64排螺旋CT冠状动脉造影与DSA的对照研究

目的:通过和冠脉造影对比,评价64排螺旋CT冠状动脉成像在冠状动脉狭窄中的临床应用价值。方法:28例患者同时行64排螺旋CT冠状动脉成像和有创性冠脉造影检查,依据AHA17段分段法,评价所有有效节段,并将两者进行对比。结果:冠脉造影显示阴性病例占7.1%(2例),单只病变占21.4%(6例),多支病变占71.4%(20例)。按节段分析,CT检出冠脉狭窄的敏感度,特异度,阳性预测值和阴性预测值分别为91.1%,94.6%,90.0和95.3%。结论:64排螺旋CT冠状动脉成像和传统的冠脉造影检查对检出正常冠脉节段以及狭窄节段具有很好的一致性。     

多层螺旋CT无创性冠状动脉造影对冠状动脉疾病的诊断价值

目的:探讨16层螺旋CT冠状动脉造影对冠状动脉病变的临床诊断价值。方法:57例疑似冠状动脉病变的患者行16排螺旋CT检查和冠状动脉造影,不包括5例为冠状动脉支架置入术后(支架12个)。将冠状动脉分为13个节段,分析所有管腔大于2mm的节段,评价图像是否能满足管腔评价。管腔狭窄大于50%认为有意义,以常规冠状动脉造影作为金标准,比较16层螺旋CT在诊断有意义的冠状动脉狭窄方面的敏感性、特异性、阳性预测值、阴性预测值。结果:在所有638个节段中,588个节段(占92.16%)能够满足冠状动脉管腔评价。对于16层螺旋CT能够显示有意义冠状动脉狭窄,与ICA相对照,若以动脉节段计数,MSCT显示中度以上狭窄的敏感性、特异性、阳性预测值、阴性预测值和准确度分别为93.61%、91.11%、89.79%、98.12%和94.63%。以动脉主干计数,MSCT显示中度以上狭窄的敏感性、特异性、阳性预测值、阴性预测值和准确度分别为92.82、、91.31%、80.43%、97.37%和82.08%。以患者计数,MSCT显示中度以上狭窄的敏感性、特异性、阳性预测值、阴性预测值和准确度分别为94.73%、90.00%、93.01%、92.99%和82.75%。结论:16层螺旋CT结合回顾性心电门控技术冠状动脉成像无创、简单易行。既能显示管腔情况又能显示冠脉管壁,弥补了ICA的不足;经严格控制影响因素,具有较高的敏感性和特异性,较高的阴性预测值可避免不必要的有创性检查。对支架术后的随访也有较高的应用价值,对血管变异的显示直观确切。可作为一种有效的筛查和随访手段应用于临床。     

16层CT显示冠状动脉狭窄与导管法造影的对照研究

目的:评价16层CT在显示冠状动脉狭窄中的价值和限度。方法:55例临床诊断或可疑冠心病的患者做16层CT冠状动脉成像检查(回顾性心电门控、0.5s螺旋扫描、单或双扇区重建算法和静脉注射对比剂),其检查结果与导管法冠状动脉造影对照。结果:在55例患者冠状动脉的568节段(血管直径≥2mm)中,CT图像能够满足管腔评价者为492节段(占86.6%),其中16层CT显示中度或中度以上狭窄(≥50%)的敏感度和特异度分别为87.5%和97.2%,阳性和阴性预测值分别为82.4%和98.1%;16层CT显示高度狭窄(≥75%)的敏感度和特异度分别为91.6%和98.7%,阳性和阴性预测值分别为 84. 6%和 99. 3%。结论:如果冠状动脉 CT 图像能够满足管腔评价, 16 层 CT 显示冠状动脉狭窄(≥50%)的准确性很高。在冠状动脉中、高度狭窄的初步诊断以及介入治疗的筛选方面,16 层 CT可以部分取代传统的导管法冠状动脉造影。     

64层螺旋CT冠状动脉造影评价冠状动脉支架再狭窄

目的 探讨64层螺旋CT冠状动脉造影对冠状动脉支架再狭窄评价的准确性.方法 采用西门子SOMATOM SENSATION CARDIAC 64层螺旋CT对59例冠脉支架植入后患者(共计112枚支架)行CT冠状动脉造影,以冠状动脉造影结果为金标准,分析检测的灵敏度、特异度等指标.结果 64层螺旋CT显示植入的112枚支架中109枚支架内腔得到清晰显示,总显示率97.3%(109/112).12处中、重度狭窄,多层螺旋CT冠状动脉造影诊断正确10处;15处轻度狭窄,多层螺旋CT冠状动脉造影正确5处,误诊10处,无漏诊.再狭窄诊断的灵敏度83.3%(10/12),特异度99%(99/100),阳性预测值90.9%(16/24),阴性预测值98%(99/101),准确率97.3%(109/112).结论 64层螺旋CT对冠状动脉支架再狭窄诊断有较高的准确性,可作为一种无创性检查用于支架术后的随访.     

