title: Low to intermediate probability of coronary artery disease: comparison of coronary CT angiography with first-pass MR myocardial perfusion imaging.
abstract: OBJECTIVE
  To compare coronary computed tomographic (CT) angiography with first-pass magnetic resonance (MR) myocardial perfusion imaging in patients with chest pain and low to intermediate probability of coronary artery disease (CAD).
  
  
  METHODS
  Local ethics committee approval and patient written informed consent were obtained. Patients with chest pain and low to intermediate pretest probability of CAD underwent both coronary CT angiography and MR myocardial perfusion imaging. Coronary CT angiographic and MR myocardial perfusion images were analyzed qualitatively by blinded observers. Obstructive CAD was defined as more than 50% diameter stenosis at coronary CT angiography. Data were expressed with 95% confidence intervals (CIs) calculated from binomial expression.
  
  
  RESULTS
  In 145 (94.2%) of 154 eligible patients, both coronary CT angiography and MR myocardial perfusion imaging were performed successfully. Mean age was 57 years +/- 10 (standard deviation), and 45.5% of patients were male. Mean interval between coronary CT angiography and MR myocardial perfusion imaging was 4.6 days +/- 3.0; median was 5.0 days. CT coronary angiography revealed obstructive CAD in 52 (35.9%) patients and 78 (17.9%) coronary arteries. At MR myocardial perfusion imaging, myocardial ischemia was demonstrated in 33 (22.8%) patients and 59 (13.6%) vessel territories. Of patients without CAD at coronary CT angiography, 90.5% (57 of 63; 95% CI: 82.6%, 95.0%) had normal myocardial perfusion at MR myocardial perfusion imaging. Of patients with nonobstructive CAD, 83.3% (25 of 30; 95% CI: 69.5%, 91.6%) had normal myocardial perfusion at MR myocardial perfusion imaging. Myocardial ischemia was detected at MR myocardial perfusion imaging in 42.3% (22 of 52; 95% CI: 29.5%, 56%) of patients with obstructive CAD at coronary CT angiography.
  
  
  CONCLUSIONS
  MR myocardial perfusion imaging and coronary CT angiography have complementary roles in evaluation of patients who are suspected of having CAD. Coronary CT angiography can be used to reliably rule out CAD, but its capability to demonstrate hemodynamically significant CAD is limited. The combination of both techniques enables the clinician to evaluate morphology and functional relevance of CAD comprehensively and noninvasively.
authors.affiliation: Department of Cardiology, VU University Medical Center, De Boelelaan 1117, Room 5F003, 1081 HV Amsterdam, the Netherlands. j.groothuis@vumc.nl
authors.forename: Jan G J
authors.initials: JG
authors.lastname: Groothuis
authors.forename: Aernout M
authors.initials: AM
authors.lastname: Beek
authors.forename: Stijn L
authors.initials: SL
authors.lastname: Brinckman
authors.forename: Martijn R
authors.initials: MR
authors.lastname: Meijerink
authors.forename: Simon C
authors.initials: SC
authors.lastname: Koestner
authors.forename: Robin
authors.initials: R
authors.lastname: Nijveldt
authors.forename: Marco J W
authors.initials: MJ
authors.lastname: Götte
authors.forename: Mark B M
authors.initials: MB
authors.lastname: Hofman
authors.forename: Cornelis
authors.initials: C
authors.lastname: van Kuijk
authors.forename: Albert C
authors.initials: AC
authors.lastname: van Rossum
mesh_terms: D016477:Artifacts; D002637:Chest Pain / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D016001:Confidence Intervals; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011336:Probability; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide