title: Comparison of cardiovascular magnetic resonance and single-photon emission computed tomography in women with suspected coronary artery disease from the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease (CE-MARC) Trial.
abstract: BACKGROUND
  Coronary artery disease is the leading cause of death in women, and underdiagnosis contributes to the high mortality. This study compared the sex-specific diagnostic performance of cardiovascular magnetic resonance (CMR) and single-photon emission computed tomography (SPECT).
  
  
  RESULTS
  A total of 235 women and 393 men with suspected angina underwent CMR, SPECT, and x-ray angiography as part of the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease (CE-MARC) study. CMR comprised adenosine stress/rest perfusion, cine imaging, late gadolinium enhancement, and magnetic resonance coronary angiography. Gated adenosine stress/rest SPECT was performed with (99m)Tc-tetrofosmin. For CMR, the sensitivity in women and men was similar (88.7% versus 85.6%; P=0.57), as was the specificity (83.5% versus 82.8%; P=0.86). For SPECT, the sensitivity was significantly worse in women than in men (50.9% versus 70.8%; P=0.007), but the specificities were similar (84.1% versus 81.3%; P=0.48). The sensitivity in both the female and male groups was significantly higher with CMR than SPECT (P<0.0001 for both), but the specificity was similar (P=0.77 and P=1.00, respectively). For perfusion-only components, CMR outperformed SPECT in women (area under the curve, 0.90 versus 0.67; P<0.0001) and in men (area under the curve, 0.89 versus 0.74; P<0.0001). Diagnostic accuracy was similar in both sexes with perfusion CMR (P=1.00) but was significantly worse in women with SPECT (P<0.0001).
  
  
  CONCLUSIONS
  In both sexes, CMR has greater sensitivity than SPECT. Unlike SPECT, there are no significant sex differences in the diagnostic performance of CMR. These findings, plus an absence of ionizing radiation exposure, mean that CMR should be more widely adopted in women with suspected coronary artery disease.
  
  
  BACKGROUND
  http://www.controlled-trials.com. Unique identifier: ISRCTN77246133.
authors.affiliation: Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics (J.P.G., M.M., N.M., P.B., S.G.B., S.P.) and Clinical Trials Research Unit (J.M.B., C.C.E., J.N.), University of Leeds, Leeds, UK; and Department of Nuclear Cardiology, Leeds General Infirmary, Leeds, UK (C.J.D.).
authors.forename: John P
authors.initials: JP
authors.lastname: Greenwood
authors.forename: Manish
authors.initials: M
authors.lastname: Motwani
authors.forename: Neil
authors.initials: N
authors.lastname: Maredia
authors.forename: Julia M
authors.initials: JM
authors.lastname: Brown
authors.forename: Colin C
authors.initials: CC
authors.lastname: Everett
authors.forename: Jane
authors.initials: J
authors.lastname: Nixon
authors.forename: Petra
authors.initials: P
authors.lastname: Bijsterveld
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Dickinson
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Ball
authors.forename: Sven
authors.initials: S
authors.lastname: Plein
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005682:Gadolinium; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012737:Sex Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D005682:Gadolinium
keywords: magnetic resonance imaging; myocardial ischemia; tomography, emission-computed, single-photon; women