64层螺旋CT冠状动脉造影对冠状动脉狭窄的诊断价值

目的：评价64层螺旋CT冠状动脉造影（64-slice CTCA）诊断冠状动脉狭窄的临床应用价值。方法：对120例临床怀疑冠状动脉疾病及支架置入术、冠脉搭桥术后的患者进行64层螺旋CT冠状动脉成像。采用回顾性心电门控扫描,并采用曲面重建、多平面重组,容积再现及最大密度投影技术显示冠状动脉主干及分支,其中30例患者近期行传统冠状动脉造影（CCA）。结果：120例患者可评价冠脉节段1377个,可满足诊断的冠脉节段1341个,占97．39％。30例患者近期行CCA检查,MSCTCA诊断冠脉狭窄节段103个与CCA相符,占88．03％,显示轻、中、重度狭窄及血管闭塞与CCA符合率分别为77．8％、93．3％、91．6％、77．8％,得出64SCTCA诊断冠脉狭窄敏感性97．52％,特异性96．02％,阳性预测值95．16％,阴性预测值96．01％。结论：64层螺旋CT冠状动脉造影在诊断冠状动脉疾病方面有很高的诊断价值,可以成为筛查、排除冠状动脉病变及支架、搭桥术后随访的常规检查方法。     

MSCT冠状动脉血管成像不同重组技术的比较

目的:探讨多层螺旋CT冠状动脉血管成像时不同重组技术对冠状动脉及其狭窄的最佳显示方法.方法:对36例临床疑诊冠心病的患者行多层螺旋CT冠状动脉血管成像检查,进行最大密度投影(MIP),曲面重组(CPR),容积再现(VR)和多平面重组(MPR)技术重组,并由2名放射科医师与常规冠状动脉造影(CAG)结果对照.结果:在36例患者的CT能满足诊断要求的289节段(血管直径＞2 mm)冠脉,在横断位图像上对正常和≥50%狭窄血管的显示及诊断符合率最高达95%以上;MIP和CPR成像清晰,对106节段正常冠脉的诊断符合率达90.2%和93.4%,对183节段狭窄(≥50%)的血管的诊断符合率达85.3%和86.3%;VR重组图像能在三维立体空间内直观、形象、清楚地显示冠状动脉的形态分布走行情况及在心脏表面的位置,但图像易造成正常血管狭窄的假象,106节段正常血管中有48节段显示狭窄改变.MPR不能显示冠脉全程,图象粗糙,在冠脉的评价中应用价值不大.结论:横断面、CPR和MIP是显示冠脉及其狭窄的最佳的重组方法,诊断准确性高,VR和MPR可作为补充显示方法.     

双源CT血管造影评价冠状动脉狭窄的临床价值

目的:评价双源CT定量诊断冠状动脉狭窄的准确性及临床价值。方法:对30例临床拟诊冠心病患者分别进行双源CT和传统冠状动脉造影检查,并将双源CT判定冠状动脉狭窄程度与冠脉造影结果进行对比分析。结果:30例共计450冠脉节段,双源CT均获得满意的评价图像(3例进行心电编辑)。双源CT判定轻度狭窄38个节段,中度狭窄23个节段,重度狭窄36个节段;与冠状动脉造影结果对比,双源CT诊断冠脉狭窄的敏感性、特异性和准确性分别为94.12%、95.34%和95.11%。结论:与冠状动脉造影对比,双源CT在定量诊断冠脉狭窄方面具有较高的敏感性和特异性,可为临床诊断冠心病提供一项准确可靠的无创手段。     

