Dual-source computed tomography angiography for diagnosis and assessment of coronary artery disease: Systematic review and meta-analysis

Background

Development of an accurate test for noninvasive assessment of coronary arteries has been highly desirable.

Objectives

We performed a systematic review of diagnostic accuracy of the dual-source computed tomography (DSCT) in the diagnosis of coronary artery disease (CAD).

Methods

Eight medical databases were searched for articles published from January 2005 through March 2011. Studies compared DSCT coronary angiography (DSCT-CA) and invasive coronary angiography, as the reference standard, in consecutive patients with suspected or known CAD, and relevant data were extracted by 2 independent reviewers. Summary diagnostic accuracies were calculated, and the effect of covariates on the diagnostic performance was evaluated by meta-regression.

Results

Twenty-five studies were included. In per-patient analysis (n = 2303), pooled sensitivity was 99% [95% confidence interval (CI), 97%–99%] with specificity of 89% (95% CI, 84%–92%). The summary positive (+LR) and negative (−LR) likelihood ratios were 8.6 (95% CI, 6.4–11.6) and 0.02 (95% CI, 0.01–0.03), respectively. In per-segment analysis (n = 32,615), pooled sensitivity was 94% (95% CI, 92%–96%) with specificity of 97% (95% CI, 96%–-98%). Summary +LR and −LR were 30.2 (95% CI, 22.1–43.5) and 0.06 (95% CI, 0.04–0.08), respectively.

Conclusions

DSCT-CA seems to be robust to elevate heart rates while maintaining a high level of diagnostic performance.

Keywords: Cardiac-gated imaging techniques, Computed tomography, Coronary angiography, Coronary artery disease, Meta-analysis