Coronary artery disease cannot be reliably evaluated by 16-slice multidetector spiral computed tomography

Objectives. Angiography by selective catheterization is the standard method for coronary artery imaging but carries a risk of rare, but serious complications. We investigated whether 16-slice multidetector spiral computed tomography (MDCT) could substitute for selective angiography for evaluation of coronary artery disease in surgically revascularized patients. Design. In a setting closely resembling routine clinical practice, 45 patients who had been operated with coronary artery bypass grafting 508 - 1135 ( mean 811) days before were examined with MDCT and conventional selective angiography on the same day. The interpreters were blinded to the results of the parallel imaging modality. Results. Significant pathology (stenosis >= 50% or occlusion) in the larger coronary artery segments was detected by MDCT with a sensitivity of 70-98% (mean 87%) and a specificity of 0-37% (mean 21%). MDCT failed to identify three of ten left main stem stenoses. Conclusion. Sixteen-slice MDCT cannot routinely replace selective angiography for evaluation of coronary artery disease.