al (2006) Contrast-enhanced coronary artery visualization by dual-source computed tomography-initial experience. Eur J Radiol 57(3):331–335PubMedCrossRefGoogle Scholar
  27. 27.
    Martuscelli E, Romagnoli A, D’Eliseo A et al (2004) Evaluation of Venous and Arterial Conduit Patency by 16-Slice Spiral Computed Tomography. Circulation 110:3234–3238PubMedCrossRefGoogle Scholar
  28. 28.
    Brundage BH, Lipton MJ, Herfkens RJ et al (1980) Detection of patent artery bypass grafts by computed tomography: a preliminary report. Circulation 61:826–831PubMedGoogle Scholar
  29. 29.
    Salm LP, Bax J, Jukem JW et al (2005) Comprehensive assessment of patients after coronary artery bypass grafting by 16-detector-row computed tomography. Am Heart J 150:775–781PubMedCrossRefGoogle Scholar
  30. 30.
    Ropers D, Ulzheimer S, Wenkel E et al. (2001) Investigation of aortocoronary artery bypass grafts by multislice spiral computed tomography with electrocardiographic-gated image reconstruction. Am J Cardiol 88(7):792–795PubMedCrossRefGoogle Scholar
  31. 31.
    Anders K, Baum U, Schmid M et al. (2006) Coronary artery bypass graft (CABG) patency: assessment with high resolution submillimeter 16-slice multidetector-row computed tomography (MDTC) versus coronary angiography. Eur J Radiol 57(3):336–344PubMedCrossRefGoogle Scholar
  32. 32.
    Marano R, Storto ML, Maddestra N et al (2004) Non-invasive assessment of coronary artery bypass graft with retrospectively ECG-gated four-row multi-detector spiral computed tomography. Eur J Radiol 14:1353–1362Google Scholar
  33. 33.
    Rossi R, Chiurlia E, Ratti C et al (2004) Noninvasive assessment of coronary artery bypass graft patency by multislice computed tomography. Ital Heart J 5(1):36–41PubMedGoogle Scholar
  34. 34.
    Hendel RC, Patel MR, Kramer CM, Poon M et al (2006) American College of cardiology foundation quality strategic directions committee appropriateness criteria working group; American College of Radiology; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; American Society of Nuclear Cardiology; North American Society for Cardiac Imaging; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol 48(7):1475–1497Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2007

Authors and Affiliations

  • Daniele Andreini
    • 1
  • Gianluca Pontone
    • 1
  • Giovanni Ballerini
    • 1
  • Carlo Quaglia
    • 1
  • Enrica Nobili
    • 1
  • Alessandra Magini
    • 1
  • Erika Bertella
    • 1
  • Mauro Pepi
    • 1
  1. 1.Centro Cardiologico Monzino, IRCCS, Institute of CardiologyUniversity of MilanMilanItaly

Personalised recommendations