title: Additive value of magnetic resonance coronary angiography in a comprehensive cardiac magnetic resonance stress-rest protocol for detection of functionally significant coronary artery disease: a pilot study.
abstract: BACKGROUND
  Cardiovascular magnetic resonance (CMR) myocardial perfusion imaging (MPI) is a state-of-the-art noninvasive modality for detection of myocardial ischemia and coronary artery disease. Magnetic resonance coronary angiography (MRCA) allows visualization of the coronary tree, but its incremental value as part of a CMR protocol including MPI and late gadolinium enhancement (LGE) is not well established. We aimed to evaluate the additive diagnostic value of a 3-dimensional whole-heart MRCA integration into a 1.5T CMR-MPI/LGE protocol for the detection of functionally significant coronary artery disease.
  
  
  RESULTS
  Forty-three symptomatic patients (61 ± 8.3 years; 65% men) with suspected coronary artery disease and intermediate/high-pretest probability underwent CMR (including CMR-MPI, MRCA, and LGE) and x-ray invasive coronary angiography (XA) with fractional flow reserve evaluation. Diagnostic performances of MRCA, CMR-MPI/LGE, and MRCA+CMR-MPI/LGE integration were determined having XA+fractional flow reserve as standard for coronary artery disease (≥90% stenosis/occlusion or fractional flow reserve ≤ 0.80 in vessels>2 mm). MRCA inclusion into the CMR protocol was associated with a mean increase of 7.9 ± 4.69 (0-17.7) minutes in total examination duration (14%). On patient-based analysis, MRCA had 96% sensitivity, 68% specificity, positive predictive value of 79%, and negative predictive value of 93%. CMR-MPI/LGE had 79% sensitivity, 95% specificity, positive predictive value of 95%, and negative predictive value of 78%. Integration of MRCA with CMR-MPI/LGE further improved CMR performance to 96% sensitivity, 89% specificity, positive predictive value of 92%, and negative predictive value of 94%, with a global accuracy of 93%.
  
  
  CONCLUSIONS
  In this intermediate/high-pretest population, integration of noncontrast-enhanced whole-heart MRCA nonsignificantly improved per-patient diagnostic accuracy of a comprehensive 1.5-T stress-rest CMR-MPI/LGE protocol at a cost of longer scanning times.
authors.affiliation: Departments of Cardiology.
authors.forename: Nuno
authors.initials: N
authors.lastname: Bettencourt
authors.forename: Nuno
authors.initials: N
authors.lastname: Ferreira
authors.forename: Amedeo
authors.initials: A
authors.lastname: Chiribiri
authors.forename: Andreas
authors.initials: A
authors.lastname: Schuster
authors.forename: Francisco
authors.initials: F
authors.lastname: Sampaio
authors.forename: Lino
authors.initials: L
authors.lastname: Santos
authors.forename: Bruno
authors.initials: B
authors.lastname: Melica
authors.forename: Alberto
authors.initials: A
authors.lastname: Rodrigues
authors.forename: Pedro
authors.initials: P
authors.lastname: Braga
authors.forename: Madalena
authors.initials: M
authors.lastname: Teixeira
authors.forename: Adelino
authors.initials: A
authors.lastname: Leite-Moreira
authors.forename: José
authors.initials: J
authors.lastname: Silva-Cardoso
authors.forename: Pedro
authors.initials: P
authors.lastname: Portugal
authors.forename: Vasco
authors.initials: V
authors.lastname: Gama
authors.forename: Eike
authors.initials: E
authors.lastname: Nagel
mesh_terms: D000368:Aged; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology; D005080:Exercise Test; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D003287:Contrast Media
keywords: coronary angiography; fractional flow reserve, myocardial; magnetic resonance imaging; perfusion imaging