The clinical value of a negative multi-detector computed tomographic angiography in patients suspected of coronary artery disease: a meta-analysis

The aim of this meta-analysis was to calculate the sensitivity of contrast-enhanced multi-detector computed tomography (MDCT) compared with coronary angiography (CAG) in incident patients suspected of coronary artery disease (CAD). We searched PubMed, Embase, bibliographies of original papers and reviews to identify original papers including >= 20 patients. Two independent reviewers selected papers and judged eligible papers on quality. Heterogeneity was assessed and homogeneous subgroups were pooled. Of the 15 included studies, ten provided moderately homogeneous patient-based analyses with absolute diagnostic numbers (n=630 patients). Pooled sensitivity was 89% (95% confidence interval: 85-92%). Scanners with 16 detectors (n=4) had higher sensitivities (pooled sensitivity: 91%) than four-detector scanners (n=6; pooling not possible due to heterogeneity). Seven studies reported sensitivity for a proximal stenosis, but different definitions were used making pooling impossible; sensitivities ranged from 75 to 100%. The sensitivity of four- and 16-detector MDCT is not sufficient to rule out any stenosis in patients suspected of CAD. No conclusions can be drawn with respect to the sensitivity for clinically relevant or proximal stenoses.