Journal of cardiovascular computed tomography · 2025
Diagnostic performance of coronary CT angiography to diagnose acute spontaneous coronary artery dissection.
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Moser Lukas J, Demmert Tristan T, Klambauer Konstantin, Schweiger Victor, Mergen Victor, Würdinger Michael, Di Vece Davide, Biondo Andrea, Gotschy Alexander, Stähli Barbara, Reiner Martin, Ghadri Jelena-R, Manka Robert, Eberhard Matthias, Templin Christian, Alkadhi Hatem
Аннотация
BACKGROUND: The diagnosis of spontaneous coronary artery dissection (SCAD) is made with invasive coronary angiography (ICA). The literature on the diagnostic performance of coronary CT angiography (coronary CTA) is sparse. The purpose of this study was to evaluate the performance of coronary CTA for the diagnosis of acute SCAD.
METHODS: This prospective single-center study included 52 patients with SCAD confirmed by ICA and 70 patients with chest pain but without SCAD (control group), who all underwent coronary CTA. Two independent readers evaluated coronary CTA for SCAD, including vessel abnormalities and myocardial hypodensity. Accuracy, sensitivity, and specificity with 95 % confidence intervals (CI) were calculated using ICA as the reference standard. Coronary CTA imaging features of SCAD were correlated with diagnostic confidence using multivariable regression analysis. Interreader agreement was determined by Cohen's Kappa.
RESULTS: Patient-level sensitivity of coronary CTA to diagnose SCAD ranged from 52 % (CI:38 %-66 %)-58 % (CI:43 %-71 %), with a specificity of 97 % (CI:90 %-100 %) and accuracy of 78 % (CI:69 %-85 %) and 80 % (CI:72 %-87 %) for both readers (Kappa = 0.891). Sensitivity and accuracy were higher for proximal (sensitivity 67 % (CI:38 %-88 %) and 73 % (CI:45 %-92 %); accuracy 93 % (CI:87 %-97 %) and 94 % (CI:89 %-98 %)) than for distal SCAD (sensitivity 40 % (CI:26 %-56 %) and 49 % (CI:34 %-64 %); accuracy 76 % (CI:68 %-83 %) and 80 % (CI:71 %-86 %)), while specificity was high irrespective of location (97 %; CI:91 %-99 %, resp.100 %). Additional myocardial hypodensity increased readers' confidence (beta coefficient -0.38; p = 0.11 for reader 1, and beta coefficient of -0.90; p = 0.004 for reader 2) and sensitivity (71 % (CI:57 %-83 %) and 65 % (CI:51 %-78 %), respectively), while reducing specificity (both 91 %, CI:82 %-97 %).
CONCLUSION: Coronary CTA has a poor sensitivity for the diagnosis of SCAD, while specificity is high irrespective of SCAD location. Patients with coronary CTA positive for SCAD might be deferred from ICA after careful consideration and when conservative management is intended.
METHODS: This prospective single-center study included 52 patients with SCAD confirmed by ICA and 70 patients with chest pain but without SCAD (control group), who all underwent coronary CTA. Two independent readers evaluated coronary CTA for SCAD, including vessel abnormalities and myocardial hypodensity. Accuracy, sensitivity, and specificity with 95 % confidence intervals (CI) were calculated using ICA as the reference standard. Coronary CTA imaging features of SCAD were correlated with diagnostic confidence using multivariable regression analysis. Interreader agreement was determined by Cohen's Kappa.
RESULTS: Patient-level sensitivity of coronary CTA to diagnose SCAD ranged from 52 % (CI:38 %-66 %)-58 % (CI:43 %-71 %), with a specificity of 97 % (CI:90 %-100 %) and accuracy of 78 % (CI:69 %-85 %) and 80 % (CI:72 %-87 %) for both readers (Kappa = 0.891). Sensitivity and accuracy were higher for proximal (sensitivity 67 % (CI:38 %-88 %) and 73 % (CI:45 %-92 %); accuracy 93 % (CI:87 %-97 %) and 94 % (CI:89 %-98 %)) than for distal SCAD (sensitivity 40 % (CI:26 %-56 %) and 49 % (CI:34 %-64 %); accuracy 76 % (CI:68 %-83 %) and 80 % (CI:71 %-86 %)), while specificity was high irrespective of location (97 %; CI:91 %-99 %, resp.100 %). Additional myocardial hypodensity increased readers' confidence (beta coefficient -0.38; p = 0.11 for reader 1, and beta coefficient of -0.90; p = 0.004 for reader 2) and sensitivity (71 % (CI:57 %-83 %) and 65 % (CI:51 %-78 %), respectively), while reducing specificity (both 91 %, CI:82 %-97 %).
CONCLUSION: Coronary CTA has a poor sensitivity for the diagnosis of SCAD, while specificity is high irrespective of SCAD location. Patients with coronary CTA positive for SCAD might be deferred from ICA after careful consideration and when conservative management is intended.