title: Direct comparison of cardiac magnetic resonance and multidetector computed tomography stress-rest perfusion imaging for detection of coronary artery disease.
abstract: OBJECTIVE
  This study sought to compare the diagnostic performance of a multidetector computed tomography (MDCT) integrated protocol (IP) including coronary angiography (CTA) and stress-rest perfusion (CTP) with cardiac magnetic resonance myocardial perfusion imaging (CMR-Perf) for detection of functionally significant coronary artery disease (CAD).
  
  
  BACKGROUND
  MDCT stress-rest perfusion methods were recently described as adjunctive tools to improve CTA accuracy for detection of functionally significant CAD. However, only a few studies compared these MDCT-IP with other clinically validated perfusion techniques like CMR-Perf. Furthermore, CTP has never been validated against the invasive reference standard, fractional flow reserve (FFR), in patients with suspected CAD.
  
  
  METHODS
  101 symptomatic patients with suspected CAD (62 ± 8.0 years, 67% males) and intermediate/high pre-test probability underwent MDCT, CMR and invasive coronary angiography. Functionally significant CAD was defined by the presence of occlusive/subocclusive stenoses or FFR measurements ≤ 0.80 in vessels >2mm.
  
  
  RESULTS
  On a patient-based model, the MDCT-IP had a sensitivity, specificity, positive and negative predictive values of 89%, 83%, 80% and 90%, respectively (global accuracy 85%). These results were closely related with those achieved by CMR-Perf: 89%, 88%, 85% and 91%, respectively (global accuracy 88%). When comparing test accuracies using noninferiority analysis, differences greater than 11% in favour of CMR-Perf can be confidently excluded.
  
  
  CONCLUSIONS
  MDCT protocols integrating CTA and stress-rest perfusion detect functionally significant CAD with similar accuracy as CMR-Perf. Both approaches yield a very good accuracy. Integration of CTP and CTA improves MDCT performance for the detection of relevant CAD in intermediate to high pre-test probability populations.
authors: Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal. bettencourt.n@gmail.com
authors: Nuno
authors: N
authors: Bettencourt
authors: Amedeo
authors: A
authors: Chiribiri
authors: Andreas
authors: A
authors: Schuster
authors: Nuno
authors: N
authors: Ferreira
authors: Francisco
authors: F
authors: Sampaio
authors: Gustavo
authors: G
authors: Pires-Morais
authors: Lino
authors: L
authors: Santos
authors: Bruno
authors: B
authors: Melica
authors: Alberto
authors: A
authors: Rodrigues
authors: Pedro
authors: P
authors: Braga
authors: Luís
authors: L
authors: Azevedo
authors: Madalena
authors: M
authors: Teixeira
authors: Adelino
authors: A
authors: Leite-Moreira
authors: José
authors: J
authors: Silva-Cardoso
authors: Eike
authors: E
authors: Nagel
authors: Vasco
authors: V
authors: Gama
mesh_terms: D000241:Adenosine; D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis*; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000175:diagnosis; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine