title: Diagnostic performance of non-contrast-enhanced whole-heart magnetic resonance coronary angiography in combination with adenosine stress perfusion cardiac magnetic resonance imaging.
abstract: BACKGROUND
  We sought to evaluate the diagnostic performance of 1.5-T non-contrast enhanced whole-heart magnetic resonance coronary angiography (MRCA) alone and in combination with adenosine stress cardiac magnetic resonance imaging (CMR-Perf). MRCA has been proposed to allow for detection of coronary artery disease (CAD). Yet, recent studies failed to show an incremental value of MRCA when added to CMR-Perf.
  
  
  METHODS
  Non-Gadolinium 1.5-T contrast-enhanced, electrocardiogram-triggered, navigator-gated free-breathing MRCA was performed in 144 patients (pts) with suspected or known CAD. Accuracy of MRCA in detecting CAD was evaluated using X-ray coronary angiography as the reference. A novel algorithm was used to combine the results of MRCA and CMR-Perf.
  
  
  RESULTS
  MRCA was diagnostic in 96/144 pts (67%) with regular breathing (mean age 62.5 ± 13); 77% of all coronary segments (939/1226) and 92% of segments suitable for percutaneous coronary intervention (792/866) were assessable. In 59 pts a novel algorithm to combine MRCA and CMR-Perf was performed with high diagnostic performance: accuracy, sensitivity, specificity, negative and positive predictive values were 91.5% (54/59; 95% CI, 84%-99%), 95.7% (22/23; 77-100), 88.9% (32/36; 74-96), 84.6% (22/26; 71-99), and 97.0% (32/33; 91-100). Compared to the combined use of CMR-Perf and late gadolinium enhancement, specificity with the novel algorithm significantly increased (P = .008).
  
  
  CONCLUSIONS
  MRCA has a high assessability in segments suitable for percutaneous coronary intervention in pts with regular breathing. The combined use of MRCA and CMR-Perf improved specificity for the detection of significant CAD.
authors.affiliation: Agatharied Academic Teaching Hospital, University of Munich, Hausham, Germany. Electronic address: tobias.heer@khagatharied.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Heer
authors.forename: Stephanie
authors.initials: S
authors.lastname: Reiter
authors.forename: Berthold
authors.initials: B
authors.lastname: Höfling
authors.forename: Günter
authors.initials: G
authors.lastname: Pilz
mesh_terms: D000241:Adenosine; D000328:Adult; D000368:Aged; D000465:Algorithms; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis*; D005080:Exercise Test; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine