title: Diagnostic performance of stress myocardial perfusion imaging for coronary artery disease: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To determine and compare the diagnostic performance of stress myocardial perfusion imaging (MPI) for the diagnosis of obstructive coronary artery disease (CAD), using conventional coronary angiography (CCA) as the reference standard.
  
  
  METHODS
  We searched Medline and Embase for literature that evaluated stress MPI for the diagnosis of obstructive CAD using magnetic resonance imaging (MRI), contrast-enhanced echocardiography (ECHO), single-photon emission computed tomography (SPECT) and positron emission tomography (PET).
  
  
  RESULTS
  All pooled analyses were based on random effects models. Articles on MRI yielded a total of 2,970 patients from 28 studies, articles on ECHO yielded a sample size of 795 from 10 studies, articles on SPECT yielded 1,323 from 13 studies. For CAD defined as either at least 50 %, at least 70 % or at least 75 % lumen diameter reduction on CCA, the natural logarithms of the diagnostic odds ratio (lnDOR) for MRI (3.63; 95 % CI 3.26-4.00) was significantly higher compared to that of SPECT (2.76; 95 % CI 2.28-3.25; P = 0.006) and that of ECHO (2.83; 95 % CI 2.29-3.37; P = 0.02). There was no significant difference between the lnDOR of SPECT and ECHO (P = 0.52).
  
  
  CONCLUSIONS
  Our results suggest that MRI is superior for the diagnosis of obstructive CAD compared with ECHO and SPECT. ECHO and SPECT demonstrated similar diagnostic performance.
authors.affiliation: Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Marcus C
authors.initials: MC
authors.lastname: de Jong
authors.forename: Tessa S S
authors.initials: TS
authors.lastname: Genders
authors.forename: Robert-Jan
authors.initials: RJ
authors.lastname: van Geuns
authors.forename: Adriaan
authors.initials: A
authors.lastname: Moelker
authors.forename: M G Myriam
authors.initials: MG
authors.lastname: Hunink
mesh_terms: D017023:Coronary Angiography / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology*; D005080:Exercise Test / Q000706:statistics & numerical data; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000706:statistics & numerical data*; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data*; D015995:Prevalence; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*