title: Diagnostic accuracy of myocardial magnetic resonance perfusion to diagnose ischemic stenosis with fractional flow reserve as reference: systematic review and meta-analysis.
abstract: OBJECTIVE
  This paper systematically analyzed the performance of magnetic resonance (MR) perfusion to diagnose coronary artery disease (CAD) with fractional flow reserve (FFR) as the reference standard.
  
  
  BACKGROUND
  Myocardial MR perfusion has passed the stage of a research technique and has demonstrated the ability to detect functional or ischemic stenosis of coronary arteries. However, the evidence is limited to single-center studies and small sample sizes.
  
  
  METHODS
  We searched PubMed and Embase databases for all published studies that evaluated the accuracy of MR perfusion to diagnose CAD versus FFR. We used an exact binomial rendition of the bivariate mixed-effects regression model with test type as a random-effects covariate to synthesize the available data. Based on Bayes' theorem, the post-test probability was calculated to guide MR perfusion's clinical utility.
  
  
  RESULTS
  We identified 14 studies evaluating 1,073 arteries and 650 patients. The pooled sensitivity and specificity were 0.90 (95% confidence interval [CI]: 0.86 to 0.93) and 0.87 (95% CI: 0.82 to 0.90) at the patient level and 0.89 (95% CI: 0.83 to 0.92) and 0.86 (95% CI: 0.77 to 0.92) at the artery and territory levels, respectively. The area under the summary receiver-operating characteristic at the patient level was 0.95 (95% CI: 0.92 to 0.96) and 0.93 (95% CI: 0.91 to 0.95) at the artery and territory levels, respectively. MR perfusion could increase the post-test probability of CAD >80% in patients with a pre-test probability of >37% and can decrease post-test probability of CAD <20% with a pre-test probability of <72%.
  
  
  CONCLUSIONS
  With FFR as the reference standard, the diagnostic ability of MR perfusion to detect ischemic CAD is high.
authors.affiliation: Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China.
authors.forename: Min
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Zhou
authors.affiliation: Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China.
authors.forename: Lin-feng
authors.initials: LF
authors.lastname: Yang
authors.affiliation: Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China.
authors.forename: Zhao-hui
authors.initials: ZH
authors.lastname: Peng
authors.affiliation: Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Ding
authors.affiliation: Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China. Electronic address: cjr.sungang@vip.163.com.
authors.forename: Gang
authors.initials: G
authors.lastname: Sun
mesh_terms: D019540:Area Under Curve; D006328:Cardiac Catheterization; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology; D003331:Coronary Vessels / Q000503:physiopathology*; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008279:Magnetic Resonance Imaging; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results
keywords: cardiac perfusion; coronary artery disease; fractional flow reserve; magnetic resonance imaging