Using a 75% threshold, Japanese and U.S. investigators found that 64-slice multidetector-row CT (MDCT) could accurately diagnose coronary artery stenosis, according to a presentation at the 2007 American College of Cardiology (ACC) meeting in New Orleans.
"Almost all studies of MDCT have used 50% stenosis as the standard for calculating diagnostic accuracy, even though 75% is considered significant in clinical practice," according to principal investigator Dr. Takeshi Kondo of Takase Clinic in Takasaki, Japan.
Working with a 75% threshold allowed the team to include people typically excluded from similar studies, such as those with arrhythmias, severe calcifications, and stents. These patients are seen quite often in the clinical setting, the researchers explained.
MDCT turned in high sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) when compared to conventional coronary angiography, Kondo said, stressing also that larger vessels -- greater than 2 mm in diameter -- are the ones that are "clinically relevant and deserving of intervention."
Their study population consisted of 59 consecutive patients who were scheduled for conventional angiography, which they had after imaging with 64-slice MDCT (Aquilion 64, Toshiba, Japan). Two patients were excluded because they could not manage the breath-hold during the scan.
Among the remaining 57 patients, there were 554 coronary segments larger than 2 mm in diameter. The investigators analyzed these vessels for stenosis that was more than 75%. They also identified 71 segments in which the vessels were smaller than 2 mm. The investigators included any patients with severe calcifications, arrhythmias, tachycardia, or stents, as well as results with motion artifacts.
When compared to conventional coronary angiography, MDCT had a sensitivity of 89% for detecting stenosis of more than 75%. Specificity was 92%, PPV was 67%, and NPV was 98%. In vessels larger than 2 mm, the diagnostic accuracy was over 90% and reached 100% in 4-mm vessels. It was least accurate in vessels that were 1 mm to 2 mm in diameter, Kondo said.
By Paula Moyer
AuntMinnie.com contributing writer
May 9, 2007
Related Reading
Dual-source coronary CTA images the calcium-burdened, May 13, 2007
Calcification percentage higher in stable carotid plaques, March 28, 2007
Copyright © 2007 AuntMinnie.com
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
