Diagnostic Performance of Multidetector CT Angiography for Assessment of Coronary Artery Disease: Meta-analysis

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Abstract
Purpose: To review the literature on the diagnostic performance of multidetector computed tomographic (CT) angiography for assessment of symptomatic coronary artery disease, with conventional coronary angiography as the reference standard. Materials and Methods: A PubMed and manual search of the literature published between January 1998 and May 2006 on use of multidetector CT angiography compared with coronary angiography in patients with symptomatic coronary artery disease was performed. Summary estimates of diagnostic odds ratio, sensitivity, and specificity were calculated. Random-effects models were used to compare the diagnostic performance of four-, 16-, and 64-detector CT angiographic units, and the proportion of nonassessable coronary arterial segments was evaluated. Results: Fifty-four studies were included in the meta-analysis: 22 studies with four-detector CT angiography, 26 with 16-detector CT angiography, and six with 64-detector CT angiography. The pooled sensitivity and specificity for detecting a greater than 50% stenosis per segment were 0.93 (95% confidence interval [CI]: 0.88, 0.97) and 0.96 (95% CI: 0.96, 0.97) for 64-detector CT angiography, 0.83 ( 95% CT: 0.76, 0.90) and 0.96 ( 95% CI: 0.95, 0.97) for 16-detector CT angiography, and 0.84 ( 95% CI: 0.81, 0.88) and 0.93 (95% CI: 0.91, 0.95) for four-detector CT angiography, respectively. Results of regression analysis indicated that the diagnostic performance significantly improved with the newer generations of multidetector CT scanners (64- and 16-detector vs four-detector units), adjusted for exclusion of nonassessable segments, and contrast agent concentration used ( P <.05). Simultaneously, the nonassessable proportion of segments significantly decreased with the newer generations of multidetector CT scanners, adjusted for heart rate, prevalence of significant disease, and mean age. Conclusion: With the newer generations of multidetector CT scanners, the diagnostic performance for the assessment of coronary artery disease has significantly improved, and the proportion of nonassessable segments has decreased.