Journal of Cardiovascular Computed Tomography
Volume 4, Issue 6 , Pages 384-390, November 2010

What is the optimal number of readers needed to achieve high diagnostic accuracy in coronary computed tomographic angiography? A comparison of alternate reader combinations

  • Troy M. LaBounty, MD

      Affiliations

    • Department of Medicine, Division of Cardiology, Weill Cornell Medical College at New York Presbyterian Hospital, Starr Pavilion 4th Floor Room K407, 520 East 70th Street New York, NY 10021, USA
    • Corresponding Author InformationCorresponding author.
    • ,
  • Jonathon Leipsic, MD

      Affiliations

    • University of British Columbia, Vancouver, BC, Canada
    • ,
  • Monvadi B. Srichai, MD

      Affiliations

    • Departments of Medicine and Radiology, New York University Langone Medical Center, New York, NY, USA
    • ,
  • G.B. John Mancini, MD

      Affiliations

    • University of British Columbia, Vancouver, BC, Canada
    • ,
  • Fay Y. Lin, MD, MA

      Affiliations

    • Department of Medicine, Division of Cardiology, Weill Cornell Medical College at New York Presbyterian Hospital, Starr Pavilion 4th Floor Room K407, 520 East 70th Street New York, NY 10021, USA
    • ,
  • Allison M. Dunning, MS

      Affiliations

    • Department of Medicine, Division of Cardiology, Weill Cornell Medical College at New York Presbyterian Hospital, Starr Pavilion 4th Floor Room K407, 520 East 70th Street New York, NY 10021, USA
    • ,
  • James K. Min, MD

      Affiliations

    • Department of Medicine, Division of Cardiology, Weill Cornell Medical College at New York Presbyterian Hospital, Starr Pavilion 4th Floor Room K407, 520 East 70th Street New York, NY 10021, USA
    • Department of Radiology, Weill Cornell Medical College at New York Presbyterian Hospital, New York, NY, USA

Received 21 June 2010; accepted 23 August 2010. published online 02 September 2010.

Background

Coronary computed tomographic angiography (CCTA) possesses high accuracy to detect coronary artery disease (CAD), although studies have reported differences in diagnostic performance. Prior trials used different numbers of interpreters, and the optimal number to detect CAD is unknown.

Objective

We compared the diagnostic performance of 1, 2, 3, and 5 randomly selected interpreters for CCTA.

Methods

We evaluated 50 patients randomly selected from 2 multicenter studies with both 64-detector CCTA and invasive quantitative coronary angiography (QCA). Five blinded, experienced readers independently interpreted CCTA and assessed for obstructive CAD (≥50% stenosis) and high-risk CAD (left main, proximal left anterior descending, or 3-vessel stenoses). A core laboratory performed QCA. For each patient, different random combinations of readers were selected; the accuracy of 1, 2, and 5 readers was compared with 3 readers.

Results

Obstructive and high-risk CAD were observed in 20 of 50 (40%) and 6 of 50 (12%) patients, respectively. With combinations of 1, 2, 3, or 5 readers, there was a range of per-patient diagnostic performance (sensitivity, 100% each; specificity, 67%–90%; accuracy, 80%–94%; P = NS), per-segment diagnostic performance (sensitivity, 67%–83%; specificity, 87%–93%; accuracy, 87%–92%; P < .001 for 1 vs 3 and 2 vs 3 readers), and detection of high-risk CAD (sensitivity, 83%–100%; specificity, 73%–80%; accuracy, 76%–82%; P = NS). The highest diagnostic accuracy was observed with 3 readers for each comparison.

Conclusion

The diagnostic performance of CCTA to detect obstructive or high-risk CAD is generally high irrespective of the number of readers. Consensus interpretation by ≥3 readers provides the highest diagnostic accuracy.

Keywords: Catheter coronary angiography, Coronary artery disease, CT angiography, Diagnostic accuracy

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 Conflict of interest: James Min receives research support and serves on the medical advisory board and speakers’ bureau for GE Healthcare. Jonathan Leipsic is on the speakers’ bureau and medical advisory board for GE Healthcare. All other authors have no financial disclosures.

PII: S1934-5925(10)00469-7

doi:10.1016/j.jcct.2010.08.006

Journal of Cardiovascular Computed Tomography
Volume 4, Issue 6 , Pages 384-390, November 2010

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