Predictors of disagreement between prospectively ECG-triggered dual-source coronary computed tomography angiography and conventional coronary angiography

Stefano Muzzarelli, Daniel Suerder, Romina Murzilli, Lucia Donato, Giovanni Pedrazzini, Elena Pasotti, Tiziano Moccetti, Catherine Klersy, Francesco Fulvio Faletra

Research output: Contribution to journalArticle

Abstract

Aims To identify causes of misinterpretation in second generation, dual-source coronary computed tomography angiography (CCTA). Methods A retrospective re-interpretation was performed on 100 consecutive CCTA studies, previously performed with a 2 × 128 slice dual-source CT. Results were compared with coronary angiography (CA). CCTA and CA images were interpreted by 2 independent readers. At CCTA vessel diameter, image quality, plaque characteristics and localization (bifurcation vs. non) were described for all segments. Finally, aortic contrast-to-noise ratio (CNR) and the total Agatston calcium score were quantified. Agreement between CCTA and CA was assessed with the Kappa statistic after categorizing the stenosis severity at significant (≥50%) and critical (≥70%) cut-offs, and independent predictors of disagreement were determined by multivariable logistic regression, including patient characteristics such as body mass index (BMI), heart rate (HR), age and gender. Results Per-segment sensitivity and specificity at ≥50% and ≥70% stenosis was of 83-95%, and 73-97%, respectively. There was a substantial agreement between CCTA and CA (kappa-50% = 0.78, SE = 0.03; kappa-70% = 0.72, SE = 0.03). Worse motion-related quality score, smaller vessel diameter, calcification within the segment of interest and LAD location were independent predictors of disagreement at 50% stenosis. The same factors, excluded LAD location, in addition to bifurcation-location of the coronary lesion predicted misdiagnosis at 70% stenosis. HR per se and BMI did not predict disagreement. Conclusion According to the literature a substantial agreement between CCTA and CA was found. However, discrepancies exist and are mainly related with motion-related degradation of image quality, specific vessel anatomy and plaque characteristics. Awareness of such potential limitations may help guiding interpretation of CCTA.

Original languageEnglish
Pages (from-to)1138-1146
Number of pages9
JournalEuropean Journal of Radiology
Volume85
Issue number6
DOIs
Publication statusPublished - Jun 1 2016

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Coronary Angiography
Electrocardiography
Pathologic Constriction
Body Mass Index
Heart Rate
Computed Tomography Angiography
Diagnostic Errors
Noise
Anatomy
Logistic Models
Calcium
Sensitivity and Specificity

Keywords

  • Coronary angiography
  • Coronary computed tomography angiography
  • Diagnostic accuracy
  • False negative
  • False positive

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Predictors of disagreement between prospectively ECG-triggered dual-source coronary computed tomography angiography and conventional coronary angiography. / Muzzarelli, Stefano; Suerder, Daniel; Murzilli, Romina; Donato, Lucia; Pedrazzini, Giovanni; Pasotti, Elena; Moccetti, Tiziano; Klersy, Catherine; Faletra, Francesco Fulvio.

In: European Journal of Radiology, Vol. 85, No. 6, 01.06.2016, p. 1138-1146.

Research output: Contribution to journalArticle

Muzzarelli, Stefano ; Suerder, Daniel ; Murzilli, Romina ; Donato, Lucia ; Pedrazzini, Giovanni ; Pasotti, Elena ; Moccetti, Tiziano ; Klersy, Catherine ; Faletra, Francesco Fulvio. / Predictors of disagreement between prospectively ECG-triggered dual-source coronary computed tomography angiography and conventional coronary angiography. In: European Journal of Radiology. 2016 ; Vol. 85, No. 6. pp. 1138-1146.
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abstract = "Aims To identify causes of misinterpretation in second generation, dual-source coronary computed tomography angiography (CCTA). Methods A retrospective re-interpretation was performed on 100 consecutive CCTA studies, previously performed with a 2 × 128 slice dual-source CT. Results were compared with coronary angiography (CA). CCTA and CA images were interpreted by 2 independent readers. At CCTA vessel diameter, image quality, plaque characteristics and localization (bifurcation vs. non) were described for all segments. Finally, aortic contrast-to-noise ratio (CNR) and the total Agatston calcium score were quantified. Agreement between CCTA and CA was assessed with the Kappa statistic after categorizing the stenosis severity at significant (≥50{\%}) and critical (≥70{\%}) cut-offs, and independent predictors of disagreement were determined by multivariable logistic regression, including patient characteristics such as body mass index (BMI), heart rate (HR), age and gender. Results Per-segment sensitivity and specificity at ≥50{\%} and ≥70{\%} stenosis was of 83-95{\%}, and 73-97{\%}, respectively. There was a substantial agreement between CCTA and CA (kappa-50{\%} = 0.78, SE = 0.03; kappa-70{\%} = 0.72, SE = 0.03). Worse motion-related quality score, smaller vessel diameter, calcification within the segment of interest and LAD location were independent predictors of disagreement at 50{\%} stenosis. The same factors, excluded LAD location, in addition to bifurcation-location of the coronary lesion predicted misdiagnosis at 70{\%} stenosis. HR per se and BMI did not predict disagreement. Conclusion According to the literature a substantial agreement between CCTA and CA was found. However, discrepancies exist and are mainly related with motion-related degradation of image quality, specific vessel anatomy and plaque characteristics. Awareness of such potential limitations may help guiding interpretation of CCTA.",
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T1 - Predictors of disagreement between prospectively ECG-triggered dual-source coronary computed tomography angiography and conventional coronary angiography

