Abstract:
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Purpose: Coronary artery calcium (CAC) score measured by electron beam tomography (EBT) is widely used as a marker of atherosclerotic disease. EBA is promising for detecting coronary luminal stenosis. The usefulness for both protocols in patients with suspected coronary artery disease (CAD) need to be compared and evaluated. We sought to evaluate the different reliability between calcium scoring and electron beam angiography (EBA) in predicting the likely severity of associated angiographic coronary artery disease (CAD, ³50% stenosis).
Methods and Materials: Both CAC screening and EBA studies were performed simultaneously in 107 consecutive patients. Quantification of CAC score (Agatston method) and detection of luminal stenosis by EBA were done on a segmental basis. EBT results were blindly compared with conventional coronary angiography.
Results: EBA and CAC scoring improved discrimination over the conventional risk factors for identification of obstructive CAD (Odds ratios were 14.5 and 11.9, respectively). Positive CAC screening (score >0) showed similar sensitivity and negative predictive values as EBA for predicting of ³50% coronary stenosis (p > 0.05). EBA was more specific and accurate than CAC for detecting none or low (score <100) calcified coronary artery stenosis (p < 0.01). In patients with segmental score >100, EBA was not significantly different from CAC screening alone (p > 0.05). Receiver operating characteristic (ROC) analysis showed that ROC curve areas were 0.80 and 0.77 for EBA and CAC in predicting CAD, respectively (p < 0.001). The optimal cut-point for diagnosing CAD was 175.7 in this group. Calcium score cut-points for 90% sensitivity and specificity were nonoverlapping and ranged from 29.8 to 319.9, respectively.
Conclusion: The use of EBA appears beneficial in patients with none or minimal amount of coronary calcifications for identifying obstructive CAD. In high CAC scores, accuracy of EBA is limited and not superior to CAC score alone in predicting the likely severity of coronary artery stenosis.
Questions about this event email: blu@vip.sina.com
Lu MD, B,
Comparison of Intravenous Electron-Beam Coronary Angiography and Calcium Scoring for Segmental Analysis of Coronary Artery Stenosis. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3103820.html
