Korean J Radiol.  2011 Aug;12(4):416-423. 10.3348/kjr.2011.12.4.416.

Diagnostic Value of 64-Slice Dual-Source CT Coronary Angiography in Patients with Atrial Fibrillation: Comparison with Invasive Coronary Angiography

• Zhang JJ
• Liu T
• Feng Y
• Wu WF
• Mou CY
• Zhai LH

• KMID: 1783207
• DOI: http://doi.org/10.3348/kjr.2011.12.4.416

Abstract

OBJECTIVE
We wanted to evaluate the image quality and diagnostic value of 64-slice dual-source computed tomography (DSCT) coronary angiography in patients with atrial fibrillation (Afib).
MATERIALS AND METHODS
The coronary arteries of 22 Afib patients seen on DSCT were classified into 15 segments and the imaging quality (excellent, good, moderate and poor) and significant stenoses (> or = 50%) were evaluated by two radiologists who were blinded to the conventional coronary angiography (CAG) results. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting important coronary artery stenosis were calculated. McNemar test was used to determine any significant difference between DSCT and CAG, and Cohen's Kappa statistics were calculated for the intermodality and interobserver agreement.
RESULTS
The mean heart rate was 89 +/- 8.3 bpm (range: 80-118 bpm). A range from 250 msec to 300 msec within the RR interval was the optimal reconstruction interval for the patients with Afib. The respective overall sensitivity, specificity, PPV and NPV values were 74%, 97%, 81% and 96% for reader 1 and 72%, 98%, 85% and 96% for reader 2. No significant difference between DSCT and CAG was found for detecting a significant stenosis (reader 1, p = 1.0; reader 2, p = 0.727). Cohen's Kappa statistics demonstrated good intermodality and interobserver agreement.
CONCLUSION
64-slice DSCT coronary angiography provides good image quality in patients with atrial fibrillation without the need for controlling the heart rate. DSCT can be used for ruling out significant stenosis in patients with atrial fibrillation with its high NPV for detecting in important stenosis.

Keyword

CT; Coronary angiography; Atrial fibrillation; Coronary artery

MeSH Terms

Aged
Aged, 80 and over
Algorithms
Atrial Fibrillation/*radiography
Contrast Media/diagnostic use
Coronary Angiography/*methods
Coronary Disease/*radiography
Echocardiography
Electrocardiography
Female
Heart Rate
Humans
Iohexol/analogs & derivatives/diagnostic use
Male
Middle Aged
Prospective Studies
Radiation Dosage
Radiographic Image Interpretation, Computer-Assisted
Tomography, X-Ray Computed/*methods

Figure

• 

  Fig. 1 CT angiography of 86-year-old man with atrial fibrillation (mean heart rate: 93 bpm, range: 66-143 bpm). A, B. Curved multiplanar image (A) and maximum intensity projection image (B) showing two slight stenoses in right coronary artery segments 1 and 2 (arrows). C. Invasive angiography confirms these two lesions (arrows). D. Curved multiplanar image showing moderate stenosis and accompanying atherosclerotic lesions in left anterior descending artery segments 6 and 7 (arrows). E. Invasive angiography of left anterior descending artery confirms lesions (arrows). F. Echocardiography is shown (reconstruction at 250 ms of cardiac cycle).

• 

  Fig. 2 CT angiography of 70-year-old woman with atrial fibrillation (mean heart rate: 87 bpm, range: 60-125 bpm). A. Curved multiplanar image showing slight stenosis in right coronary artery segment 1 (arrow). B. Invasive angiography of right coronary artery confirms presence (arrow) of mild lesion. C, D. Maximum intensity projection image (C) and curved multiplanar image (D) showing slight stenosis and accompanying atherosclerotic lesions in left anterior descending artery segment 7 (arrows). E. Invasive angiography confirms presence of lesion (arrow). F. Echocardiography is shown (reconstruction at 300 ms of cardiac cycle).

• 

  Fig. 3 Relationship between heart rate and cardiac phase that provided for optimal image quality.

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