Does Clinical Pretest Probability Influence Image Quality and Diagnostic Accuracy in Dual-Source Coronary CT Angiography?

作者：Thomas Christoph^*; Brodoefel Harald; Tsiflikas Ilias; Bruckner Friederike; Reimann Anja; Ketelsen Dominik; Drosch Tanja; Claussen Claus D; Kopp Andreas; Heuschmid Martin; Burgstahler Christof

来源：Academic Radiology, 2010, 17(2): 212-218.

DOI：10.1016/j.acra.2009.08.010

• DSCT
• coronary CTA
• pretest probability
• Morise score
• accuracy

Rationale and Objectives: To prospectively evaluate the influence of the clinical pretest probability assessed by the Morise score onto image quality and diagnostic accuracy in coronary dual-source computed tomography angiography (DSCTA).
Materials and Methods: In 61 patients, DSCTA and invasive coronary angiography were performed. Subjective image quality and accuracy for stenosis detection (>50%) of DSCTA with invasive coronary angiography as gold standard were evaluated. The influence of pretest probability onto image quality and accuracy was assessed by logistic regression and chi-square testing. Correlations of image quality and accuracy with the Morise score were determined using linear regression.
Results: Thirty-eight patients were categorized into the high, 21 into the intermediate, and 2 into the low probability group. Accuracies for the detection of significant stenoses were 0.94, 0.97, and 1.00, respectively. Logistic regressions and chi-square tests showed statistically significant correlations between Morise score and image quality (P < .0001 and P < .001) and accuracy (P = .0049 and P = .027). Linear regression revealed a cutoff Morise score for a good image quality of 16 and a cutoff for a barely diagnostic image quality beyond the upper Morise scale.
Conclusion: Pre-test probability is a weak predictor of image quality and diagnostic accuracy in coronary DSCTA. A sufficient image quality for diagnostic images can be reached with all pretest probabilities. Therefore, coronary DSCTA might be suitable also for patients with a high pretest probability.

• 出版日期2010-2