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Direct Comparison of Cardiac Magnetic Resonance and Multidetector Computed Tomography Stress-Rest Perfusion Imaging for Detection of Coronary Artery Disease

2013; Elsevier BV; Volume: 61; Issue: 10 Linguagem: Inglês

10.1016/j.jacc.2012.12.020

1558-3597

Nuno Bettencourt, Amedeo Chiribiri, Andreas Schuster, Nuno Ferreira, Francisco Sampaio, Gustavo Pires‐Morais, Lino Santos, Bruno Melica, Alberto Rodrigues, Pedro Braga, Luís Filipe Azevedo, Madalena Teixeira, Adelino Leite‐Moreira, José Silva‐Cardoso, Eike Nagel, Vasco Gama,

Advanced X-ray and CT Imaging

This study sought to compare the diagnostic performance of a multidetector computed tomography (MDCT) integrated protocol (IP) including coronary angiography (CTA) and stress-rest perfusion (CTP) with cardiac magnetic resonance myocardial perfusion imaging (CMR-Perf) for detection of functionally significant coronary artery disease (CAD). MDCT stress-rest perfusion methods were recently described as adjunctive tools to improve CTA accuracy for detection of functionally significant CAD. However, only a few studies compared these MDCT-IP with other clinically validated perfusion techniques like CMR-Perf. Furthermore, CTP has never been validated against the invasive reference standard, fractional flow reserve (FFR), in patients with suspected CAD. 101 symptomatic patients with suspected CAD (62 ± 8.0 years, 67% males) and intermediate/high pre-test probability underwent MDCT, CMR and invasive coronary angiography. Functionally significant CAD was defined by the presence of occlusive/subocclusive stenoses or FFR measurements ≤0.80 in vessels >2mm. On a patient-based model, the MDCT-IP had a sensitivity, specificity, positive and negative predictive values of 89%, 83%, 80% and 90%, respectively (global accuracy 85%). These results were closely related with those achieved by CMR-Perf: 89%, 88%, 85% and 91%, respectively (global accuracy 88%). When comparing test accuracies using noninferiority analysis, differences greater than 11% in favour of CMR-Perf can be confidently excluded. MDCT protocols integrating CTA and stress-rest perfusion detect functionally significant CAD with similar accuracy as CMR-Perf. Both approaches yield a very good accuracy. Integration of CTP and CTA improves MDCT performance for the detection of relevant CAD in intermediate to high pre-test probability populations.