128层螺旋CT冠脉成像在诊断及分级评价冠心病的临床价值

目的探讨128层螺旋CT冠脉成像在临床诊断及分级评价冠心病中的应用价值。方法对120例进行128层螺旋CT检查诊断的疑似冠心病患者的临床检查结果分析,并与CAG对比评价冠脉狭窄程度分级诊断的准确性。结果120例患者经冠状动脉造影检查确诊冠状动脉狭窄阳性84例,阳性率为70.00%;阴性36例,阴性率为30%。另外,120例患者经冠状动脉造影检查发现冠状动脉内斑块出现钙化82例,钙化率为68.33%,非钙化38例,非钙化率为31.67%。120例患者经冠状动脉成像检查确诊冠状动脉狭窄阳性85例,阳性率为70.83%;阴性35例,阴性率为29.17%。另外,120例患者经冠状动脉成像检查发现冠状动脉内斑块出现钙化83例,钙化率为69.17%,非钙化37例,非钙化率为30.83%(37/120)。经统计学分析经冠状动脉成像检查与经冠状动脉造影检查两种方法对冠状动脉狭窄的阳性率和冠状动脉内斑块检查中钙化率检出情况比较无明显差异。120例患者检出1572段血管节段,在行冠脉狭窄程度检查时,其对狭窄程度分级过程中均清晰显现出较多的低估或高估情况。结论 128层螺旋CT冠状动脉成像技术可作为可疑冠心病患者筛查手段或低危冠心病患者的复查手段,具有可靠、简便、准确、快捷的优点。     

多层螺旋CT冠状动脉成像与冠状动脉造影对照研究

目的：评价16层螺旋CT诊断冠状动脉疾病的准确性及局限性。方法：25例患者进行16层螺旋CT冠状动脉成像(回顾性心电门控、O．42s螺旋扫描)，并与常规冠状动脉造影对照。结果：在25例患者的186节段(血管直径≥2mm)中，CT图像能满足诊断要求的有161节段(86．5％)。对于CT图像能满足诊断要求的冠状动脉节段，MSCT显示中度和中度以上狭窄的敏感度和特异度分别83．8％(26／31)和95．3％(124／130)。若将不能满足诊断要求的25节段包括内，则MSCT显示中度和中度以上狭窄的敏感度为76．4％(26／34)。结论：16层螺旋CT冠状动脉成像可用于无创性诊断冠状动脉中高度狭窄，局限性伪影的影响不可避免。     

64层螺旋CT在冠状动脉搭桥术后随访中的初步应用

目的:评价64层螺旋CT在冠状动脉搭桥术后随访中的应用价值.方法:14例搭桥术后患者行64层螺旋CT冠状动脉造影检查,分别评价CT图像桥血管近远端吻合口、桥血管本身和吻合口远端引流血管的图像质量及冠状动脉图像质量.有选择性冠状动脉造影作对照的病例,评价CT诊断桥血管通畅性和冠状动脉是否存在狭窄的可靠性,以管腔狭窄大于50%作为诊断血管狭窄的指标.结果:14例患者共发现桥血管33根,桥血管近远端吻合口可评价率分别为93.9%(31/33)和90.9%(30/33);桥血管本身近、中、远三段的可评价率分别为97.0%(32/33)、100%(33/33)和97.0%(32/33);远端引流血管的可评价率为93.9%(31/33).CTA共显示冠状动脉139段,冠状动脉节段可评价率为69.1%(96/139).CTA对评价桥血管的通畅性和冠状动脉是否存在狭窄未出现假阳性及假阴性结果.结论:64层螺旋CT在冠状动脉搭桥术后随访中具有重要的临床应用价值.     

16-detector row computed tomographic coronary angiography in patients undergoing evaluation for aortic valve replacement: comparison with catheter angiography

