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High-tech scan for blocked arteries matches conventional tests in finding root of symptoms

the arteries of older people, are also drawbacks.

The U-M analysis looked at studies that evaluated EBCT's use in diagnosing patients with symptoms, specifically in finding plaques that blocked more than half of any given artery - enough to alter blood flow dangerously. They compared how often the test found real plaques and how often it gave a false positive, depending on how the EBCT machines were set.

Overall, they found that at the optimal setting for reliability, EBCT could find large plaques 75 percent of the time in people who have them (a measure called sensitivity), while still giving 75 percent of those without plaques an accurate diagnosis (a measure called specificity).

If the test is adjusted to be more sensitive to the presence of calcium, its sensitivity can be as high as 92 percent of the time, preventing doctors from missing plaques but also raising the risk of false positives to nearly 50 percent. Other settings can minimize the risk of false positives but also reduce the chance that the scan will pick up every blockage bigger than 50 percent.

These levels of reliability, though not perfect, are similar to what can be achieved by a trained stress-test operator using monitors and/or radioactive tracers to assess a patient's blood flow while he or she is exercising on a treadmill.

Similar levels of accuracy, though based on far fewer patients, are being seen with an EBCT-like scan that can now be performed with state-of-the-art CT scanners equipped with special software. This approach, which analyzes calcium density in arteries but doesn't require the purchase of a special EBCT machine, is what UMHS is exploring for its Cardiovascular Center.

Nallamothu and his colleagues can't say whether their results will be enough to tip the balance toward the purchase of an EBCT machine by any medical center, or coverage of the scans by insurers. They note that new diagnostic technologies have to clear a higher hurdle to be accepted, n
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Contact: Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System
24-Mar-2001


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