Review Article

Diagnostic accuracy of 64-Slice computed tomography angiography in patients with chest pain vs. SPECT in the assessment of significant Coronary Artery Disease: A systematic review and meta-analysis.]


Abstract: The aim of this systematic review and meta-analysis is to investigate the diagnostic accuracy of Computed Tomography Angiography (CTA) in comparison with that of Single-photon emission computed tomography (SPECT) for the diagnosis of Coronary Artery Disease (CAD) in patients with chest pain who have no prior history of cardiovascular diseases Invasive coronary angiography was considered as the reference test.

Method: Cochrane, Scopus, Science Direct, Pubmed and Embase databases were searched. Meta-analysis was performed for determination of pooling estimates of sensitivity, specificity and positive and negative likelihood ratios in CTA and SPECT tests.

Results: The pooled sensitivity and specificity of CTA were 91% (95% Confidence Interval [CI] 88%-94%) and 87% (95% CI 84%-98%), respectively. The pooled positive and negative likelihood ratios and the area under the Receiver Operating Characteristic (ROC) curve for CTA were 7.93 (95% CI 5.11-12.29), 0.1 (95% CI 0.06-0.17) and 0.96, respectively.

The pooled sensitivity and specificity of SPECT were 81% (95% CI 79%-83%) and 74% (95% CI 71%-78%), respectively. The pooled positive and negative likelihood ratio sand the area under the ROC curve for SPECT were 3.03 (95% CI 2.34-3.91), 0.25 (95% CI 0.21-0.30) and 0.86, respectively.

Conclusions: According to the results, the diagnostic accuracy of CTA and SPECT tests lie in the excellent and the very good ranges, respectively. CTA is a stronger evidence than SPECT to rule out cardiovascular diseases in patients with low to intermediate risks for CAD who had no prior history of cardiovascular diseases.