AIM: To evaluate the diagnostic accuracy of 16-detector row computed tomography (CT) in assessing haemodynamically significant coronary artery stenoses in patients under evaluation for aortic stenosis pre-aortic valve replacement. SUBJECTS AND METHODS: Forty consecutive patients under evaluation for severe aortic stenosis and listed for cardiac catheterization before potential aortic valve replacement underwent coronary artery calcium (CAC) scoring and retrospective electrocardiogram (ECG)-gated multi-detector row computed tomographic coronary angiography (MDCTA) using a GE Lightspeed 16-detector row CT within 1 month of invasive coronary angiography (ICA) for comparative purposes. All 13 major coronary artery segments of the American Heart Association model were evaluated for the presence of > or =50% stenosis and compared to the reference standard. Data were analysed on a segment-by-segment basis and also in "whole patient" terms. RESULTS: A total of 412/450 segments from 35 patients were suitable for analysis. The overall accuracy of MDCTA for detection of segments with > or =50% stenosis was high, with a sensitivity of 81.3%, specificity 95.0%, positive predictive value (PPV) 57.8%, and negative predictive value (NPV) 98.4%. On a "whole-patient" basis, 100% (19/19) of patients with significant coronary disease were correctly identified and there were no false-negatives. Excluding patients with CAC >1000 from the analysis improved the accuracy of MDCTA to: sensitivity 90%, specificity 98.1%, PPV 60%, NPV 99.7%. CONCLUSION: Non-invasive 16-detector row MDCTA accurately excludes significant coronary disease in patients with severe aortic stenosis undergoing evaluation before aortic valve replacement and in whom ICA can therefore be avoided. Its segment-by-segment accuracy is improved further if CAC>1000 is used as a gatekeeper to MDCTA.     

64排螺旋CT对冠心病的诊断价值

目的研究64排螺旋CT冠状动脉成像对冠状动脉疾病的诊断价值。方法搜集128例可疑或已确诊为冠心病的患者进行64排螺旋CT扫描和常规冠状动脉造影,然后对2种检查方法的结果进行对比分析。结果128例患者共有1920个冠状动脉节段可用于评价,结果显示64排螺旋CT诊断冠状动脉病变的敏感性为92%,特异性为94%,阳性预测值为82%,阴性预测值为96%。结论64排螺旋CT对冠心病的诊断及病变程度的评估具有较高的准确性、特异性和敏感性。     

Multi-detector row CT versus coronary angiography: preoperative evaluation before totally endoscopic coronary artery bypass grafting

PURPOSE: To assess multi-detector row spiral computed tomography (CT) for preoperative evaluation of patients undergoing totally endoscopic coronary artery bypass grafting and to correlate the data with coronary angiographic and intraoperative findings. MATERIALS AND METHODS: Thirty-six patients preoperatively underwent multi-detector row CT (4 x 1-mm collimation, pitch of 1.5, 500-msec rotation time, retrospective electrocardiographic gating, 1.25-mm effective section thickness) and coronary angiography. Assessment criteria for both techniques were visibility and cardiac course of coronary arteries, localization and degree of stenoses, composition of atherosclerotic plaques, and vascular diameter at anastomosis site. Site for distal bypass anastomosis was recommended. Results at multi-detector row CT were calculated relative to results at coronary angiography and surgery. RESULTS: Multi-detector row CT properly displayed 79.4% (154 of 194) of all surgical relevant coronary segments and 80.4% (434 of 540) of all coronary segments. For coronary angiography, ratios of 88.7% (172 of 194) and 94.6% (511 of 540), respectively, were observed. For detection of calcified plaques, multi-detector row CT results exceeded those at coronary angiography by a difference of 17% (18 of 18 [100%] compared with 15 of 18 [83%]). Hemodynamically relevant stenoses were identified with multi-detector row CT in 76% (42 of 55) of cases. Bridging of coronary segments through either myocardium (four of five) or epicardial fat (two of three) was better identified at multi-detector row CT than it was at coronary angiography (one of five compared with zero of three, respectively). At multi-detector row CT, 76% (28 of 37) of all distal bypass touchdown segments were identified, but at coronary angiography, only 70% (26 of 37) were identified. CONCLUSION: Multi-detector row CT provides extended information about coronary target site and therefore should be regarded as an ideal additive planning tool for complex minimally invasive procedures such as totally endoscopic coronary artery bypass grafting or minimally invasive direct coronary artery bypass grafting.     

64排螺旋CT冠脉成像中双筒注射技术探讨

目的:探讨64排螺旋CT冠状动脉成像中,应用双筒注射技术消除上腔静脉伪影的作用。方法:182例疑冠心病的患者行64排螺旋CT冠状动脉成像,采用双筒高压注射器,高速注射对比剂后立刻以相同流率注射30~50ml生理盐水。评价上腔静脉伪影对图像质量的影响,图像质量分优、良和差3个等级。结果:本组中CT冠脉成像质量优者占85%,良占14%,差占1%。结论:通过采用双筒高压注射器,可消除上腔静脉和右心房内潴留对比剂而产生的伪影,提高64排螺旋CT冠状动脉成像质量。     

Diagnostic performance of multidetector CT angiography for assessment of coronary artery disease: meta-analysis

