Feasibility of 64-slice gadolinium-enhanced cardiac CT for the evaluation of obstructive coronary artery disease.

OBJECTIVE

To assess the feasibility of gadolinium-enhanced 64-slice cardiac CT (CCT) for the diagnosis of obstructive coronary artery disease.

DESIGN

Comparative prospective study.

SETTING

Outpatient Imaging Diagnostic Centre, Diagnóstico Maipú, Buenos Aires, Argentina.

PATIENTS

Twenty patients with suspected coronary artery disease.

INTERVENTIONS

Gadolinium-enhanced 64-slice CCT was performed before invasive coronary angiography (ICA).

MAIN OUTCOME MEASURES

The feasibility of gadolinium-enhanced 64-slice CCT for detection of obstructive coronary artery disease (>50% diameter reduction) was evaluated, using ICA as the 'gold standard'. Mean lumen attenuation, non-calcified and calcified plaques densities were correlated between gadolinium-enhanced CCT studies and iodine-enhanced CCT studies of a control group. Renal function was strictly monitored.

RESULTS

Gadolinium-enhanced CCT demonstrated adequate visualisation of 283/289 coronary segments that were evaluable by ICA, 31 of which had >50% luminal stenosis. In per-segment analysis, gadolinium-enhanced CCT showed a sensitivity of 90.3%, specificity of 96.8%, positive predictive value of 77.8% and negative predictive value of 98.8%. The agreement of coronary stenosis between multidetector CT (MDCT) and ICA was 94.1% (272/289). The mean lumen attenuation, non-calcified and calcified plaques densities in gadolinium-enhanced CCT studies were 140.1 Hounsfield units (HU), 51.1 HU and 523.6 HU, whereas in iodine-enhanced CCT studies the values were 354.1 HU, 101.0 HU and 778.5 HU, respectively (p < 0.001).

CONCLUSION

Gadolinium-enhanced CCT is a feasible alternative for patients with severe contraindications to iodinated contrast agents referred for MDCT coronary angiography.