Mollet NR et al. (2005) High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional angiography. Circulation 112: 2318–2323

Multislice CT scanners show promise for the noninvasive detection of coronary stenosis. Rapid improvements in technology mean that newer-generation spiral CT scanners are capable of higher spatial and temporal resolution than earlier scanners; 64-slice coronary artery CT has recently been reported as being highly sensitive and specific for the detection of significant lesions.

Mollet and colleagues used the latest 64-slice CT scanner to assess 52 patients with sinus rhythm presenting with atypical chest pain, stable or unstable angina pectoris or non-ST-segment elevation myocardial infarction, who were referred for conventional diagnostic angiography. The authors found that 64-slice CT coronary angiography detected severe coronary stenoses (≥50% luminal narrowing) with 99% sensitivity and 95% specificity compared with conventional angiography. There was good agreement between the two techniques in classifying patients as having no, single-vessel or multi-vessel disease. The slightly lower specificity in this study was attributed to overestimation of lesion severity by CT scan, which resulted in a number of false-positive outcomes. Severe calcification led to overestimation of lesion severity because of technical artefacts (blooming), and resulted in lower specificity in patients with high calcium scores.

The authors suggest that this noninvasive technique could be used in place of standard coronary angiography in selected patients.