PURPOSE: To review the literature on the diagnostic performance of multidetector computed tomographic (CT) angiography for assessment of symptomatic coronary artery disease, with conventional coronary angiography as the reference standard. MATERIALS AND METHODS: A PubMed and manual search of the literature published between January 1998 and May 2006 on use of multidetector CT angiography compared with coronary angiography in patients with symptomatic coronary artery disease was performed. Summary estimates of diagnostic odds ratio, sensitivity, and specificity were calculated. Random-effects models were used to compare the diagnostic performance of four-, 16-, and 64-detector CT angiographic units, and the proportion of nonassessable coronary arterial segments was evaluated. RESULTS: Fifty-four studies were included in the meta-analysis: 22 studies with four-detector CT angiography, 26 with 16-detector CT angiography, and six with 64-detector CT angiography. The pooled sensitivity and specificity for detecting a greater than 50% stenosis per segment were 0.93 (95% confidence interval [CI]: 0.88, 0.97) and 0.96 (95% CI: 0.96, 0.97) for 64-detector CT angiography, 0.83 (95% CI: 0.76, 0.90) and 0.96 (95% CI: 0.95, 0.97) for 16-detector CT angiography, and 0.84 (95% CI: 0.81, 0.88) and 0.93 (95% CI: 0.91, 0.95) for four-detector CT angiography, respectively. Results of regression analysis indicated that the diagnostic performance significantly improved with the newer generations of multidetector CT scanners (64- and 16-detector vs four-detector units), adjusted for exclusion of nonassessable segments, and contrast agent concentration used (P < .05). Simultaneously, the nonassessable proportion of segments significantly decreased with the newer generations of multidetector CT scanners, adjusted for heart rate, prevalence of significant disease, and mean age. CONCLUSION: With the newer generations of multidetector CT scanners, the diagnostic performance for the assessment of coronary artery disease has significantly improved, and the proportion of nonassessable segments has decreased.     

128层螺旋CT血管成像对胆囊动脉的研究

目的：探讨128层CT血管成像（CTA）对胆囊动脉的正常解剖及其变异的显示能力.方法：107例患者采用128层螺旋CT行胆囊动脉成像,并行多平面重组（MPR）、薄层最大密度投影（SMIP）、全体积最大密度投影（VMIP）和容积再现（VR）成像,观察胆囊动脉的起源、支数、走行及其与胆囊三角之间的解剖关系.结果：103例（96.3%）CTA能显示胆囊动脉（n=128）及其起源,起源于正常肝右动脉105支（82.0%）,变异肝右动脉8支（6.3%）,其它动脉15支（11.7%）;单支胆囊动脉78例（75.7%）,双支胆囊动脉25例（24.3%）,共同起源于正常肝右动脉20例（80%）.98例（95.1%）MPR、SMIP图像能清晰地显示胆囊动脉与胆囊三角之间的解剖关系,1支胆囊动脉走行于胆囊三角内55例（56.1%）,1支胆囊动脉走行于胆囊三角外18例（18.4%）,1支胆囊动脉走行于胆囊三角内而另外1支走行于胆囊三角外18例（18.4%）.103例横轴面CT、MPR和SMIP图像均能显示胆囊动脉,VMIP图像能显示胆囊动脉92支（71.9%）,VR图像仅能显示胆囊动脉59支（46.1%）.结论：CTA能清晰地显示胆囊动脉的起源、支数、走行及其与胆囊三角之间的解剖关系,为临床外科提供解剖学依据.     

Aortoiliac and lower extremity arteries assessed with 16-detector row CT angiography: prospective comparison with digital subtraction angiography

