Assessment of Coronary Artery Disease Using Magnetic Resonance Coronary Angiography A National Multicenter Trial

OBJECTIVES: This national multicenter study determined the diagnostic performance of 1.5-T whole-heart coronary magnetic resonance angiography (MRA) in patients with suspected coronary artery disease (CAD). Whole-heart coronary MRA using steady-state free precession allows noninvasive detection of CAD without the administration of contrast medium. However, the accuracy of this approach has not been determined in a multicenter trial.

METHODS: Using a 1.5-T magnetic resonance imaging unit, free-breathing steady-state free precession whole-heart coronary MRA images were acquired for 138 patients with suspected CAD at 7 hospitals. The accuracy of MRA for detecting a ≥50% reduction in diameter was determined using X-ray coronary angiography as the reference method.

RESULTS: Acquisition of whole-heart coronary MRA images was performed in 127 (92%) of 138 patients with an average imaging time of 9.5 ± 3.5 min. The areas under the receiver-operator characteristic curve from MRA images according to vessel- and patient-based analyses were 0.91 (95% confidence interval [CI]: 0.87 to 0.95) and 0.87 (95% CI: 0.81 to 0.93), respectively. The sensitivity, specificity, positive and negative predictive values, and accuracy of MRA according to a patient-based analysis were 88% (49 of 56, 95% CI: 75% to 94%), 72% (51 of 71, 95% CI: 60% to 82%), 71% (49 of 69, 95% CI: 59% to 81%), 88% (51 of 58, 95% CI: 76% to 95%), and 79% (100 of 127, 95% CI: 72% to 86%), respectively.

CONCLUSIONS: Non–contrast-enhanced whole-heart coronary MRA at 1.5-T can noninvasively detect significant CAD with high sensitivity and moderate specificity. A negative predictive value of 88% indicates that whole-heart coronary MRA can rule out CAD. Alex Redmond Jersey

PMID:

Posted in Magnetic Resonance Imaging and tagged , , , .

3 Comments

  1. Very interesting study! Nicely illustrated! The authors write: “The use of a patient-specific acquisition window in the cardiac cycle can provide optimal temporal resolution for each patient, allowing the acquisition of diagnostic coronary MR images without the administration of beta-blockers, even in patients with a high HR (70 beats/min).” One variable that is not mentioned is the impact of arrhythmia and/or ectopic beats on this multi-segment acquisition which can sometimes be overcome on CT by analyzing additional cardiac phases when acquired retrospectively.

  2. See also:

    Motonori Nagata, Shingo Kato, Kakuya Kitagawa, Nanaka Ishida, Hiroshi Nakajima, Shiro Nakamori, Masaki Ishida, Masatoshi Miyahara, Masaaki Ito, and Hajime Sakuma.
    Radiology 2011;259 384-392.

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