CLINICAL RESEARCH: COMPARISON OF CARDIAC IMAGING
Head-to-Head Comparison of Three-Dimensional Navigator-Gated Magnetic Resonance Imaging and 16-Slice Computed Tomography to Detect Coronary Artery Stenosis in Patients
Joëlle Kefer, MD*,
Emmanuel Coche, MD ,
Gabin Legros, MD*,2,
Agnès Pasquet, MD*,
Cécile Grandin, MD,
Bernard E. Van Beers, MD,
Jean-Louis Vanoverschelde, MD, FACC* and
Bernhard L. Gerber, MD*,1,*
* Division of Cardiology, Cliniques Universitaires St. Luc UCL, Brussels, Belgium
Division of Radiology, Cliniques Universitaires St. Luc UCL, Brussels, Belgium
Manuscript received September 29, 2004;
revised manuscript received February 28, 2005,
accepted March 22, 2005.
* Reprint requests and correspondence: Dr. Bernhard L. Gerber, Department of Cardiology, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, B-1200 Woluwe St. Lambert, Belgium (Email: bernhard.gerber{at}clin.ucl.ac.be).
OBJECTIVES: The purpose of this research was to compare the diagnostic accuracy of three-dimensional navigator-gated magnetic resonance (MR) imaging and 16-slice multidetector row computed tomography (MDCT) versus quantitative coronary angiography (QCA) for the detection of coronary artery stenosis in patients.
BACKGROUND: Both MR and MDCT are novel non-invasive tests, which have been proposed for noninvasive detection of coronary artery disease. Yet their diagnostic accuracy has not been directly compared in the same population.
METHODS: Fifty-two patients underwent coronary MR and 16-slice MDCT before invasive coronary angiography. Diameter stenosis (DS) severity in vessels >1.5-mm reference diameter were graded visually and measured quantitatively on both MR and MDCT images. Diagnostic accuracy of both methods was compared using QCA as the reference test.
RESULTS: According to QCA, 81 of 452 (18%) coronary segments with >1.5 mm diameter had >50% DS. By visual analysis, MR and MDCT had similar sensitivity (75% vs. 82%, p = NS), specificity (77% vs. 79%, p = NS), and diagnostic accuracy (77%, vs. 80%, p = NS) for detection of >50 % DS. Quantitative measures of DS by MR (r = 0.60, p < 0.001) and MDCT (r = 0.75, both p < 0.001) correlated well with QCA. Receiver-operating characteristic analysis demonstrated that quantification of DS severity improved the diagnostic accuracy of MDCT (area under curve [AUC] 0.81 vs. 0.92, p < 0.001) but not that of MR (AUC 0.78 vs. 0.83, p = NS).
CONCLUSIONS: Visual assessment of coronary diameter stenosis severity by MR or MDCT allows identification of significant coronary artery disease with a similar high diagnostic accuracy. Quantitative analysis significantly further improves the diagnostic accuracy of MDCT but not that of MR.
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Abbreviations and Acronyms
| | CNR = contrast-to-noise ratio | | CT = computed tomography | | DS = diameter stenosis | | LAD = left anterior descending coronary artery | | LCx = left circumflex coronary artery | | LM = left main coronary artery | | MDCT = multidetector row computed tomography | | MLD = minimal luminal diameter | | MRI = magnetic resonance imaging | | QCA = quantitative coronary angiography | | RCA = right coronary artery | | RVD = reference vessel diameter |
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