AU - Muzzarelli, Stefano

AU - Suerder, Daniel

AU - Murzilli, Romina

AU - Donato, Lucia

AU - Pedrazzini, Giovanni

AU - Pasotti, Elena

AU - Moccetti, Tiziano

AU - Klersy, Catherine

AU - Faletra, Francesco Fulvio

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N2 - Aims To identify causes of misinterpretation in second generation, dual-source coronary computed tomography angiography (CCTA). Methods A retrospective re-interpretation was performed on 100 consecutive CCTA studies, previously performed with a 2 × 128 slice dual-source CT. Results were compared with coronary angiography (CA). CCTA and CA images were interpreted by 2 independent readers. At CCTA vessel diameter, image quality, plaque characteristics and localization (bifurcation vs. non) were described for all segments. Finally, aortic contrast-to-noise ratio (CNR) and the total Agatston calcium score were quantified. Agreement between CCTA and CA was assessed with the Kappa statistic after categorizing the stenosis severity at significant (≥50%) and critical (≥70%) cut-offs, and independent predictors of disagreement were determined by multivariable logistic regression, including patient characteristics such as body mass index (BMI), heart rate (HR), age and gender. Results Per-segment sensitivity and specificity at ≥50% and ≥70% stenosis was of 83-95%, and 73-97%, respectively. There was a substantial agreement between CCTA and CA (kappa-50% = 0.78, SE = 0.03; kappa-70% = 0.72, SE = 0.03). Worse motion-related quality score, smaller vessel diameter, calcification within the segment of interest and LAD location were independent predictors of disagreement at 50% stenosis. The same factors, excluded LAD location, in addition to bifurcation-location of the coronary lesion predicted misdiagnosis at 70% stenosis. HR per se and BMI did not predict disagreement. Conclusion According to the literature a substantial agreement between CCTA and CA was found. However, discrepancies exist and are mainly related with motion-related degradation of image quality, specific vessel anatomy and plaque characteristics. Awareness of such potential limitations may help guiding interpretation of CCTA.

AB - Aims To identify causes of misinterpretation in second generation, dual-source coronary computed tomography angiography (CCTA). Methods A retrospective re-interpretation was performed on 100 consecutive CCTA studies, previously performed with a 2 × 128 slice dual-source CT. Results were compared with coronary angiography (CA). CCTA and CA images were interpreted by 2 independent readers. At CCTA vessel diameter, image quality, plaque characteristics and localization (bifurcation vs. non) were described for all segments. Finally, aortic contrast-to-noise ratio (CNR) and the total Agatston calcium score were quantified. Agreement between CCTA and CA was assessed with the Kappa statistic after categorizing the stenosis severity at significant (≥50%) and critical (≥70%) cut-offs, and independent predictors of disagreement were determined by multivariable logistic regression, including patient characteristics such as body mass index (BMI), heart rate (HR), age and gender. Results Per-segment sensitivity and specificity at ≥50% and ≥70% stenosis was of 83-95%, and 73-97%, respectively. There was a substantial agreement between CCTA and CA (kappa-50% = 0.78, SE = 0.03; kappa-70% = 0.72, SE = 0.03). Worse motion-related quality score, smaller vessel diameter, calcification within the segment of interest and LAD location were independent predictors of disagreement at 50% stenosis. The same factors, excluded LAD location, in addition to bifurcation-location of the coronary lesion predicted misdiagnosis at 70% stenosis. HR per se and BMI did not predict disagreement. Conclusion According to the literature a substantial agreement between CCTA and CA was found. However, discrepancies exist and are mainly related with motion-related degradation of image quality, specific vessel anatomy and plaque characteristics. Awareness of such potential limitations may help guiding interpretation of CCTA.

KW - Coronary angiography

KW - Coronary computed tomography angiography

KW - Diagnostic accuracy

KW - False negative

KW - False positive

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