Intravenous three-dimensional coronary angiography using contrast enhancedelectron beam computed tomography

Coronary angiography remains the diagnostic standard for establishing the p resence, site, and severity of coronary artery disease (CAD). Electron beam computed tomography (EBCT), with its 3-dimensional capabilities, is an eme rging technology with the potential for obtaining essentially noninvasive c oronary arteriograms. The purpose of this study was to (1) test the accurac y of intravenous coronary arteriography using the EBCT to conventional coro nary arteriographic images; (2) establish the inter-reader variability of t his procedure; (3) determine the limitations due to location within the cor onary tree; and (4) identify factors that contributed to improved image qua lity of the 3-dimensional EBCT angiograms. Fifty-two patients underwent bot h EBCT angiography and coronary angiography within 2 weeks. The coronary an giogram and the EBCT 3-dimensional Images were analyzed by 2 observers blin ded to the results of the other techniques. EBCT correctly identified 43 of 55 significantly stenosed arteries (sensitivity 78%), and correctly identi fied 118 of 130 of the nonobstructed arteries, yielding a specificity of 91 % (p <0.001, chi-square analysis). The overall accuracy for EBCT angiograph y was 87%. Significantly more left main and anterior descending coronary ar teries were adequately visualized than the circumflex and right coronary ve ssels (p = 0.003). Overall, 23 of 208 (11%) major epicardial vessels were n oninterpretable by the blinded EBCT readers, primarily due to motion artifa cts caused by cardiac and respiratory motion and poor electrocardiographic gating. The inter-reader variability was similar to that of angiography, an d its high accuracy makes this a clinically useful test This study demonstr ates, by using intravenous contrast enhancement, that EBCT can clearly depi ct the coronary artery anatomy and can permit identification of coronary ar tery stenosis. (C) 1999 by Excerpta Medico, Inc.