1. World Health Organization: WHO [Internet]. Geneva: World Health Organization; 2018 May [cited 2019 July 09]. Available from:
2. Task Force Members, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. European heart journal. 2013 Aug 30;34(38):2949-3003.
3. Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, Fonarow GC, Lange RA, Levine GN, Maddox TM, Naidu SS. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Journal of Thoracic and Cardiovascular Surgery. 2015 Mar 1;149(3):e5-23.
4. Refolo P, Sacchini D, Marchetti M, Autti Rämö I, Saarni S, Lühmann D, Hofmann B, Velasco Garrido M. Ethical analysis in EUnetHTA. 2008. EUnetHTA WP4-Core HTA on MSCT Coronary Angiography 31 Dec 2008.
5. Ify R Mordi, Athar A Badar, R John Irving, Jonathan R Weir-McCall, J Graeme Houston, Chim C Lang. Efficacy of noninvasive cardiac imaging tests in diagnosis and management of stable coronary artery disease. Vascular Health and Risk Management . 2017:13 427–437
6. Abdulla J, Abildstrom SZ, Gotzsche O, Christensen E, Kober L, Torp-Pedersen C. 64-multislice detector computed tomography coronary angiography as potential alternative to conventional coronary angiography: a systematic review and meta-analysis. European heart journal. 2007 Nov 2;28(24):3042-50.
7. Meijer AB, O YL, Geleijns J, Kroft LJ. Meta-analysis of 40-and 64-MDCT angiography for assessing coronary artery stenosis. American journal of roentgenology. 2008;191(6):1667-75.
8. Mowatt G, Cook JA, Hillis GS, Walker S, Fraser C, Jia X, et al. 64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart. 2008;94(11):1386-93.
9. Nance Jr JW, Bamberg F, Schoepf UJ. Coronary computed tomography angiography in patients with chronic chest pain: systematic review of evidence base and cost-effectiveness. Journal of thoracic imaging. 2012;27(5):277-88.
10. Mowatt G, Cummins E, Waugh N, Walker S, Cook JA, Jia X, et al. Systematic review of the clinical effectiveness and cost-effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease. Health Technology Assessment, 2008; 12 (17).
11. Vanhoenacker PK, Heijenbrok-Kal MH, Van Heste R, Decramer I, Van Hoe LR, Wijns W, et al. Diagnostic performance of multidetector CT angiography for assessment of coronary artery disease: meta-analysis. Radiology. 2007;244(2):419-28.
12. Yang F-B, Guo W-L, Sheng M, Sun L, Ding Y-Y, Xu Q-Q, et al. Diagnostic accuracy of coronary angiography using 64-slice computed tomography in coronary artery disease. Saudi medical journal. 2015;36(10):1156.
13. Takx RA, Blomberg BA, Aidi HE, Habets J, de Jong PA, Nagel E, et al. Diagnostic accuracy of stress myocardial perfusion imaging compared to invasive coronary angiography with fractional flow reserve meta-analysis. Circulation: Cardiovascular Imaging. 2015;8(1):e002666.
14. Gonzalez JA, Lipinski MJ, Flors L, Shaw PW, Kramer CM, Salerno M. Meta-analysis of diagnostic performance of coronary computed tomography angiography, computed tomography perfusion, and computed tomography-fractional flow reserve in functional myocardial ischemia assessment versus invasive fractional flow reserve. The American journal of cardiology. 2015;116(9):1469-78.
15. Jiang B, Wang J, Lv X, Cai W. Dual-source CT versus single-source 64-section CT angiography for coronary artery disease: A meta-analysis. Clinical radiology. 2014;69(8):861-9.
16. Jaarsma C, Leiner T, Bekkers SC, Crijns HJ, Wildberger JE, Nagel E, et al. Diagnostic performance of noninvasive myocardial perfusion imaging using single-photon emission computed tomography, cardiac magnetic resonance, and positron emission tomography imaging for the detection of obstructive coronary artery disease: a meta-analysis. Journal of the American College of Cardiology. 2012;59(19):1719-28.
17. Nudi F, Iskandrian AE, Schillaci O, Peruzzi M, Frati G, Biondi-Zoccai G. Diagnostic Accuracy of Myocardial Perfusion Imaging With CZT Technology: Systemic Review and Meta-Analysis of Comparison With Invasive Coronary Angiography. JACC Cardiovascular imaging. 2017;10(7):787-94.
18. amon M, Morello R, Riddell JW, Hamon M. Coronary arteries: diagnostic performance of 16- versus 64-section spiral CT compared with invasive coronary angiography--meta-analysis. Radiology. 2007;245(3):720-31.
19. Hamon M, Morello R, Riddell JW, Hamon M. Coronary arteries: diagnostic performance of 16- versus 64-section spiral CT compared with invasive coronary angiography--meta-analysis. Radiology. 2007;245(3):720-31.
20. Sun Z, Jiang W. Diagnostic value of multislice computed tomography angiography in coronary artery disease: a meta-analysis. European journal of radiology. 2006;60(2):279-86.
