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

Greenwood, John P; Motwani, Manish; Maredia, Neil; Brown, Julia; Everett, Colin; Nixon, John; Bijsterveld, Petra; Dickinson, Catherine J; Ball, Stephen G.; Plein, Sven

doi:10.1161/circulationaha.112.000071

Cited by 149 publications

(78 citation statements)

References 34 publications

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“…False‐negative MR studies are difficult to identify and evaluate, in part due to the large number of patients required for such an analysis and the lack of a consistent reference standard applied to patients with negative noninvasive imaging, with potential for patient selection bias in clinical populations. The Clinical Evaluation of MAgnetic Resonance imaging in Coronary artery disease (CE‐MARC) study prospectively enrolled 752 patients with suspected CHD, providing a large and homogenous patient population for subanalyses 8, 9. All patients in CE‐MARC were scheduled to undergo MR and myocardial perfusion scintigraphy using single photon‐emission computed tomography (SPECT) (in a randomized order) plus radiographic coronary angiography,10 and the study was notable in having both a large study population and a consistent reference standard applied to all patients, including those with negative noninvasive imaging.…”

mentioning

confidence: 99%

Factors associated with false‐negative cardiovascular magnetic resonance perfusion studies: A Clinical evaluation of magnetic resonance imaging in coronary artery disease (CE‐MARC) substudy

Kidambi

Sourbron

Maredia

et al. 2015

Magnetic Resonance Imaging

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PurposeTo examine factors associated with false‐negative cardiovascular magnetic resonance (MR) perfusion studies within the large prospective Clinical Evaluation of MR imaging in Coronary artery disease (CE‐MARC) study population. Myocardial perfusion MR has excellent diagnostic accuracy to detect coronary heart disease (CHD). However, causes of false‐negative MR perfusion studies are not well understood.Materials and MethodsCE‐MARC prospectively recruited patients with suspected CHD and mandated MR, myocardial perfusion scintigraphy, and invasive angiography. This subanalysis identified all patients with significant coronary stenosis by quantitative coronary angiography (QCA) and MR perfusion (1.5T, T 1‐weighted gradient echo), using the original blinded image read. We explored patient and imaging characteristics related to false‐negative or true‐positive MR perfusion results, with reference to QCA. Multivariate regression analysis assessed the likelihood of false‐negative MR perfusion according to four characteristics: poor image quality, triple‐vessel disease, inadequate hemodynamic response to adenosine, and Duke jeopardy score (angiographic myocardium‐at‐risk score).ResultsIn all, 265 (39%) patients had significant angiographic disease (mean age 62, 79% male). Thirty‐five (5%) had false‐negative and 230 (34%) true‐positive MR perfusion. Poor MR perfusion image quality, triple‐vessel disease, and inadequate hemodynamic response were similar between false‐negative and true‐positive groups (odds ratio, OR [95% confidence interval, CI]: 4.1 (0.82–21.0), P = 0.09; 1.2 (0.20–7.1), P = 0.85, and 1.6 (0.65–3.8), P = 0.31, respectively). Mean Duke jeopardy score was significantly lower in the false‐negative group (2.6 ± 1.7 vs. 5.4 ± 3.0, OR 0.34 (0.21–0.53), P < 0.0001).ConclusionFalse‐negative cardiovascular MR perfusion studies are uncommon, and more common in patients with lower angiographic myocardium‐at‐risk. In CE‐MARC, poor image quality, triple‐vessel disease, and inadequate hemodynamic response were not significantly associated with false‐negative MR perfusion. J. MAGN. RESON. IMAGING 2016;43:566–573.

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confidence: 99%

Factors associated with false‐negative cardiovascular magnetic resonance perfusion studies: A Clinical evaluation of magnetic resonance imaging in coronary artery disease (CE‐MARC) substudy

Kidambi

Sourbron

Maredia

et al. 2015

Magnetic Resonance Imaging

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“…34 The Clinical Evaluation of MRI in Coronary Heart Disease study confirmed a higher sensitivity with cMRI than was found with SPECT, independent of the patient's gender. 35 Subanalysis of the original study indicated that cMRI is a cost-effective test and supported more widespread use of the modality. 36 Direct comparison to SPECT further benefits cMRI for its lack of ionizing radiation dose and higher spatial resolution.…”

Section: Cardiac Mr Perfusion Imagingmentioning

confidence: 99%

Cardiac CT for myocardial ischaemia detection and characterization—comparative analysis

Bucher¹,

Cecco²,

Schoepf³

et al. 2014

BJR

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The assessment of patients presenting with symptoms of myocardial ischaemia remains one of the most common and challenging clinical scenarios faced by physicians. Current imaging modalities are capable of three-dimensional, functional and anatomical views of the heart and as such offer a unique contribution to understanding and managing the pathology involved. Evidence has accumulated that visual anatomical coronary evaluation does not adequately predict haemodynamic relevance and should be complemented by physiological evaluation, highlighting the importance of functional assessment. Technical advances in CT technology over the past decade have progressively moved cardiac CT imaging into the clinical workflow. In addition to anatomical evaluation, cardiac CT is capable of providing myocardial perfusion parameters. A variety of CT techniques can be used to assess the myocardial perfusion. The single energy firstpass CT and dual energy first-pass CT allow static assessment of myocardial blood pool. Dynamic cardiac CT imaging allows quantification of myocardial perfusion through time-resolved attenuation data. CT-based myocardial perfusion imaging (MPI) is showing promising diagnostic accuracy compared with the current reference modalities. The aim of this review is to present currently available myocardial perfusion techniques with a focus on CT imaging in light of recent clinical investigations. This article provides a comprehensive overview of currently available CT approaches of static and dynamic MPI and presents the results of corresponding clinical trials.

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“…12,13 Even with these improvements, the fundamental deficiencies of the Anger camera remain, namely low detector sensitivity and the requirement for photo-multiplication. Solid-state technology has brought improvements that promise to rejuvenate SPECT imaging in general both for cardiac and now for non-cardiac applications.…”

Section: Advances In Spect Technologymentioning

confidence: 99%

“…In the setting of globally reduced perfusion, this may not be the case and global inducible ischemia can be underestimated or in rare cases may not be apparent at all. These disadvantages may explain in part the performance of SPECT MPS in modern comparisons with other techniques such as CMR 12 and fractional flow reserve. 5 Positron emission tomography (PET) MPS has many of the virtues of SPECT and it is often considered to be superior because of its spatial resolution and the ability to quantify perfusion in absolute terms.…”

Section: Introductionmentioning

confidence: 99%

PET should not replace routine SPECT MPS for the assessment of patients with known or suspected CAD

Stirrup

Underwood

2017

Journal of Nuclear Cardiology

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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

Cited by 149 publications

References 34 publications

Factors associated with false‐negative cardiovascular magnetic resonance perfusion studies: A Clinical evaluation of magnetic resonance imaging in coronary artery disease (CE‐MARC) substudy

Factors associated with false‐negative cardiovascular magnetic resonance perfusion studies: A Clinical evaluation of magnetic resonance imaging in coronary artery disease (CE‐MARC) substudy

Cardiac CT for myocardial ischaemia detection and characterization—comparative analysis

PET should not replace routine SPECT MPS for the assessment of patients with known or suspected CAD

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