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Low-dose CT and cardiac MR for the diagnosis of coronary artery disease: accuracy of single and combined approaches

Scheffel, Hans ; Stolzmann, Paul ; Alkadhi, Hatem ; Azemaj, Naim ; Plass, André ; Baumueller, Stephan ; Desbiolles, Lotus ; Leschka, Sebastian ; Kozerke, Sebastian ; Falk, Volkmar ; Boesiger, Peter ; Wyss, Christophe ; Marincek, Borut ; Donati, Olivio

In: The International Journal of Cardiovascular Imaging, 2010, vol. 26, no. 5, p. 579-590

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    Titre
    • Low-dose CT and cardiac MR for the diagnosis of coronary artery disease: accuracy of single and combined approaches
    Auteur
    • Scheffel, Hans. Institute of Diagnostic Radiology, University Hospital Zurich, Raemistr 100, 8091, Zurich, Switzerland
    • Stolzmann, Paul. Institute of Diagnostic Radiology, University Hospital Zurich, Raemistr 100, 8091, Zurich, Switzerland
    • Alkadhi, Hatem. Institute of Diagnostic Radiology, University Hospital Zurich, Raemistr 100, 8091, Zurich, Switzerland
    • Azemaj, Naim. Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
    • Plass, André. Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
    • Baumueller, Stephan. Institute of Diagnostic Radiology, University Hospital Zurich, Raemistr 100, 8091, Zurich, Switzerland
    • Desbiolles, Lotus. Institute of Diagnostic Radiology, University Hospital Zurich, Raemistr 100, 8091, Zurich, Switzerland
    • Leschka, Sebastian. Institute of Diagnostic Radiology, University Hospital Zurich, Raemistr 100, 8091, Zurich, Switzerland
    • Kozerke, Sebastian. Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
    • Falk, Volkmar. Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
    • Boesiger, Peter. Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
    • Wyss, Christophe. Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland
    • Marincek, Borut. Institute of Diagnostic Radiology, University Hospital Zurich, Raemistr 100, 8091, Zurich, Switzerland
    • Donati, Olivio. Institute of Diagnostic Radiology, University Hospital Zurich, Raemistr 100, 8091, Zurich, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • The International Journal of Cardiovascular Imaging, 2010, vol. 26, no. 5, p. 579-590. Springer Netherlands
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:319796
    Summary
    To prospectively compare the diagnostic performance of low-dose computed tomography coronary angiography (CTCA) and cardiac magnetic resonance imaging (CMR) and combinations thereof for the diagnosis of significant coronary stenoses. Forty-three consecutive patients with known or suspected coronary artery disease underwent catheter coronary angiography (CA), dual-source CTCA with prospective electrocardiography-gating, and cardiac CMR (1.5Tesla). The following tests were analyzed: (1) low-dose CTCA, (2) adenosine stress-rest perfusion-CMR, (3) late gadolinium enhancement (LGE), (4) perfusion-CMR and LGE, (5) low-dose CTCA combined with perfusion-CMR, (5) low-dose CTCA combined with late gadolinium-enhancement, (6) low-dose CTCA combined with perfusion-CMR and LGE. CA served as the standard of reference. CA revealed >50% diameter stenoses in 68/129 (57.7%) coronary arteries in 29/43 (70%) patients. In the patient-based analysis, sensitivity, specificity, NPV and PPV of low-dose CTCA for the detection of significant stenoses were 100, 92.9, 100 and 96.7%, respectively. For perfusion-CMR and LGE, sensitivity, specificity, NPV, PPV, and accuracy were 89.7, 100, 82.4, and 100%, respectively. In the artery-based analysis, sensitivity and NPV of low-dose CTCA was significantly (P<0.05) higher than that of perfusion-CMR and LGE. All combinations of low-dose CTCA and perfusion-CMR and/or LGE did not improve the diagnostic performance when compared to low-dose CTCA alone. Taking CA as standard of reference, low-dose CTCA outperforms CMR with regard to sensitivity and NPV, whereas CMR is more specific and has a higher PPV than low-dose CTCA