Noninvasive Detection of Coronary Artery Stenoses with Multislice Computed Tomography or Magnetic Resonance Imaging

19 September 2006 | Volume 145 Issue 6 | Pages 407-415

Background: Multislice computed tomography (CT) and magnetic resonance imaging (MRI) are the main candidates for noninvasive coronary angiography; however, multislice CT, unlike MRI, exposes patients to radiation and an iodinated intravenous contrast agent.

Objective: To compare the diagnostic accuracy of multislice CT and MRI for noninvasive detection of clinically significant coronary stenoses (50%).

Design: Prospective intention-to-diagnose study.

Setting: Single tertiary referral center, Berlin, Germany.

Patients: 129 consecutive patients with suspected coronary artery disease.

Interventions: Multislice CT and MRI were both performed within a median of 1 day before conventional coronary angiography, which served as the reference standard.

Measurements: Diagnostic performance of multislice CT and MRI.

Results: 129 patients completed the study. Altogether, 108 patients with 430 vessels could be examined with both multislice CT and MRI and were used for analysis. In the per-patient analysis, the sensitivity of multislice CT (92% [95% CI, 82% to 96%]) was significantly higher than that of MRI (74% [CI, 61% to 83%]; P = 0.013). The sensitivity for detecting clinically significant stenoses was 82% for multislice CT and 54% for MRI (P < 0.001). Specificity and negative predictive value of multislice CT and MRI in the per-vessel analysis were 90% versus 87% (P = 0.73) and 95% versus 90% (P = 0.032), respectively. The effective radiation dose used with multislice CT (mean, 12.3 mSv [SD, 1.4]) in a consecutive subgroup of 73 patients was not significantly different from that used with diagnostic cardiac catheterization (11.4 mSv [SD, 4.8]) (P = 0.169). Most patients (74%) indicated that they would prefer multislice CT for future diagnostic imaging (P < 0.001).

Limitations: This was a single-center study with 129 patients.

Conclusions: In patients referred for conventional coronary angiography, multislice CT compares favorably with MRI for noninvasive detection of coronary stenoses.

Editors' Notes Context A negative result on a noninvasive coronary artery imaging test could reduce the need for coronary angiography. Contribution The authors did 3 coronary artery imaging tests—multislice computed tomography (CT), magnetic resonance imaging (MRI), and conventional radiography (the reference standard)—in 108 patients with clinically suspected coronary artery disease (CAD). The likelihood ratios for positive test results were 14.4 for multislice CT and 18.8 for MRI. For negative test results, they were 0.08 for multislice CT and 0.16 for MRI. Implications These tests' potential value is to rule out CAD. Multislice CT is superior to MRI for this purpose, but neither test reliably excludes CAD if the pretest odds are high, as in typical angina pectoris. —The Editors

 

Author and Article Information

From Humboldt-Universität, Berlin, Germany.

Note: This paper was presented in part in abstract form (no. 1706CA-p) at the conference of the Radiological Society of North America, Chicago, Illinois, 27 November to 3 December 2004.

Acknowledgments: The authors thank the technicians of the 3 laboratories for facilitating the performance of the trial. The following investigators also helped collect the conventional angiographic data unless otherwise noted: Hans-Peter Dübel, MD; Volker Gliech, MD; Arne Kieback, MD; Eva Schönenberger, MD (conception and design); and Heinz Theres, MD.

Grant Support: The study was initiated by the investigators (investigator-sponsored study) and was supported in part by a grant from GE Healthcare (formerly Amersham Buchler), which covered the cost of the multislice CT and MRI examinations.

Potential Financial Conflicts of Interest: Dr. Dewey has received grant support from GE Healthcare (for the present study) and lecture fees from Toshiba Medical Systems. Dr. Dewey is a principal investigator of an ongoing multicenter study (CorE64) on multislice CT coronary angiography sponsored by Toshiba Medical Systems. Dr. Rogalla has received lecture fees from Toshiba Medical Systems. Dr. Hamm has received grant support from GE Healthcare (for the present study), Schering, Siemens Medical Solutions, GE Healthcare, and Toshiba Medical Systems, and lecture fees from Siemens Medical Solutions and Schering.

Requests for Single Reprints: Marc Dewey, MD, Department of Radiology, Charité Medical School, Humboldt-Universität zu Berlin, Schumannstrasse 20/21, 10117 Berlin, Germany; e-mail, marc.dewey{at}charite.de.

Current Author Addresses: Drs. Dewey, Teige, Schnapauff, Rogalla, Taupitz, and Hamm: Department of Radiology, Charité Medical School, Humboldt-Universität zu Berlin, Schumannstrasse 20/21, 10117 Berlin, Germany.

Drs. Laule, Borges, Baumann, and Rutsch: Department of Cardiology, Charité Medical School, Humboldt-Universität zu Berlin, Schumannstrasse 20/21, 10117 Berlin, Germany.

Dr. Wernecke and Ms. Schink: Department of Medical Statistics, Charité Medical School, Humboldt-Universität zu Berlin, Schumannstrasse 20/21, 10117 Berlin, Germany.

Author Contributions: Conception and design: M. Dewey, G. Baumann, W. Rutsch, B. Hamm.

Analysis and interpretation of the data: M. Dewey, F. Teige, D. Schnapauff, M. Laule, A.C. Borges, K.-D. Wernecke, T. Schink, P. Rogalla, M. Taupitz.

Drafting of the article: M. Dewey.

Critical revision of the article for important intellectual content: F. Teige, D. Schnapauff, M. Laule, A.C. Borges, K.-D. Wernecke, T. Schink, G. Baumann, W. Rutsch, P. Rogalla, M. Taupitz, B. Hamm.

Final approval of the article: M. Dewey, F. Teige, D. Schnapauff, M. Laule, A.C. Borges, K.-D. Wernecke, T. Schink, G. Baumann, W. Rutsch, M. Taupitz, B. Hamm.

Statistical expertise: M. Dewey, K.-D. Wernecke, T. Schink.

Obtaining of funding: M. Dewey, B. Hamm.

Administrative, technical, or logistic support: F. Teige, D. Schnapauff.

Collection and assembly of data: M. Dewey, F. Teige, D. Schnapauff.

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