Free-breathing coronary CT angiography using 16-cm wide-detector for challenging patients: comparison with invasive coronary angiography.

AIM: To investigate the superiority of free-breathing coronary computed tomography angiography (CCTA) with 16-cm wide-detector CT for challenging patients who cannot hold their breath.

MATEIALS AND METHODS: A total of 76 patients (62% with either heart rate >75 beats/min or arrhythmia) who were unable to breath-hold underwent both free-breathing CCTA and invasive coronary angiography (ICA) were included. Two reviewers evaluated coronary arteries on a per-segment, per-vessel, and per-patient basis for image quality using a four-point scale and stenosis degree. CCTA results were compared with ICA to calculate the diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

RESULTS: Out of 1,368 segments, 228 (16.7%) were <1.5 mm in diameter and were excluded. Thirty-two (2.3%) with calcification and 26 (1.9%) with motion artefacts were considered positive at CT. One thousand and eighty-two segments (79.1%) were evaluated both on CCTA and ICA, and 128 (11.8%) segments had ≥50% stenosis on ICA. The diagnostic accuracy, sensitivity, specificity, PPV, and NPV of CCTA were 90.8%, 88.3%, 91.1%, 57.1%, and 98.3% on a per-segment basis; 93.4%, 90.6%, 94.2%, 80.5% and 97.4% on a per-vessel basis; and 92.1%, 100%, 85%, 85.7% and 100% on a per-patient basis. For patients with high heart rates or arrhythmia, 81% (versus 79.1%) segments were evaluable, and the accuracy, sensitivity, specificity, PPV, and NPV were statistically the same as the entire study population.

CONCLUSION: Free-breathing CCTA using 16-cm wide-detector CT has high accuracy compared to ICA for detecting coronary artery stenosis for challenging patients.