Concordance and diagnostic accuracy of vasodilator stress cardiac MRI and 320-detector row coronary CTA

Abstract

Vasodilator stress cardiac magnetic resonance (CMR) detects ischemia whereas coronary CT angiography (CTA) detects atherosclerosis. The purpose of this study was to determine concordance and accuracy of vasodilator stress CMR and coronary CTA in the same subjects. We studied 151 consecutive subjects referred to detect or exclude suspected obstructive coronary artery disease (CAD) in patients without known disease or recurrent stenosis or ischemia in patients with previously treated CAD. Vasodilator stress CMR was performed on a 1.5 T scanner. CTA was performed on a 320-detector row system. Subjects were followed for cardiovascular events and downstream diagnostic testing. Subjects averaged 56 ± 12 years (60 % male), and 62 % had intermediate pre-test probability for obstructive CAD. Follow-up averaged 450 ± 115 days and was 100 % complete. CMR and CTA agreed in 92 % of cases (κ 0.81, p < 0.001). The event-free survival was 97 % for non-ischemic and 39 % for ischemic CMR (p < 0.0001). The event-free survival was 99 % for non-obstructive and 36 % for obstructive CTA (p < 0.0001). Using a reference standard including quantitative invasive angiography or major cardiovascular events, CMR and CTA had respective sensitivities of 93 and 98 %; specificities of 96 and 96 %; positive predictive values of 91 and 91 %; negative predictive values of 97 and 99 %; and accuracies of 95 and 97 %. Non-ischemic vasodilator stress CMR or non-obstructive coronary CTA were highly concordant and each confer an excellent prognosis. CMR and CTA are both accurate for assessment of obstructive CAD in a predominantly intermediate risk population.

The impact of small motion on the visualization of coronary vessels and lesions in cardiac CT: A simulation study

“…In numerous prospective clinical trials, coronary x-ray computed tomography angiography (CCTA) with ≥ 64slice scanners has demonstrated an excellent ability to rule out obstructive coronary artery disease with extremely high negative predictive value. 1,2 In addition, CCTA "markedly clarifies" the diagnosis of angina due to coronary heart disease and reduces the need for further stress testing, 3 and reduces patient time in the emergency department. 4,5 Furthermore, CT-derived Calcium Scores have proven far superior to all other biomarkers for predicting future major cardiac events.…”

Noninvasive Imaging for the Assessment of Coronary Artery Disease

“…Stress CMR showed no difference in diagnostic accuracy when compared to SPECT MPI for CAD detection [105]. The concordance and accuracy of stress CMR with 320-detector row CT, showed an excellent agreement (92%, kappa value = 0.81) in an intermediate risk cohort [106]. Adenosine perfusion was the most accurate component of the stress CMR study in predicting which patients had significant CAD, compared with resting WMA and LGE [107].…”

Comparative assessment of non-invasive imaging in detecting coronary artery disease

“…80 Comparing multidetector CCTA with other non-invasive imaging techniques, a meta-analysis by 81 showed that MSCT (4, 8 and 16-detectors) has higher diagnostic accuracy compared to CMR with sensitivity of 85% vs. 72% and specificity of 95% vs. 87%, respectively. Moreover, a recent single centre trial by Chen et al (2014) 82 showed comparable results; sensitivity; 93% vs. 98%, specificity; 96% vs. 96%, PPV; 91% vs. 91% and NPV; 97% vs. 99% for CMR and 320-detector CTA, respectively. Furthermore, a number of small studies compared MSCT with stress nuclear imaging have shown that MSCT has higher diagnostic accuracy.…”