SynthesisEuropean radiology2016
Diagnostic accuracy and utility of coronary CT angiography with consideration of unevaluable results: A systematic review and multivariate Bayesian random-effects meta-analysis with intention to diagnose.
Synthesis in European radiology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Small Study Effects in Diagnostic Imaging Accuracy: A Meta-Analysis.JAMA network open · 2022Pooled it
- Implementation of Cardiac Computed Tomography for Aortic Valve Infective Endocarditis: Coronary Arteries Evaluation and Concordance with Transoesophageal Findings.Diagnostics (Basel, Switzerland) · 2026Article
- Application of one heartbeat acquisition with motion correction algorithm in CCTA of patients with atrial fibrillation: evaluation of coronary artery stenoses using artificial intelligence assisted diagnostic system.Frontiers in radiology · 2025Article
- Comparison of machine learning-based CT fractional flow reserve with cardiac MR perfusion mapping for ischemia diagnosis in stable coronary artery disease.European radiology · 2024Article
- Chest Pain Evaluation: Diagnostic Testing.CJC open · 2023Review
- Review
- Missing values and inconclusive results in diagnostic studies - A scoping review of methods.Statistical methods in medical research · 2023Article
- Enhancing Radiation Dose Efficiency in Prospective ECG-Triggered Coronary CT Angiography Using Calcium-Scoring CT.Diagnostics (Basel, Switzerland) · 2023Article
- [Morphological and functional diagnostics of coronary artery disease by computed tomography].Herz · 2023Review
- Image quality and diagnostic performance evaluation in transcatheter aortic valve implantation candidates with atrial fibrillation using a whole-heart coverage CT scanner.European radiology · 2022Article
- EANM procedural guidelines for PET/CT quantitative myocardial perfusion imaging.European journal of nuclear medicine and molecular imaging · 2021Article
- The Incremental Role of Coronary Computed Tomography in Chronic Coronary Syndromes.Journal of clinical medicine · 2020Review
- [Computed tomography or cardiovascular magnetic resonance imaging for diagnosis of chronic coronary syndrome?]Der Radiologe · 2020Review
- The usefulness of cardiac CT integrated with FFRCT for planning myocardial revascularization in complex coronary artery disease: a lesson from SYNTAX studies.Cardiovascular diagnosis and therapy · 2020Review
- The value of coronary computed tomography angiography in assessing the cardiac circulation of an outpatient-based population.Medicine · 2020Article
- The revolution project: replacing coronary artery angiography with coronary computed tomography with functional evaluation.European heart journal supplements : journal of the European Society of Cardiology · 2020Article
- A multinomial quadrivariate D-vine copula mixed model for meta-analysis of diagnostic studies in the presence of non-evaluable subjects.Statistical methods in medical research · 2020Article
- Review
- Accuracy of Myocardial Blood Flow Estimation From Dynamic Contrast-Enhanced Cardiac CT Compared With PET.Circulation. Cardiovascular imaging · 2019Article
- Image quality and radiation dose of coronary CT angiography performed with whole-heart coverage CT scanner with intra-cycle motion correction algorithm in patients with atrial fibrillation.European radiology · 2018Article
Corrections and comments
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo meta-analyze diagnostic accuracy, test yield and utility of coronary computed tomography angiography (CCTA) in coronary artery disease (CAD) by an intention-to-diagnose approach with inclusion of unevaluable results.
methodsFour databases were searched from 1/2005 to 3/2013 for prospective studies that used 16-320-row or dual-source CTs and provided 3 × 2 patient-level data of CCTA (positive, negative, or unevaluable) versus catheter angiography (positive or negative) for diagnosing ≥50% coronary stenoses. A Bayesian multivariate 3 × 2 random-effects meta-analysis considered unevaluable CCTAs.
resultsThirty studies (3422 patients) were included. Compared to 16-40 row CT, test yield and accuracy of CCTA has significantly increased with ≥64-row CT (P < 0.05). In ≥64-row CT, about 2.5% (95%-CI, 0.9-4.8%) of diseased patients and 7.5% (4.5-11.2%) of non-diseased patients had unevaluable CCTAs. A positive likelihood ratio of 8.9 (6.1-13.5) indicated moderate suitability for identifying CAD. A negative likelihood ratio of 0.022 (0.01-0.04) indicated excellent suitability for excluding CAD. Unevaluable CCTAs had an equivocal likelihood ratio of 0.42 (0.22-0.71). In the utility analysis, CCTA was useful at intermediate pre-test probabilities (16-70%).
conclusionsCCTA is useful at intermediate CAD pre-test probabilities. Positive CCTAs require verification to confirm CAD, unevaluable CCTAs require alternative diagnostics, and negative CCTAs exclude obstructive CAD with high certainty. KEY POINTS: • This 3 × 2 Bayesian meta-analysis included unevaluable CCTAs with intention-to-diagnose. • CCTA is currently useful at intermediate CAD pre-test probabilities. • Unevaluable CCTAs should not, generally, be treated as if they are positive. • Positive CCTAs require verification by other methods to confirm CAD. • Negative CCTAs exclude CAD with high certainty.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.