21. Nikolaou K, Flohr T, Knez A, Rist C, Wintersperger B, Johnson T, et al. Advances in cardiac CT imaging: 64-slice scanner. The international journal of cardiovascular imaging. 2004;20(6):535-40.
23. Powell H, Cosson P. Comparison of 64-slice computed tomography angiography and coronary angiography for the detection and assessment of coronary artery disease in patients with angina: a systematic review. Radiography. 2013;19(2):168-75.
24. Parker MW, Iskandar A, Limone B, Perugini A, Kim H, Jones C, et al. Diagnostic accuracy of cardiac positron emission tomography versus single photon emission computed tomography for coronary artery disease: a bivariate meta-analysis. Circulation: Cardiovascular Imaging. 2012;5(6):700-7.
25. HAAGA, J. R. CT and MRI of the whole body. Philadelphia, PA, Mosby/Elsevier. (2009).
26. Šimundić A-M. Measures of diagnostic accuracy: basic definitions. Ejifcc. 2009;19(4):203.
27. Cleland, J. (2005). Orthopaedic Clinical Examination: An Evidence-Based Approach for Physical Therapists. Philadelphia: Elsevier.
28. Knuuti J, Ballo H, Juarez-Orozco LE, Saraste A, Kolh P, Rutjes AWS, et al. The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta-analysis focused on post-test disease probability. European heart journal. 2018;39(35):3322-30.
29. Dragana IS, Sonja J. Multislice computed tomography coronary angiography in patients with angina pectoris. Russian Journal of Cardiology. 2016;132(4):165-8.
30. Achenbach S, Ropers U, Kuettner A, Anders K, Pflederer T, Komatsu S, et al. Randomized Comparison of 64-Slice Single- and Dual-Source Computed Tomography Coronary Angiography for the Detection of Coronary Artery Disease. JACC: Cardiovascular Imaging. 2008;1(2):177-86.
31. Herzog C, Nguyen SA, Savino G, Zwerner PL, Doll J, Nielsen CD, et al. Does two-segment image reconstruction at 64-section CT coronary angiography improve image quality and diagnostic accuracy? Radiology. 2007;244(1):121-9.
32. Ropers D, Rixe J, Anders K, Küttner A, Baum U, Bautz W, et al. Usefulness of multidetector row spiral computed tomography with 64- x 0.6-mm collimation and 330-ms rotation for the noninvasive detection of significant coronary artery stenoses. American Journal of Cardiology. 2006;97(3):343-8.
33. Sheikh M, Ben-Nakhi A, Shukkur AM, Sinan T, Al-Rashdan I. Accuracy of 64-multidetector-row computed tomography in the diagnosis of coronary artery disease. Medical Principles and Practice. 2009;18(4):323-8.
34. Budoff MJ, Kalia N, Cole J, Nakanishi R, Nezarat N, Thomas JL. Diagnostic accuracy of Visipaque enhanced coronary computed tomographic angiography: a prospective multicenter trial. Coronary artery disease. 2017;28(1):52‐6.
35. Chow BJW, Freeman MR, Bowen JM, Levin L, Hopkins RB, Provost Y, et al. Ontario multidetector computed tomographic coronary angiography study: field evaluation of diagnostic accuracy. Archives of internal medicine. 2011;171(11):1021‐9.
36. Kerl JM, Schoepf UJ, Zwerner PL, Bauer RW, Abro JA, Thilo C, et al. Accuracy of coronary artery stenosis detection with CT versus conventional coronary angiography compared with composite findings from both tests as an enhanced reference standard. European Radiology. 2011;21(9):1895-903.
37. Husmann L, Schepis T, Scheffel H, Gaemperli O, Leschka S, Valenta I, et al. Comparison of Diagnostic Accuracy of 64-Slice Computed Tomography Coronary Angiography in Patients with Low, Intermediate, and High Cardiovascular Risk. Academic Radiology. 2008;15(4):452-61.
38. Ladeiras-Lopes R, Bettencourt N, Ferreira N, Sampaio F, Pires-Morais G, Santos L, et al. CT myocardial perfusion and coronary CT angiography: Influence of coronary calcium on a stress–rest protocol. Journal of Cardiovascular Computed Tomography. 2016;10(3):215-20.
39. Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, et al. Diagnostic Performance of 64-Multidetector Row Coronary Computed Tomographic Angiography for Evaluation of Coronary Artery Stenosis in Individuals Without Known Coronary Artery Disease. Results From the Prospective Multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) Trial. Journal of the American College of Cardiology. 2008;52(21):1724-32.
40. Herzog BA, Wyss CA, Husmann L, Gaemperli O, Valenta I, Treyer V, et al. First head-to-head comparison of effective radiation dose from low-dose 64-slice CT with prospective ECG-triggering versus invasive coronary angiography. Heart. 2009;95(20):1656-61.
41. van Werkhoven JM, Heijenbrok MW, Schuijf JD, Jukema JW, Boogers MM, van der Wall EE, et al. Diagnostic Accuracy of 64-Slice Multislice Computed Tomographic Coronary Angiography in Patients With an Intermediate Pretest Likelihood for Coronary Artery Disease. American Journal of Cardiology. 2010;105(3):302-5.
