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Background: Computed tomography coronary angiography (CTCA) has become a popular noninvasive test for diagnosing coronary artery disease. Objective: To compare the accuracy and clinical utility of stress testing and CTCA for identifying patients who require invasive coronary angiography (ICA). Design: Observational study. Setting: University medical center in Rotterdam, the Netherlands. Patients: 517 patients referred by their treating physicians for evaluation of chest symptoms by using stress testing or ICA. Intervention: Stress testing and CTCA in all patients. Measurements: Diagnostic accuracy of stress testing and CTCA compared with ICA; pretest probabilities of disease by Duke clinical score; and clinical utility of noninvasive testing, defined as a pretest or posttest probability that suggests how to proceed with testing (no further testing if ⩾5%, proceed with ICA if between 5% and 90%, and refer directly for ICA if ⩾90%). Results: Stress testing was not as accurate as CTCA; CTCA sensitivity approached 100%. In patients with a low (<20%) pretest probability of disease, negative stress test or CTCA results suggested no need for ICA. In patients with an intermediate (20% to 80%) pretest probability, a positive CTCA result suggested need to proceed with ICA (posttest probability, 93% [95% CI, 92% to 93%]) and a negative result suggested no need for further testing (posttest probability, 1% [CI, 1% to 1%]). Physicians could proceed directly with ICA in patients with a high (>80%) pretest probability (91% [CI, 90% to 92%]). Limitations: Referral and verification bias might have influenced findings. Stress testing provides functional information that may add value to that from anatomical (CTCA or ICA) imaging. Conclusion: Computed tomography coronary angiography seems most valuable in patients with intermediate pretest probability of disease, because the test can distinguish which of these patients need invasive angiography. These findings need to be confirmed before CTCA can be routinely recommended for these patients. [ABSTRACT FROM AUTHOR]

Background: Multislice computed tomography (MSCT) is a relatively new noninvasive imaging modality in the evaluation of patients with suspected coronary artery disease (CAD). Whether diagnostic accuracy is influenced by gender or risk factors for CAD is currently unknown and was evaluated in this study.Methods and Results: In 197 patients (171 men and 26 women; mean age, 60 +/- 11 years) 16-slice MSCT was performed and compared with invasive coronary angiography at 2 different centers (Leiden and Rotterdam, The Netherlands). Diagnostic accuracy for the detection of 50% luminal narrowing or greater was calculated for all patients combined, as well as for patients with known versus suspected CAD. In addition, diagnostic accuracy was determined in men versus women and in different subsets of patients based on the presence of risk factors for CAD including hypertension, type 2 diabetes mellitus, hypercholesterolemia, and obesity. Only segments with a diameter of 2.0 mm or greater were evaluated, whereas smaller segments and stents were excluded from the analysis. Overall, a sensitivity and specificity of 99% and 86%, respectively, on a patient level were demonstrated, with corresponding positive and negative predictive values of 95% and 96%, respectively. Similar values were observed in the different subsets of patients, with no statistical differences.Conclusion: These findings confirm the high diagnostic accuracy of MSCT, regardless of gender or risk factors. [ABSTRACT FROM AUTHOR]

Death or myocardial infarction, the most serious clinical consequences of atherosclerosis, often result from plaque rupture at non-flow limiting lesions. Current diagnostic imaging with coronary angiography only detects large plaques that already impinge on the lumen and cannot accurately identify those that have a propensity to cause unheralded events. Accurate evaluation of the composition or of the biomechanical characteristics of plaques with invasive or non-invasive methods, alone or in conjunction with assessment of circulating biomarkers, could help identify high-risk patients, thus providing the rationale for aggressive treatments in order to reduce future clinical events. The IBIS (Integrated Biomarker and Imaging Study) study is a prospective, single-center, non-randomized, observational study conducted in Rotterdam. The aim of the IBIS study is to evaluate both invasive (quantitative coronary angiography, intravascular ultrasound (IVUS) and palpography) and non-invasive (multislice spiral computed tomography) imaging techniques to characterize non-flow limiting coronary lesions. In addition, multiple classical and novel biomarkers will be measured and their levels correlated with the results of the different imaging techniques. A minimum of 85 patients up to a maximum of 120 patients will be included. This paper describes the study protocol and methodological solutions that have been devised for the purpose of comparisons among several imaging modalities. It outlines the analyses that will be performed to compare invasive and non-invasive imaging techniques in conjunction with multiple biomarkers to characterize non-flow limiting subclinical coronary lesions. [ABSTRACT FROM AUTHOR]

Efficiently obtaining a reliable coronary artery centerline from computed tomography angiography data is relevant in clinical practice. Whereas numerous methods have been presented for this purpose, up to now no standardized evaluation methodology has been published to reliably evaluate and compare the performance of the existing or newly developed coronary artery centerline extraction algorithms. This paper describes a standardized evaluation methodology and reference database for the quantitative evaluation of coronary artery centerline extraction algorithms. The contribution of this work is fourfold: (1) a method is described to create a consensus centerline with multiple observers, (2) well-defined measures are presented for the evaluation of coronary artery centerline extraction algorithms, (3) a database containing 32 cardiac CTA datasets with corresponding reference standard is described and made available, and (4) 13 coronary artery centerline extraction algorithms, implemented by different research groups, are quantitatively evaluated and compared. The presented evaluation framework is made available to the medical imaging community for benchmarking existing or newly developed coronary centerline extraction algorithms.