User comment on MSCT

User Jan comments

Have just had a clinical experience that anecdotally supports the limited correlation of CT and cath. The patient did have heavy calcification on CT and was read as having > 50 LAD, 75 RCA and 30 Cx. On cath he had total occlusion of LAD and RCA with non-obstructive dz in the Cx.
The CT was done at an outside facility, so not sure who did the interpretation; our physicians did not review the CT.
The chief of our cardiology department thinks that CT angio may be a good screening exam in patients who present with non-typical CP that is not clearly cardiac - the usual pt that would be admitted with R/O MI.
Do you see that as a possible use?

Firt off, thanks for your comments.

You are right. With MSCT, the positive corelations (MSCT and cor. angio. agreeing that there is disease) is 70-75%, meaning that it is right 3 out of 4 times. BUT the negative corelation (MSCT and cor. angio. agreeing that there is no disease) is 99% (almost always right).

In Mayo and John Hopkins (two of the centers that we consulted privately) they have their first 64MSCT parked near ER, so that patients with odd chest pains can have an MSCT. If the calcium score is zero, and the MSCT is negative, that patient can be safely sent home. Meaning that the chest pains is unlikely to be due to cardiac cause.

Hope that helps. Thanks for your comments.