title: Superior diagnostic performance of perfusion-cardiovascular magnetic resonance versus SPECT to detect coronary artery disease: The secondary endpoints of the multicenter multivendor MR-IMPACT II (Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary Artery Disease Trial).
abstract: BACKGROUND
  Perfusion-cardiovascular magnetic resonance (CMR) is generally accepted as an alternative to SPECT to assess myocardial ischemia non-invasively. However its performance vs gated-SPECT and in sub-populations is not fully established. The goal was to compare in a multicenter setting the diagnostic performance of perfusion-CMR and gated-SPECT for the detection of CAD in various populations using conventional x-ray coronary angiography (CXA) as the standard of reference.
  
  
  METHODS
  In 33 centers (in US and Europe) 533 patients, eligible for CXA or SPECT, were enrolled in this multivendor trial. SPECT and CXA were performed within 4 weeks before or after CMR in all patients. Prevalence of CAD in the sample was 49% and 515 patients received MR contrast medium. Drop-out rates for CMR and SPECT were 5.6% and 3.7%, respectively (ns). The study was powered for the primary endpoint of non-inferiority of CMR vs SPECT for both, sensitivity and specificity for the detection of CAD (using a single-threshold reading), the results for the primary endpoint were reported elsewhere. In this article secondary endpoints are presented, i.e. the diagnostic performance of CMR versus SPECT in subpopulations such as multi-vessel disease (MVD), in men, in women, and in patients without prior myocardial infarction (MI). For diagnostic performance assessment the area under the receiver-operator-characteristics-curve (AUC) was calculated. Readers were blinded versus clinical data, CXA, and imaging results.
  
  
  RESULTS
  The diagnostic performance (= area under ROC = AUC) of CMR was superior to SPECT (p = 0.0004, n = 425) and to gated-SPECT (p = 0.018, n = 253). CMR performed better than SPECT in MVD (p = 0.003 vs all SPECT, p = 0.04 vs gated-SPECT), in men (p = 0.004, n = 313) and in women (p = 0.03, n = 112) as well as in the non-infarct patients (p = 0.005, n = 186 in 1-3 vessel disease and p = 0.015, n = 140 in MVD).
  
  
  CONCLUSIONS
  In this large multicenter, multivendor study the diagnostic performance of perfusion-CMR to detect CAD was superior to perfusion SPECT in the entire population and in sub-groups. Perfusion-CMR can be recommended as an alternative for SPECT imaging.
  
  
  BACKGROUND
  ClinicalTrials.gov, Identifier: NCT00977093.
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: Kurt
authors.initials: K
authors.lastname: Debl
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: D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D003326:Coronary Circulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*