Direct Comparison of Cardiac Magnetic Resonance and Multidetector Computed Tomography Stress-Rest Perfusion Imaging for Detection of Coronary Artery Disease

• Published in: Journal of the American College of Cardiology Vol. 61; no. 10; pp. 1099 - 1107
• Main Authors: Bettencourt, Nuno, Chiribiri, Amedeo, Schuster, Andreas, Ferreira, Nuno, Sampaio, Francisco, Pires-Morais, Gustavo, Santos, Lino, Melica, Bruno, Rodrigues, Alberto, Braga, Pedro, Azevedo, Luís, Teixeira, Madalena, Leite-Moreira, Adelino, Silva-Cardoso, José, Nagel, Eike, Gama, Vasco
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 12.03.2013; Elsevier; Elsevier Limited
• Subjects: Accuracy; Acquisitions & mergers; Adenosine; Adult; Aged; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Coronary Angiography; coronary artery disease; Coronary Artery Disease - diagnosis; Coronary Circulation; Coronary heart disease; Coronary Stenosis - diagnosis; Coronary vessels; Female; fractional flow reserve; Fractional Flow Reserve, Myocardial - physiology; Heart; Heart rate; Humans; Ischemia; magnetic resonance; Magnetic Resonance Imaging, Cine; Male; Medical imaging; Medical sciences; Middle Aged; Multidetector Computed Tomography; myocardial perfusion; Myocardial Perfusion Imaging - methods; Patients; Predictive Value of Tests; Sensitivity and Specificity; Vasodilator Agents; coronary artery disease; magnetic resonance; CAD; IP; CMR; xA; MDCT; Perf; CTA; FFR; NPV; multidetector computed tomography; PPV; myocardial perfusion; fractional flow reserve; CTP; positive predictive value; myocardial perfusion imaging; x-ray coronary angiography; computed tomography angiography; integrated protocol; computed tomography perfusion; cardiac magnetic resonance; negative predictive value; Heart; Radiodiagnosis; Magnetic resonance; Cardiovascular disease; Medical screening; Coronary heart disease; Nuclear magnetic resonance imaging; Stress; Rest; Multidetector scanner; Perfusion imaging; Medical imagery; Computerized axial tomography; Circulatory system; Cardiology; Detection; Comparative study
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2012.12.020

This study sought to compare the diagnostic performance of a multidetector computed tomography (MDCT) integrated protocol (IP) including coronary angiography (CTA) and stress-rest perfusion (CTP) with cardiac magnetic resonance myocardial perfusion imaging (CMR-Perf) for detection of functionally significant coronary artery disease (CAD). MDCT stress-rest perfusion methods were recently described as adjunctive tools to improve CTA accuracy for detection of functionally significant CAD. However, only a few studies compared these MDCT-IP with other clinically validated perfusion techniques like CMR-Perf. Furthermore, CTP has never been validated against the invasive reference standard, fractional flow reserve (FFR), in patients with suspected CAD. 101 symptomatic patients with suspected CAD (62 ± 8.0 years, 67% males) and intermediate/high pre-test probability underwent MDCT, CMR and invasive coronary angiography. Functionally significant CAD was defined by the presence of occlusive/subocclusive stenoses or FFR measurements ≤0.80 in vessels >2mm. On a patient-based model, the MDCT-IP had a sensitivity, specificity, positive and negative predictive values of 89%, 83%, 80% and 90%, respectively (global accuracy 85%). These results were closely related with those achieved by CMR-Perf: 89%, 88%, 85% and 91%, respectively (global accuracy 88%). When comparing test accuracies using noninferiority analysis, differences greater than 11% in favour of CMR-Perf can be confidently excluded. MDCT protocols integrating CTA and stress-rest perfusion detect functionally significant CAD with similar accuracy as CMR-Perf. Both approaches yield a very good accuracy. Integration of CTP and CTA improves MDCT performance for the detection of relevant CAD in intermediate to high pre-test probability populations.