ORIGINAL PAPER Multislice computed tomography for determination of coronary artery disease in a symptomatic patient population Alexander Becker Æ Alexander Leber Æ Carl W. White Æ Christoph Becker Æ Maximilian F. Reiser Æ Andreas Knez Received: 22 May 2006 / Accepted: 24 October 2006 / Published online: 8 December 2006 Ó Springer Science+Business Media B.V. 2006 Abstract Background Multislice computed tomography (MSCT) has started to replace Electron beam CT for quantitation of coronary artery calcium. However no study has evaluated the diagnostic accuracy of MSCT for prediction of coronary artery disease (CAD) in a symptomatic patient population using the volume score. Methods and Results 1347 symptomatic subjects (male = 803, mean age = 62 years) with suspected CAD underwent MSCT studies 1 ± 2 days before the coronary angiogram. The Agatston (ACS) and Volumetric calcium score (VCS) were calculated using a proprietary workstation. Statistical analy- ses included the Pearson’s correlation coefficient and the nonparametric Mann–Whitney U-test to compare the calcium score in different age groups and between men and women. Sensitivity, speci- ficity and predictive accuracy were calculated for different calcium thresholds for prediction of CAD. ROC curve analyses were used to establish relations between the coronary calcium score and presence or absence of CAD. In 720 (53%) subjects (male = 419) angiography revealed a minimal lumen diameter stenosis greater than 50%. Patients with significant CAD had signifi- cantly higher total calcium score values than patients without CAD (P = 0.001). ACS and VCS demonstrate a close correlation for the whole study group, r = 0.99. The overall sensitiv- ity of any calcium to predict stenosis was 99%, specificity = 32%. Exclusion of calcium was highly accurate for exclusion of CAD in subjects older than 50 years (predictive accuracy = 98%). An absolute cutoff >100 and an age and sex specific threshold (score over 75th percentile) were iden- tified as the cutoff levels with the highest sensitiv- ities (86–89%) and lowest false positive rates (20– 22%). ROC analyses revealed MSCT calcium scanning as a good clinical test which can be performed with similar accuracy in all age groups with an area under the curve of 0.84. Conclusion Determination of coronary calcium with MSCT is an accurate imaging modality for prediction of significant CAD in a patient popu- lation with intermediate likelihood of CAD. Exclusion of any calcium provided strong evi- dence that patients older than 50 years did not have obstructive CAD. ACS and VCS show an A. Becker (&)  A. Leber  A. Knez Department of Cardiology, Ludwig-Maximilians- University Munich, Marchioninistr. 15, D-81377 Grosshadern, Munich, Germany e-mail: alexander.becker@med.uni-muenchen.de C. W. White Department of Cardiology, University of Minnesota, Minneapolis, MN, USA C. Becker  M. F. Reiser Department of Clinical Radiology, Ludwig- Maximilians-University Munich, Marchioninistr. 15, D-81377 Grosshadern, Munich, Germany 123 Int J Cardiovasc Imaging (2007) 23:361–367 DOI 10.1007/s10554-006-9189-1