Coronary Vasospastic Angina: Assessment by Multidetector CT Coronary Angiography

• Published in: Korean journal of radiology Vol. 13; no. 1; pp. 27 - 33
• Main Authors: Kang, Koung Mi, Choi, Sang Il, Chun, Eun Ju, Kim, Jeong A, Youn, Tae-Jin, Choi, Dong Ju
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Radiology 01.01.2012; 대한영상의학회
• Subjects: Accuracy; Angina pectoris; Angina Pectoris - diagnostic imaging; Calcification; Chi-Square Distribution; Comorbidity; Contrast Media; Coronary Angiography - methods; Coronary vessels; Electrocardiography; Emergency medical care; Ergonovine; Female; Humans; Iopamidol - analogs & derivatives; Male; Medical imaging; Middle Aged; Original; Outpatient care facilities; Oxytocics; Pain; Patients; Predictive Value of Tests; Radiographic Image Interpretation, Computer-Assisted; Retrospective Studies; Sensitivity and Specificity; Stents; Tomography, X-Ray Computed - methods; 방사선과학; Netherlands; Spasm; Multidetector CT; Coronary artery
• ISSN: 1229-6929; 2005-8330; 2005-8330
• DOI: 10.3348/kjr.2012.13.1.27

We aimed to describe the imaging findings of multidetector CT coronary angiography (MDCTA) in cases of vasospastic angina (VA) and to determine the accuracy of MDCTA in the identification of VA as compared with invasive coronary angiography with an ergonovine provocation test (CAG with an EG test). Fifty-three patients with clinically suspected VA were enrolled in this study. Two radiologists analyzed the stenosis degree, presence or absence of plaque, plaque composition, and a remodeling index of the related-segment in CAG with an EG test, which were used as a gold standard. We evaluated the diagnostic performances of MDCTA by comparing the MDCTA findings with those of CAG with an EG test. Among the 25 patients with positive CAG with an EG test, all 12 patients with significant stenosis showed no definite plaque with the negative arterial remodeling. Of the six patients with insignificant stenosis, three (50%) had non-calcified plaque (NCP), two (33%) had mixed plaque, and one (17%) had calcified plaque. When the criteria for significant stenosis with negative remodeling but no definite evidence of plaque as a characteristic finding of MDCTA were used, results showed sensitivities, specificities, positive predictive values (PPV), and negative predictive values (NPV) of 48%, 100%, 100%, and 68%, respectively. Significant stenosis with negative remodeling, but no definite evidence of plaque, is the characteristic finding on MDCTA of VA. Cardiac MDCTA shows good diagnostic performance with high specificity and PPV as compared with CAG with an EG test.