title: Non-invasive diagnostic workup of patients with suspected stable angina by combined computed tomography coronary angiography and magnetic resonance perfusion imaging.
abstract: BACKGROUND
  To evaluate additional adenosine magnetic resonance perfusion (MRP) imaging in the diagnostic workup of patients with suspected stable angina with computed tomography coronary angiography (CTCA) as first-line diagnostic modality.
  
  
  RESULTS
  Two hundred and thirty symptomatic patients (male, 52%; age, 56 year) with suspected stable angina underwent CTCA. In patients with a stenosis of >50% as visually assessed, MRP was performed and the quantitative myocardial perfusion reserve index (MPRI) was calculated. Coronary flow reserve (CFR) using invasive coronary flow measurements served as the standard of reference. CTCA showed non-significant CAD in 151/230 (66%) patients and significant CAD in 79/230 patients (34%), of whom 50 subsequently underwent MRP and CFR. MRP showed reduced perfusion in 32 patients (64%), which was confirmed by CFR in 27 (84%). All 18 cases of normal MRP (36%) were confirmed by CFR. The positive likelihood ratio of MRP for the presence of functional significant disease in patients with a lesion on CTCA was 4.49 (95% confidence interval [CI] 2.12-9.99). The negative likelihood ratio was 0.05 (95%CI 0.01-0.34).
  
  
  CONCLUSIONS
  CTCA as first-line diagnostic modality excluded coronary artery disease in a high percentage of patients referred for diagnostic workup of suspected stable angina. MRP made a significant contribution to the detection of functional significant lesions in patients with a positive CTCA.
authors.affiliation: Department of Cardiology, Erasmus University Medical Center, Erasmus University Medical Center, Rotterdam, The Netherland.
authors.forename: Sharon W
authors.initials: SW
authors.lastname: Kirschbaum
authors.forename: Koen
authors.initials: K
authors.lastname: Nieman
authors.forename: Tirza
authors.initials: T
authors.lastname: Springeling
authors.forename: Annick C
authors.initials: AC
authors.lastname: Weustink
authors.forename: Steve
authors.initials: S
authors.lastname: Ramcharitar
authors.forename: Carlos van
authors.initials: Cv
authors.lastname: Mieghem
authors.forename: Alexia
authors.initials: A
authors.lastname: Rossi
authors.forename: Eric
authors.initials: E
authors.lastname: Duckers
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Pim J
authors.initials: PJ
authors.lastname: de Feyter
authors.forename: Robert-Jan M
authors.initials: RJ
authors.lastname: van Geuns
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis* / Q000209:etiology; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis*; D003331:Coronary Vessels / Q000473:pathology / Q000503:physiopathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed