Riccardo Marano MD, Presenter: Nothing to Disclose

Francesco Aldo De Cobelli MD, Abstract Co-Author: Nothing to Disclose

Christoph Richard F. Becker MD, Abstract Co-Author: Nothing to Disclose

Christopher Herzog MD, Abstract Co-Author: Nothing to Disclose

Alessandro Del Maschio MD, Abstract Co-Author: Nothing to Disclose

Lorenzo Bonomo MD, Abstract Co-Author: Nothing to Disclose

To assess the diagnostic performance of MDCT in patients enrolled for first elective X-ray coronary angiography (CA) in a prospective Italian multicenter study by using different MDCT manufacturers.

Twenty participating sites prospectively enrolled 367 patients from July 2004 to June 2006, with a resulted sample size (350) according to the targeted number. In every institution a MDCT scan was performed within 2 weeks before conventional CA using a predefined state of art scan protocol for each type of 16 and 64-slice MDCT scanner manufacturer, during i.v. injection of 100-120 ml of contrast medium (Iopromide 370; Bayer Schering Pharma AG, Berlin, Germany) and characterized by the thinnest slice-collimation (0.5-0.75 mm) and temporal resolution (single-segment algorithm) of 165-200 msec. MDCT findings were compared with quantitative CA (QCA). Patient with heart-rate >70 bpm received a ß-receptor blocker i.v. or orally. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) for detection of coronary stenosis ≥50% were evaluated on per-patient and per-segment basis. An Off-site per-patient MDCT analysis was also performed by two blinded readers.

Per-patient In-site analysis was conducted on 327 patients, since 23 were excluded because at least one coronary segment was not-assessable. Sensitivity, specificity, PPV, NPV, and DA of MDCT for detection of stenosis ≥50% were 94%, 88%, 91%, 91%, and 91%, respectively for In-site analysis, and 73%, 93%, 93%, 73%, and 82% for Off-site evaluation. In per-segment(4628) In-site analysis the sensitivity, specificity, PPV, NPV, and DA of MDCT for detection of stenosis ≥50% were 70%, 96%, 72%, 96%, and 93%, respectively.

This first national multicenter study confirms the capability of MDCT to exclude significant coronary stenoses, even if conducted by using different MDCT scanner manufacturers, underlining the need of joining CT findings with patient clinical information.

Large-scale prospective trials by multi-MDCT scanner manufacturers are mandatory to establish the clinical application of cardiac CT and its role as worldwide diagnostic method.

Marano, R, De Cobelli, F, Becker, C, Herzog, C, Del Maschio, A, Bonomo, L, Noninvasive Multicenter Italian Study for Coronary Artery Disease (NIMIS-CAD Study): Multicenter Intra-Individually Controlled Comparison Study to Evaluate the NPV of 16 and 64 Slice MDCT Imaging in Patients Scheduled for Coronary Angiography.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5004865.html