title: Diagnostic accuracy of magnetic resonance angiography for detection of coronary artery disease: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To review the diagnostic performance of MR coronary angiography (MRCA) for coronary artery disease (CAD).
  
  
  METHODS
  Two independent reviewers searched on MEDLINE/EMBASE with the following inclusion criteria: 01/01/2000-03/23/2015 publication date; per-patient sensitivity/specificity for >50 % stenosis confirmed by conventional coronary angiography with raw data provided or retrievable; sample size >10. Quality was appraised using QUADAS2.
  
  
  RESULTS
  Nine hundred eighteen studies were retrieved, 24 of them, including 1,638 patients, were selected. Using a bivariate model, the pooled sensitivity was 89 % (95 % confidence interval 86-92 %), the pooled specificity 72 % (63-79 %). Meta-regression did not show a significant impact on sensitivity/specificity for both year of publication and disease prevalence (p ≥ 0.114). Sensitivity of contrast-enhanced examinations (95 %, 90-97 %) was higher (p = 0.005) than that of unenhanced examinations (87 %, 83-90 %). Specificity of whole-heart acquisition mode (78 %, 72-84 %) was higher (p = 0.006) than that of targeted mode (57 %, 45-69 %). Specificity at 3 T (83 %, 69-92 %) was higher (p = 0.067) than that at 1.5 T (68 %, 60-76 %). Risk of bias and concerns regarding applicability were low.
  
  
  CONCLUSIONS
  Sensitivity and specificity of MRCA for CAD were 89 % and 72 %, respectively. A specificity higher than 80 % may be obtained at 3 T. Whole-heart contrast-enhanced protocols should be preferred for a higher diagnostic performance.
  
  
  CONCLUSIONS
  • MRCA sensitivity and specificity for CAD are below those of CTA. • Contrast administration increased sensitivity to 95 % (90-97 %), comparable with that of CTA. • Whole-heart mode increased specificity to 78 % (72-84 %), comparable with that of CTA. • Specificity at 3 T was borderline-significantly higher (p = 0.067) than at 1.5 T. • Whole-heart contrast-enhanced protocols are the best approach for MRCA.
authors.affiliation: Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097, San Donato Milanese, Italy. gianni.dileo77@gmail.com.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Leo
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Genova, Via G.B. Alberti 4, 16132, Genova, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Fisci
authors.affiliation: Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097, San Donato Milanese, Italy.|PhD Course in Integrative Biomedical Research, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Secchi
authors.affiliation: PhD Course in Integrative Biomedical Research, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Alì
authors.affiliation: Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Vanzetti 5, 20133, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Ambrogi
authors.affiliation: Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097, San Donato Milanese, Italy.|Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, via Morandi 30, 20097, San Donato Milanese, Italy.
authors.forename: Luca Maria
authors.initials: LM
authors.lastname: Sconfienza
authors.affiliation: Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097, San Donato Milanese, Italy.|Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, via Morandi 30, 20097, San Donato Milanese, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
mesh_terms: D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media
keywords: Coronary angiography; Coronary artery disease; Diagnostic accuracy; Magnetic resonance imaging; Meta-analysis