Low-dose CT and cardiac MR for the diagnosis of coronary artery disease: accuracy of single and combined approaches.
To prospectively compare the diagnostic performance of low-dose computed tomography coronary angiography (CTCA) and cardiac magnetic resonance imaging (CMR) and combinations thereof for the diagnosis of significant coronary stenoses. Forty-three consecutive patients with known or suspected coronary artery disease underwent catheter coronary angiography (CA), dual-source CTCA with prospective electrocardiography-gating, and cardiac CMR (1.5 Tesla). The following tests were analyzed: (1) low-dose CTCA, (2) adenosine stress-rest perfusion-CMR, (3) late gadolinium enhancement (LGE), (4) perfusion-CMR and LGE, (5) low-dose CTCA combined with perfusion-CMR, (5) low-dose CTCA combined with late gadolinium-enhancement, (6) low-dose CTCA combined with perfusion-CMR and LGE. CA served as the standard of reference. CA revealed >50% diameter stenoses in 68/129 (57.7%) coronary arteries in 29/43 (70%) patients. In the patient-based analysis, sensitivity, specificity, NPV and PPV of low-dose CTCA for the detection of significant stenoses were 100, 92.9, 100 and 96.7%, respectively. For perfusion-CMR and LGE, sensitivity, specificity, NPV, PPV, and accuracy were 89.7, 100, 82.4, and 100%, respectively. In the artery-based analysis, sensitivity and NPV of low-dose CTCA was significantly (P < 0.05) higher than that of perfusion-CMR and LGE. All combinations of low-dose CTCA and perfusion-CMR and/or LGE did not improve the diagnostic performance when compared to low-dose CTCA alone. Taking CA as standard of reference, low-dose CTCA outperforms CMR with regard to sensitivity and NPV, whereas CMR is more specific and has a higher PPV than low-dose CTCA.
Institute of Diagnostic Radiology, University Hospital Zurich, Raemistr 100, 8091, Zurich, Switzerland. hans.scheffel@usz.ch
Hans
H
Scheffel
Paul
P
Stolzmann
Hatem
H
Alkadhi
Naim
N
Azemaj
André
A
Plass
Stephan
S
Baumueller
Lotus
L
Desbiolles
Sebastian
S
Leschka
Sebastian
S
Kozerke
Volkmar
V
Falk
Peter
P
Boesiger
Christophe
C
Wyss
Borut
B
Marincek
Olivio F
OF
Donati
D000241:Adenosine; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007472:Iohexol / Q000031:analogs & derivatives; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011829:Radiation Dosage; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014665:Vasodilator Agents
D003287:Contrast Media; D014665:Vasodilator Agents; D007472:Iohexol; C038192:iopromide; D000241:Adenosine