42. Joutsiniemi E, Saraste A, Pietilä M, Ukkonen H, Kajander S, Mäki M, et al. Resting coronary flow velocity in the functional evaluation of coronary artery stenosis: Study on sequential use of computed tomography angiography and transthoracic Doppler echocardiography. European Heart Journal Cardiovascular Imaging. 2012;13(1):79-85.
43. San Román JA, Vilacosta I, Castillo JA, Rollán MJ, Hernández M, Peral V, et al. Selection of the optimal stress test for the diagnosis of coronary artery disease. Heart (british cardiac society). 1998;80(4):370‐6.
44. Tsougos E, Paraskevaidis I, Dagres N, Varounis C, Panou F, Karatzas D, et al. Detection of high-burden coronary artery disease by exercise-induced changes of the E/E’ratio. The international journal of cardiovascular imaging. 2012;28(3):521-30.
45. Ozguven M, OztUrk E. Value of Dobutamine Technetium-99m-Sestamibi SPE@ T and Echocardiography in the Detection of Coronary Artery Disease Compared with Coronary Angiography. J Nucl Med. 1993;34:889-94.
46. Marwick T, D'hondt A-M, Baudhuin T, Willemart B, Wijns W, Detry J-M, et al. Optimal use of dobutamine stress for the detection and evaluation of coronary artery disease: combination with echocardiography or scintigraphy, or both? Journal of the American College of Cardiology. 1993;22(1):159-67.
47. Matzer L, Kiat H, Wang FP, Van Train K, Germano G, Friedman J, et al. Pharmacologic stress dual-isotope myocardial perfusion single-photon emission computed tomography. American heart journal. 1994;128(6):1067-76.
48. Shin JH, Pokharna HK, Williams KA, Mehta R, Ward RP. SPECT myocardial perfusion imaging with prone-only acquisitions: correlation with coronary angiography. Journal of nuclear cardiology. 2009;16(4):590-6.
49. Bokhari S, Shahzad A, Bergmann SR. Superiority of exercise myocardial perfusion imaging compared with the exercise ECG in the diagnosis of coronary artery disease. Coronary artery disease. 2008;19(6):399-404.
50. Ma H, Li S, Wu Z, Liu J, Liu H, Guo X. Comparison of 99mTc-N-DBODC5 and 99mTc-MIBI of myocardial perfusion imaging for diagnosis of coronary artery disease. Biomed research international. 2013.
51. Di Bello V, Bellina CR, Molea N, Talarico L, Boni G, Magagnini E, et al. Simultaneous dobutamine stress echocardiography and dobutamine scintigraphy (99mTc-MIBI-SPET) for assessment of coronary artery disease. International Journal of Cardiac Imaging. 1996;12(3):185-90.
52. Yao ZM, Li W, Qu WY, Zhou C, He Q, Ji FS. Comparison of 99mTc-methoxyisobutylisonitrile myocardial single-photon emission computed tomography and electron beam computed tomography for detecting coronary artery disease in patients with no myocardial infarction. Chinese medical journal. 2004;117(5):700-5.
53. Bai J, Hashimoto J, Suzuki T, Nakahara T, Kubo A, Iwanaga S, et al. Comparison of image reconstruction algorithms in myocardial perfusion scintigraphy. Annals of nuclear medicine. 2001;15(1):79-83.
54. Freeman MR, Konstantinou C, Barr A, Greyson ND. Clinical comparison of 180-degree and 360-degree data collection of technetium 99m sestamibi SPECT for detection of coronary artery disease. Journal of Nuclear Cardiology. 1998;5(1):14-8.
55. Mak K, Ang E, Goh A, Na K, Sundram F, Tan A. Myocardial perfusion imaging with technetium‐99m sestamibi SPECT in the evaluation of coronary artery disease. Australasian radiology. 1995;39(2):112-7.
56. Herbst C, Theron HdT, Van Aswegen A, Kleynhans P, Otto A, Minnaar P. A comparison of the clinical relevance of thallium201 and technetium-99m-methoxyisobutyl-isonitrile for the evaluation of myocardial blood flow. South African Medical Journal. 1990;78(9):277-80.
57. Chen GB, Wu H, He XJ, Huang JX, Yu D, Xu WY, et al. Adenosine stress thallium-201 myocardial perfusion imaging for detecting coronary artery disease at an early stage. Journal of x-ray science and technology. 2013;21(2):317‐22.
58. Bijani M, Valizadeh A, Sayari A, Samizadeh B. Surveying the Reasons for Refusing Coronary Angiography in Patients Referring to Cardiac Ward of Valiasr Hospital in Fasa. Journal of Fasa University of Medical Sciences. 2015;4(4):375-81.
IssueVol 4, No2 (2020) QRcode
SectionReview Article
Coronary Artery Disease Computed Tomography Angiography Single-photon emission computed tomography (SPECT) sensitivity specificity

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Jamali M, Daroudi R, Tajdini M, Akbarisari A, Alaei S, Salehi S. Diagnostic accuracy of 64-Slice computed tomography angiography in patients with chest pain vs. SPECT in the assessment of significant Coronary Artery Disease: A systematic review and meta-analysis.]. Health Tech Ass Act. 4(2).