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CARDIAC IMAGING

Diagnostic performance of coronary magnetic resonance angiography as compared against conventional x-ray angiography

A meta-analysis

Peter G. Danias, MD, PhD, FACC^*,,,*, Arkadios Roussakis, MD and John P.A. Ioannidis, MD^,||

^* *2nd Cardiology Clinic
Cardiac MRI Center, Hygeia Hospital, Athens, Greece; Department of Medicine
Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
Clinical Trials and Evidence-Based Medicine Unit and Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine and the Biomedical Research Institute, Foundation for Research and Technology-Hellas, Ioannina, Greece
^|| Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, MassachusettsUSA

Manuscript received September 21, 2003; revised manuscript received July 26, 2004, accepted July 29, 2004.

^* Reprint requests and correspondence: Dr. Peter G. Danias, Cardiac MR Center, Hygeia Hospital, 4 Erythrou Stavrou Street and Kifissias Avenue, Maroussi 15123, Greece (Email: pdanias{at}hygeia.gr).

OBJECTIVES: This study was designed to define the current role of coronary magnetic resonance angiography (CMRA) for the diagnosis of coronary artery disease (CAD).

BACKGROUND: Coronary magnetic resonance angiography has been proposed as a promising noninvasive method for diagnosis of CAD, but individual studies evaluating its clinical value have been of limited sample size.

METHODS: We identified all studies (MEDLINE and EMBASE) that evaluated CAD by both CMRA and conventional angiography in 10 subjects during the period 1991 to January 2004. We recorded true and false positive and true and false negative CMRA assessments for detection of CAD using X-ray angiography as the reference standard. Analysis was done at segment, vessel, and subject level.

RESULTS: We analyzed 39 studies (41 separate comparisons). Across 25 studies (27 comparisons) with data on 4,620 segments (993 subjects), sensitivity and specificity for detection of CAD were 73% and 86%, respectively. Vessel-level analyses (16 studies, 2,041 vessels) showed sensitivity 75% and specificity 85%. Subject-level analyses (13 studies, 607 subjects) showed sensitivity 88% and specificity 56%. At the segment level, sensitivity was 69% to 79% for all but the left circumflex (61%) coronary artery; specificity was 82% to 91%. There was considerable between-study heterogeneity, but weighted summary receiver-operating characteristic curves agreed with these estimates. There were no major differences between subgroups based on technical or population characteristics, year of publication, reported blinding, or sample size.

CONCLUSIONS: In evaluable segments of the native coronary arteries, CMRA has moderately high sensitivity for detecting significant proximal stenoses and may have value for exclusion of significant multivessel CAD in selected subjects considered for diagnostic catheterization.

Abbreviations and Acronyms   CAD = coronary artery disease   CMRA = coronary magnetic resonance angiography   SROC = summary receiver-operating characteristic   3D = three-dimensional   2D = two-dimensional

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