title: Additional value of myocardial perfusion imaging during dobutamine stress magnetic resonance for the assessment of coronary artery disease.
abstract: BACKGROUND
  Dobutamine stress magnetic resonance (DSMR) imaging has emerged as a valuable tool for the detection of inducible wall motion abnormalities. The role of perfusion imaging during DSMR is not well defined. We examined whether the addition of myocardial perfusion imaging during DSMR provides incremental benefit for the evaluation of coronary artery disease.
  
  
  RESULTS
  DSMR was combined with perfusion imaging in 455 consecutive patients who were scheduled for clinically indicated invasive coronary angiography. Perfusion images were acquired in 3 standard short-views at rest and during maximum dobutamine-atropine stress. Wall motion and perfusion images were interpreted sequentially, blinded to other data. Significant (> or =70%) stenoses were present in 285 patients on invasive coronary angiography. The use of DSMR combined with perfusion imaging versus DSMR increased sensitivity (91% versus 85%, P=0.001), but not specificity (70% versus 82%, P=0.001), resulting in identical overall diagnostic accuracy (84% versus 84%, P=NS; Youden index 0.61 versus 0.67). DSMR combined with perfusion imaging enabled the correct diagnosis of coronary artery disease in an additional 13% of DSMR-negative patients at the cost of 11% more false-positive cases.
  
  
  CONCLUSIONS
  The addition of perfusion imaging during DSMR improves sensitivity for the diagnosis of coronary artery disease but does not enhance overall diagnostic accuracy because of a concomitant decrease in specificity.
authors.affiliation: German Heart Institute Berlin, Augustenburger Platz 1, Berlin, Germany. gebker@dhzb.de
authors.forename: Rolf
authors.initials: R
authors.lastname: Gebker
authors.forename: Cosima
authors.initials: C
authors.lastname: Jahnke
authors.forename: Robert
authors.initials: R
authors.lastname: Manka
authors.forename: Ashraf
authors.initials: A
authors.lastname: Hamdan
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schnackenburg
authors.forename: Eckart
authors.initials: E
authors.lastname: Fleck
authors.forename: Ingo
authors.initials: I
authors.lastname: Paetsch
mesh_terms: D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000150:complications; D004280:Dobutamine; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications; D008279:Magnetic Resonance Imaging; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D055414:Myocardial Perfusion Imaging; D012680:Sensitivity and Specificity
chemical_list: D004280:Dobutamine