title: MR-IMPACT II: Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary artery disease Trial: perfusion-cardiac magnetic resonance vs. single-photon emission computed tomography for the detection of coronary artery disease: a comparative multicentre, multivendor trial.
abstract: OBJECTIVE
  Perfusion-cardiac magnetic resonance (CMR) has emerged as a potential alternative to single-photon emission computed tomography (SPECT) to assess myocardial ischaemia non-invasively. The goal was to compare the diagnostic performance of perfusion-CMR and SPECT for the detection of coronary artery disease (CAD) using conventional X-ray coronary angiography (CXA) as the reference standard.
  
  
  RESULTS
  In this multivendor trial, 533 patients, eligible for CXA or SPECT, were enrolled in 33 centres (USA and Europe) with 515 patients receiving MR contrast medium. Single-photon emission computed tomography and CXA were performed within 4 weeks before or after CMR in all patients. The prevalence of CAD in the sample was 49%. Drop-out rates for CMR and SPECT were 5.6 and 3.7%, respectively (P = 0.21). The primary endpoint was non-inferiority of CMR vs. SPECT for both sensitivity and specificity for the detection of CAD. Readers were blinded vs. clinical data, CXA, and imaging results. As a secondary endpoint, the safety profile of the CMR examination was evaluated. For CMR and SPECT, the sensitivity scores were 0.67 and 0.59, respectively, with the lower confidence level for the difference of +0.02, indicating superiority of CMR over SPECT. The specificity scores for CMR and SPECT were 0.61 and 0.72, respectively (lower confidence level for the difference: -0.17), indicating inferiority of CMR vs. SPECT. No severe adverse events occurred in the 515 patients.
  
  
  CONCLUSIONS
  In this large multicentre, multivendor study, the sensitivity of perfusion-CMR to detect CAD was superior to SPECT, while its specificity was inferior to SPECT. Cardiac magnetic resonance is a safe alternative to SPECT to detect perfusion deficits in CAD.
authors.affiliation: University Hospital Lausanne, Rue de Bugnon 46, CH-1011 Lausanne, Switzerland. jurg.schwitter@chuv.ch
authors.forename: Juerg
authors.initials: J
authors.lastname: Schwitter
authors.forename: Christian M
authors.initials: CM
authors.lastname: Wacker
authors.forename: Norbert
authors.initials: N
authors.lastname: Wilke
authors.forename: Nidal
authors.initials: N
authors.lastname: Al-Saadi
authors.forename: Ekkehart
authors.initials: E
authors.lastname: Sauer
authors.forename: Kalman
authors.initials: K
authors.lastname: Huettle
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schönberg
authors.forename: Andreas
authors.initials: A
authors.lastname: Luchner
authors.forename: Oliver
authors.initials: O
authors.lastname: Strohm
authors.forename: Hakan
authors.initials: H
authors.lastname: Ahlstrom
authors.forename: Thorsten
authors.initials: T
authors.lastname: Dill
authors.forename: Nadja
authors.initials: N
authors.lastname: Hoebel
authors.forename: Tamas
authors.initials: T
authors.lastname: Simor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000175:diagnosis*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000009:adverse effects / Q000379:methods