Diagnostic Performance and Clinical Utility of Myocardial Perfusion MRI for Coronary Artery Disease with Fractional Flow Reserve as the Standard Reference: A Meta-analysis.
BACKGROUND
Stress myocardial perfusion imaging is a noninvasive alternative to invasive fractional flow reserve for evaluating haemodynamically significant coronary artery disease. We aimed to systematically analyse the diagnostic performance and clinical utility of myocardial perfusion MRI for coronary artery disease (CAD) using fractional flow reserve (FFR) as the standard reference.


METHODS
We searched PubMed, EMBASE, and Cochrane Library to July 2015 for studies using perfusion MR as a diagnostic test for CAD versus FFR. The meta-analysis was performed based on Cochrane guideline.


RESULTS
We identified 20 studies with 1,570 patients. Pooled analyses were performed at per-patient level (1,041 patients) and per-territory level (2,690 coronary territories). The sensitivity, specificity, area under sROC curve were 0.88 (95% CI: 0.85, 0.91), 0.88 (95% CI: 0.84, 0.90), and 0.94 (95% CI: 0.92, 0.96) at per-patient level, and 0.86 (95% CI: 0.81, 0.90), 0.88 (95% CI: 0.84, 0.92), and 0.93 (95% CI: 0.91, 0.95) at per-territory level. Post-test probability was altered by positive (likelihood ratio) LR of 7.1 (95% CI: 5.6, 9.0) and negative LR of 0.13 (95% CI: 0.10, 0.17) based on Bayes' theorem.


CONCLUSIONS
Diagnostic accuracy of myocardial perfusion MRI for CAD is high and can alter the post-test probability of CAD.
Department of Radiology, Sir Yifu Hospital Affiliated with Nanjing Medical University, China.
Binghu
B
Jiang
Department of Cardiology, BenQ Medical Center, Nanjing Medical University, China.
Wei
W
Cai
Department of Interventional Radiology, BenQ Medical Center, Nanjing Medical University, China.
Xianjun
X
Lv
Department of Radiology, the Second Hospital of Hebei Medical University, China. Electronic address: huaijunliu2@126.com.
Huaijun
H
Liu
D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D009206:Myocardium
Coronary artery disease; Fractional flow reserve; Myocardial perfusion MR