Purpose: To retrospectively evaluate the diagnostic accuracy of mul-tidetector computed tomography (CT) coronary angiogra-phy for detection of hemodynamically significant (<50%) stenoses by using various image postprocessing methods, with conventional coronary angiography as the reference standard.
Materials and Methods:The analysis used data from previous studies, use of which had been approved by the Institutional Review Board. Sixteen-section multidetector CT data sets for 40 patients (30 men, 10 women; mean age 56 years ± 8; mean heart rate, 61 beats per minute ± 6) were evaluated. Six independent investigators evaluated the data sets for the presence of stenoses with diameter reduction of 50% or more, by using either exclusively transverse images, free oblique multiplanar reconstructions (MPRs), free oblique maximum intensity projections (MIPs, 5 mm thick), preren-dered curved MPRs, prerendered curved MIPs, or preren-dered three-dimensional volume rendered reconstructions (VRTs). Evaluation results were compared with conven-tional coronary angiography for each artery in a blinded fashion (x2 test).
Results: Overall, 35 coronary artery stenoses were present. Per-centage of evaluable arteries and accuracy for detecting stenosis (percentages of accurately classified arteries were, respectively, 99% and 88% for transverse, 99% and 91% for oblique MPR, 94% and 86% for oblique M1P, 94% and 83% for curved M1P, 93% and 81% for curved MPR, and 91% and 73% for VRT). Accuracy was significantly higher for oblique MPR than for curved MPR (P = .01), curved MIP (P = .03), and VRT (P < .001).
Conclusion: The evaluation of multidetector CT coronary angiography with interactive image display methods, especially interactive oblique MPRs, permits higher diagnostic accuracy than evaluation of prerendered images (curved MPR, curved MIP, or VRT images).