STATE-OF-THE-ART PAPER
Clinical utility of computed tomography and magnetic resonance techniques for noninvasive coronary angiography
Matthew J. Budoff, MD*,*,
Stephan Achenbach, MD and
Andre Duerinckx, MD
* Division of Cardiology, Saint John's Cardiovascular Research Center, Harbor–UCLA Medical Center Research and Education Institute, Torrance, California, USA
Department of Internal Medicine II, University of Erlangen-Nuremberg, Erlangen, Germany
Division of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
Manuscript received February 25, 2003;
revised manuscript received June 26, 2003,
accepted July 1, 2003.
* Reprint requests and correspondence: Dr. Matthew J. Budoff, Harbor–UCLA Research and Education Institute, 1124 W. Carson Street, RB2, Torrance, California 90502, USA.
Budoff{at}flash.net
OBJECTIVES: The purpose of this study was to provide a comprehensive review of the literature relating to electron beam angiography (EBA), magnetic resonance angiography, and spiral computed tomography, currently the three most promising noninvasive methods to visualize obstructions in the coronary tree.
BACKGROUND: Given the high costs and invasiveness of coronary angiography, there is increased interest in noninvasive coronary angiography, which has made great strides to become a clinically useful tool to augment conventional coronary angiography (CCA).
METHODS: MEDLINE searches were performed to include all articles related to noninvasive angiography utilizing either magnetic resonance imaging (MRI), multi-row detector spiral computed tomography (MDCT), and electron beam tomography (EBT). Weighted analysis was performed to define the published sensitivity and specificity for each technique.
RESULTS: Electron beam angiography (EBA) provides an overall sensitivity of 87% and specificity of 91% for the detection of obstructive coronary artery disease (CAD). Four-level MDCT data demonstrated an overall sensitivity of 59% and specificity of 89%, with higher accuracy in two recent studies of 16-level detector devices. Magnetic resonance angiography demonstrated sensitivity for detection of obstructive CAD of 77% and specificity of 71%.
CONCLUSIONS: Noninvasive coronary angiography is a rapidly developing technique and currently not an alternative to CCA in all cases. All three methods are currently used clinically in certain centers with appropriate expertise. Selective use should prove both cost-effective and provide a safer, less-invasive method for patients to determine the need for medical versus revascularization therapy.
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Abbreviations and Acronyms
| | 3D | = three-dimensional | | CABG | = coronary artery bypass graft | | CAC | = coronary artery calcifications | | CAD | = coronary artery disease | | CCA | = conventional coronary angiography | | CT | = computed tomography | | EBA | = electron-beam angiography | | EBT | = electron-beam tomography | | ECG | = electrocardiographic | | HR | = heart rate | | MDCT | = multi-row-detector spiral computed tomography | | MRA | = magnetic resonance angiography | | MRI | = magnetic resonance imaging |
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