title: Whole-heart coronary magnetic resonance angiography at 1.5 Tesla: does a blood-pool contrast agent improve diagnostic accuracy?
abstract: OBJECTIVE
  To evaluate the impact of the blood-pool contrast agent gadofosveset trisodium on diagnostic accuracy of whole-heart coronary magnetic resonance angiography (CMRA) at 1.5 Tesla.
  
  
  METHODS
  Thirty consecutive patients with suspected coronary artery disease underwent free-breathing whole-heart CMRA at 1.5 Tesla. CMRA was performed with a T2-prepared steady-state free precession sequence (unenhanced CMRA) and an inversion-recovery-prepared steady-state free precession sequence after administration of gadofosveset trisodium (contrast-enhanced CMRA). Two readers independently performed a per-segment evaluation of CMRA (8 proximal and mid coronary segments) for detection of significant stenosis (≥50%) using invasive coronary angiography as reference. Disagreement was settled by consensus reading and interobserver variability was assessed using an unweighted kappa statistic.
  
  
  RESULTS
  Whole-heart CMRA was successfully performed in 27 patients. The percentage of assessable segments was significantly lower on unenhanced CMRA compared with contrast-enhanced CMRA (Reader 1: 79% [170/216] vs. 89% [192/216], respectively; Reader 2: 73% [157/216] vs. 87% [188/216], respectively; P < 0.001). Intention-to-diagnose analysis of the consensus reading yielded sensitivity, specificity, and diagnostic accuracy of unenhanced versus contrast-enhanced CMRA as follows: 73.1% versus 73.1% (P = 1.0), 68.3% versus 80.2% (P = 0.002), and 68.9% versus 79.3% (P = 0.004), respectively. The kappa value for interobserver agreement was 0.61 (95% confidence interval = 0.50-0.72) for unenhanced CMRA and 0.72 (95% confidence interval = 0.62-0.82) for contrast-enhanced CMRA.
  
  
  CONCLUSIONS
  The blood-pool contrast agent gadofosveset trisodium increased the number of assessable coronary segments on whole-heart CMRA in comparison to unenhanced whole-heart CMRA. The impact of gadofosveset trisodium on diagnostic accuracy, however, was only minor.
authors.affiliation: Department of Radiology, Charité-Universitätsmedizin Berlin, Germany. moritz.wagner@charite.de
authors.forename: Moritz
authors.initials: M
authors.lastname: Wagner
authors.forename: Roberta
authors.initials: R
authors.lastname: Rösler
authors.forename: Alexander
authors.initials: A
authors.lastname: Lembcke
authors.forename: Craig
authors.initials: C
authors.lastname: Butler
authors.forename: Marc
authors.initials: M
authors.lastname: Dewey
authors.forename: Michael
authors.initials: M
authors.lastname: Laule
authors.forename: Alexander
authors.initials: A
authors.lastname: Huppertz
authors.forename: Carsten
authors.initials: C
authors.lastname: Schwenke
authors.forename: Carsten
authors.initials: C
authors.lastname: Warmuth
authors.forename: Matthias
authors.initials: M
authors.lastname: Rief
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
authors.forename: Matthias
authors.initials: M
authors.lastname: Taupitz
mesh_terms: D003287:Contrast Media; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D023921:Coronary Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005682:Gadolinium; D015637:Gated Blood-Pool Imaging; D006321:Heart; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D013223:Statistics as Topic
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D005682:Gadolinium; C109932:gadofosveset trisodium