[Assessment of coronary artery by four-detector multislice computed tomography: diagnostic accuracy and limitations for coronary artery lesions].

OBJECTIVES: The applicability of four-detector multislice computed tomography (MSCT) was investigated for evaluating coronary arteries. METHODS: MSCT (Somatom Volume Zoom, Siemens) was used to evaluate the coronary arteries in 94 patients. The reconstructed images were analyzed using retrospective electrocardiographic gating to determine the image quality of the coronary arteries. In addition, the ability of MSCT to detect coronary artery lesions of > or = 70% (> or = 50% in the left main trunk) diameter stenoses documented by standard coronary angiography was assessed in 67 patients who underwent coronary angiography within the same period. RESULTS: Good image quality was displayed in 488 (58%) and fair in 184 (22%) of a total of 846 coronary segments, but non-assessable in 174 (21%) due to degraded image quality. MDCT detected 33 stenotic lesions correctly in 494 assessable segments, comparable to coronary angiography. The sensitivity and specificity of MSCT were 0.79 and 0.95, respectively. However, an additional 15 lesions were detected by coronary angiography among the non-assessable segments. In total, 24 lesions were missed by MSCT. Accordingly, coronary segments were completely assessable and correctly detected by MSCT in only 20 patients (30%), or 35 (52%) if the distal coronary segments were excluded from analysis. CONCLUSIONS: Four-detector MSCT for detection of coronary artery lesions was applicable to assessable segments. However, clinical use may presently be limited because of the insufficient overall accuracy. Further technical improvement is expected in the near future.