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European Radiology

, Volume 22, Issue 11, pp 2415–2423

First Online: 06 June 2012Received: 06 January 2012Revised: 23 March 2012Accepted: 12 April 2012


ObjectivesTo investigate the diagnostic accuracy of CT coronary angiography CTCA in women at low to intermediate pre-test probability of coronary artery disease CAD compared with men.

MethodsIn this retrospective study we included symptomatic patients with low to intermediate risk who underwent both invasive coronary angiography and CTCA. Exclusion criteria were previous revascularisation or myocardial infarction. The pre-test probability of CAD was estimated using the Duke risk score. Thresholds of less than 30 % and 30–90 % were used for determining low and intermediate risk, respectively. The diagnostic accuracy of CTCA in detecting obstructive CAD ≥50 % lumen diameter narrowing was calculated on patient level. P < 0.05 was considered significant.

ResultsA total of 570 patients 46 % women 262-570 were included and stratified as low women 73 % 80-109 and intermediate risk women 39 % 182-461. Sensitivity, specificity, PPV and NPV were not significantly different in and between women and men at low and intermediate risk. For women vs. men at low risk they were 97 % vs. 100 %, 79 % vs. 90 %, 80 % vs. 80 % and 97 % vs. 100 %, respectively. For intermediate risk they were 99 % vs. 99 %, 72 % vs. 83 %, 88 % vs. 93 % and 98 % vs. 99 %, respectively.

ConclusionCTCA has similar diagnostic accuracy in women and men at low and intermediate risk.

Key Points• Coronary artery disease CAD is increasingly investigated by computed tomography angiography CTCA.

• CAD detection or exclusion by CTCA is not different between sexes.

• CTCA diagnostic accuracy was similar between low and intermediate risk sex-specific-groups.

• CTCA rarely misses obstructive CAD in low–intermediate risk women and men.

• CAD yield by invasive coronary angiography after positive CTCA is similar between sex-risk-specific groups.

KeywordsDiagnostic accuracy CT coronary angiography Multidetector computed tomography Coronary artery disease Duke pre-test probability Sex, women and men AbbreviationsAUCarea under receiver-operating characteristic curve

CADcoronary artery disease

CTCAcomputed tomography coronary angiography


HRheart rate

ICAinvasive coronary angiography

NPVnegative predictive value

PPVpositive predictive value

PTPpre-test probability



SPECTsingle photon emission computed tomography

QCAquantitative coronary angiography

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Autor: Anoeshka S. Dharampal - Stella L. Papadopoulou - Alexia Rossi - Annick C. Weustink - Nico R. A. Mollet - W. Bob Meijbo



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