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Pierre Atallah M.D., F.A.C.C.*, Ruthmarie Shea B.S.N., M.A., P. Charbel Atallah B.S., Karl Duncan M.D., Delair Gardi M.D., Richard Spears M.D., F.A.C.C.**. Background: The aim of this study was to compare the sensitivity and specificity of non-invasive coronary angiography using Multi-Slice Computed Tomography (MSCT) with invasive coronary angiography. Continuous technological advances in hardware acquisition and software processing are steadily improving its accuracy in the detection of coronary artery obstruction. Methods: 86 consecutive patients with abnormal coronary MSCT angiography results were subsequently studied by invasive angiography. A total of 688 native main vessels, secondary branches and bypass grafts were analyzed by two sets of blinded observers. Lesions causing ≥ 50% stenosis were considered significant. CT angiography was performed with a 16 slice helical CT, with isotropic images, 0.5 mm slice thickness, 400 msec gantry rotation, and retrospective EKG gating. Analysis was performed using 3D volume rendering with vessel probing, and standard axial, coronal and sagital Maximal Intensity Projection (MIP) views. Results: Compared with invasive digital angiography, coronary MSCT angiography of the main coronary arteries demonstrated a sensitivity of 97% and a specificity of 96%, with a positive predictive value of 89%, and a negative predictive value of 99%. Overall sensitivity and specificity for all coronary arteries, their branches and bypass grafts was 95% and 98% respectively; with a positive predictive value of 92%, and a negative predictive value of 99%, with a 95% confidence level. Conclusions: This data indicates that MSCT coronary angiography has reached a high sensitivity and specificity in the non-invasive diagnosis of coronary obstructive disease. This level of accuracy will likely impact on the use of diagnostic invasive coronary angiography.
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