PURPOSE: To prospectively compare the accuracy of 16-detector row computed tomographic (CT) angiography with conventional digital subtraction angiography (DSA) as the reference standard in the assessment of aortoiliac and lower extremity arteries in patients with peripheral arterial disease. MATERIALS AND METHODS: This study was approved by the institutional review board, and informed consent was obtained. A total of 39 consecutive patients (27 men [mean age, 66 years] and 12 women [mean age, 64 years]) with peripheral arterial disease underwent both conventional DSA and 16-detector row CT angiography. For data analysis, the arterial vascular system was divided into 35 segments. A total of 1365 arterial segments were analyzed for arterial stenosis by two independent blinded readers using a four-point grading system (grade 1, <10% luminal narrowing; grade 2, 10%-49% luminal narrowing; grade 3, 50%-99% luminal narrowing; grade 4, occlusion). Interobserver agreements were calculated by using kappa statistics. A third independent blinded reader assessed possible reasons for disagreements between 16-detector row CT angiographic findings and conventional DSA findings. Effective radiation dose was calculated for both imaging modalities. RESULTS: Sixteen-detector row CT angiographic and conventional DSA findings were diagnostic in all vascular segments. Compared with conventional DSA, the sensitivity and specificity of 16-detector row CT angiography with regard to detection of hemodynamically significant stenosis in all 35 arterial segments were 96% and 97%, respectively, for both readers. Readers 1 and 2 overestimated arterial stenosis in 42 (3%) and 34 (2%) arterial segments, respectively, and underestimated arterial stenosis in 13 (1%) and 10 (1%) arterial segments, respectively. Interobserver agreement was excellent (kappa = 0.84-1.00). Presence of anteroposteriorly located luminal narrowing and extensive vascular wall calcification were considered main reasons for disagreements between imaging modalities. Effective radiation dose was lower for 16-detector row CT angiography (1.6-3.9 mSv) than for conventional DSA (6.4-16.0 mSv). CONCLUSION: Sixteen-detector row CT angiography is an accurate and reliable noninvasive alternative to conventional DSA in the assessment of aortoiliac and lower extremity arteries in patients with peripheral arterial disease.     

Coronary artery stent patency assessed with in-stent contrast enhancement measured at multi-detector row CT angiography: initial experience

The authors investigated the contrast enhancement characteristics of the coronary artery stent lumen to assess patency and then evaluated the accuracy of computed tomographic (CT) measurement of the in-stent luminal diameter. Nineteen patients (16 men and three women; mean age, 58.7 years) with 26 stents underwent cardiac-gated CT angiography with a 16-detector row scanner 1-3 weeks after stent placement. CT images depicted the lumina of 20 stents in 14 patients. CT attenuation measured in the treated lumen was higher than, and correlated highly (r >/= 0.87) with, attenuation in the proximal and distal untreated lumen. Estimated values for in-stent luminal diameter were lower with CT than with conventional angiography (P <.001), and the mean error (16.1%) that resulted from estimation based on sharp-kernel CT images was significantly smaller than that (27.3%) from estimation based on medium-smooth-kernel CT images (P <.001). Visualization of the in-stent lumen at CT angiography with a 16-detector row scanner allows assessment of coronary artery stent patency on the basis of measured contrast enhancement.     

16层螺旋CT肺血管造影对亚段肺栓塞诊断的成像技术探讨

目的:研究16层螺旋CT肺血管造影在急性肺动脉栓塞(PE)诊断中的应用价值。着重探讨亚段水平周围型肺栓塞的适宜扫描参数及显示方法。方法:应用16层螺旋CT扫描机(GE ligtspeed 16)对临床拟诊肺栓塞的42例患者进行前瞻性研究。依据患者屏气时间长短,设定3组扫描参数。结果:CT诊断肺栓塞31例。中央型22例,周围型9例。3组扫描参数均可清晰显示亚段水平肺动脉栓子。高质量扫描模式肺动脉CTA成像质量最高,常规扫描模式次之,高速扫描模式再次之。结论:16层螺旋CT肺血管造影快速、无创、敏感性、特异性高。选择适宜扫描参数及显示方法,急性肺栓塞诊断可以达到亚段水平。2组常规扫描模式更为适宜PE患者。     

Multi-detector row CT coronary angiography in patients with cardiomyopathy -- initial single-centre experience

AIMS: To evaluate the diagnostic accuracy of computed tomography (CT) in assessing haemodynamically significant coronary artery stenoses in patients with cardiomyopathy (CM). SUBJECTS AND METHODS: Eighteen patients with CM were approached to undergo CT coronary angiography to evaluate the use of this technique for investigating the presence of significant coronary artery disease (CAD), and also to compare the findings with catheter angiography. RESULTS: On a segment-by-segment analysis the sensitivity, specificity, positive and negative predictive values in the CM group were 66.7, 96.5, 40 and 98.8%, respectively, with 100% accuracy in "whole-patient terms". CONCLUSION: Non-invasive, 16-detector row CT coronary angiography in patients with presumed CM would seem to be a useful clinical tool for the exclusion of significant coronary artery disease. However, the presence of suboptimal contrast opacification in this patient group means that the implication of these results must be interpreted with caution.