title: Combined non-invasive functional and anatomical diagnostic work-up in clinical practice: the magnetic resonance and computed tomography in suspected coronary artery disease (MARCC) study.
abstract: OBJECTIVE
  The combined use of cardiac computed tomography (CT) coronary angiography (CTCA) and myocardial perfusion imaging allows the non-invasive evaluation of coronary morphology and function. Cardiovascular magnetic resonance (CMR) imaging has several advantages: it can simultaneously assess myocardial perfusion, ventricular and valvular function, cardiomyopathy, and aortic disease and does not involve any additional ionizing radiation. We investigated the combined use of cardiac CT and CMR for the diagnostic evaluation of patients with suspected coronary artery disease (CAD) in clinical practice.
  
  
  RESULTS
  A total of 192 patients with low or intermediate pre-test probability of CAD underwent CTCA and CMR. All patients with obstructive CAD on CTCA and/or myocardial ischaemia on CMR were referred for invasive coronary angiography (ICA). Fractional flow reserve was measured in case of intermediate lesions (30-70% diameter stenosis) on ICA. Additional cardiac and extra-cardiac findings by CTCA and CMR were registered. The combination of CTCA and CMR significantly improved specificity and overall accuracy (94 and 91%) for the detection of significant CAD compared with their use as a single technique (CTCA 39 and 57%, P < 0.0001; CMR 82 and 83%, P = 0.016). No events were recorded during follow-up (18 ± 6 months) in 104 patients who did not undergo ICA. Furthermore, the combined strategy provided an alternative diagnosis in 19 patients.
  
  
  CONCLUSIONS
  The combined use of CTCA and CMR significantly improved specificity and overall diagnostic accuracy for the detection of significant CAD and allowed the detection of alternative (extra-)cardiac disease in patients without significant CAD.
authors.affiliation: Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. j.groothuis@vumc.nl
authors.forename: Jan G J
authors.initials: JG
authors.lastname: Groothuis
authors.forename: Aernout M
authors.initials: AM
authors.lastname: Beek
authors.forename: Stijn L
authors.initials: SL
authors.lastname: Brinckman
authors.forename: Martijn R
authors.initials: MR
authors.lastname: Meijerink
authors.forename: Mijntje L P
authors.initials: ML
authors.lastname: van den Oever
authors.forename: Mark B M
authors.initials: MB
authors.lastname: Hofman
authors.forename: Cornelis
authors.initials: C
authors.lastname: van Kuijk
authors.forename: Albert C
authors.initials: AC
authors.lastname: van Rossum
mesh_terms: D003324:Coronary Artery Disease / Q000175:diagnosis*; D023921:Coronary Stenosis / Q000175:diagnosis; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis; D015588:Observer Variation; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
keywords: Cardiac CT; Coronary artery disease; Magnetic resonance imaging