Novel 320‐slice multislice CT angiography as a gatekeeper for invasive coronary angiography

The diagnostic accuracy of 64‐slice CTA, currently the most widely used CTA system, has been well established by several multicenter studies [4–6]. In a recent prospective multicenter, multivendor trial by Meijboom and coworkers, high diagnostic accuracy of 64‐slice CTA was observed in the evaluation of 360 symptomatic patients with acute and stable angina [5]. On a per‐patient basis, the sensitivity and specificity for the detection of obstructive CAD were 99 and 64%, respectively. The positive and negative predictive values were 86 and 97%, respectively. Owing to the high negative predictive value, the authors concluded that CTA is reliable for the exclusion of obstructive CAD. Similarly, in another recent prospective multicenter investi‐ gation, the Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography (ACCURACY) trial, the diagnostic accuracy of 64‐slice CTA was determined in 230 patients with an intermediate prevalence of CAD [4]. On a per‐patient basis, the sensitivity, specificity, positive and negative predictive values were 95, 83, 64 and 99%, respectively. These observa‐ tions further strengthened the notion that the high negative predictive value may establish CTA as a useful alternative to ICA to rule out the presence of significant CAD. Conversely, the CORE‐64 trial resulted in a different outcome. Invasive coronary angiography (ICA) is consid‐ ered to be the gold standard for the diagnosis of coronary artery disease (CAD). However, in many cases ICA is used for diagnostic evalu‐ ation only and is not followed by coronary revascularization. Consequently, these patients could benefit from a noninvasive approach to visualize the coronary arteries. To this end, use of multislice computed tomography angio‐ graphy (CTA) has been proposed. Since its intro duction, the technique has evolved into a promising imaging modality for non invasive imaging of the coronary arteries. Owing to rapid technological innovations, such as increasing temporal and spatial resolution as well as an increasing number of detectors, accu‐ rate assessment of CAD has become possible. Most recently, 256‐ and 320‐slice systems have become available, for the first time allowing volumetric scanning of the entire heart in a s ingle heart beat [1,2]. It is anticipated that these developments will continue to translate into superior image quality and further improve‐ ments in the evaluation of CAD. In the current article, the role of novel CTA technology in the evaluation of patients with known or suspected CAD is discussed.