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• W4376879072 abstract "Background Incorporating coronary CT angiography (CCTA) into Emergency Department (ED) workflows has been limited by the need for 24/7 real-time post-processing. PURPOSE This study studied whether interpretation of trans-axial CCTA images alone (LI) is noninferior to interpretation of combined trans-axial and multiplanar reformation images (FI) in assessing acute chest pain patients in the ED. MATERIALS AND METHODS CCTA exams of 74 patients were evaluated by two radiologists, one without dedicated CCTA training and one with basic CCTA experience. Each exam was evaluated three times in separate sessions, once by LI and twice by FI, in random order. Nineteen coronary artery segments were rated as having significant stenosis (≥ 50%) or not. Inter-reader agreement was assessed using Cohen’s kappa. The primary analysis was whether the accuracy of LI for detecting significant stenosis was noninferior to FI at the patient-level (margin =-10%). Secondary analyses included similar analyses of sensitivity and specificity, at both the patient- and vessel-level. RESULTS Inter-reader agreement for significant stenosis was good for both LI and FI (kappa:0.72vs.0.70, P =.74). Average accuracy for significant stenosis at the patient-level was 90.5% for LI and 91.9% for FI, with a difference of -1.4%. The accuracy of LI was noninferior to FI as the CI did not include the noninferiority margin. Noninferiority was also found for patient-level sensitivity, and for accuracy, sensitivity, and specificity at the vessel-level. CONCLUSION Limited interpretation of the coronary arteries using trans-axial CCTA images may be sufficient for the detection of significant CAD in the ED setting. Incorporating coronary CT angiography (CCTA) into Emergency Department (ED) workflows has been limited by the need for 24/7 real-time post-processing. This study studied whether interpretation of trans-axial CCTA images alone (LI) is noninferior to interpretation of combined trans-axial and multiplanar reformation images (FI) in assessing acute chest pain patients in the ED. CCTA exams of 74 patients were evaluated by two radiologists, one without dedicated CCTA training and one with basic CCTA experience. Each exam was evaluated three times in separate sessions, once by LI and twice by FI, in random order. Nineteen coronary artery segments were rated as having significant stenosis (≥ 50%) or not. Inter-reader agreement was assessed using Cohen’s kappa. The primary analysis was whether the accuracy of LI for detecting significant stenosis was noninferior to FI at the patient-level (margin =-10%). Secondary analyses included similar analyses of sensitivity and specificity, at both the patient- and vessel-level. Inter-reader agreement for significant stenosis was good for both LI and FI (kappa:0.72vs.0.70, P =.74). Average accuracy for significant stenosis at the patient-level was 90.5% for LI and 91.9% for FI, with a difference of -1.4%. The accuracy of LI was noninferior to FI as the CI did not include the noninferiority margin. Noninferiority was also found for patient-level sensitivity, and for accuracy, sensitivity, and specificity at the vessel-level. Limited interpretation of the coronary arteries using trans-axial CCTA images may be sufficient for the detection of significant CAD in the ED setting." @default.
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• W4376879072 date "2023-05-01" @default.
• W4376879072 modified "2023-10-14" @default.
• W4376879072 title "Limited Axial Interpretation of Coronary CT Angiography in the Emergency Department Setting" @default.
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• W4376879072 doi "https://doi.org/10.1016/j.jacr.2023.04.005" @default.
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