This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2007.06.030v1 50/14/1343    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (6) Citing Articles via Google Scholar Google Scholar Articles by Nandalur, K. R. Articles by Carlos, R. C. Search for Related Content PubMed Articles by Nandalur, K. R. Articles by Carlos, R. C.

CLINICAL RESEARCH: CARDIAC IMAGING

Diagnostic Performance of Stress Cardiac Magnetic Resonance Imaging in the Detection of Coronary Artery Disease

A Meta-Analysis

Kiran R. Nandalur, MD^_*,_*, Ben A. Dwamena, MD^_*,, Asim F. Choudhri, MD, Mohan R. Nandalur, MD and Ruth C. Carlos, MD, MS^_*

^_* Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
Department of Nuclear Medicine, Veterans Affairs, Ann Arbor Health Care System, Ann Arbor, Michigan
Department of Radiology, University of Virginia Health System, Charlottesville, Virginia
Department of Cardiovascular Medicine, Georgetown University/Washington Hospital Center, Washington, DC.

Manuscript received February 23, 2007; revised manuscript received May 9, 2007, accepted June 25, 2007.

^_* Reprint requests and correspondence: Dr. Kiran Nandalur, William Beaumont Hospital, 3601 W. Thirteen Mile Road, Royal Oak, Michigan 48073. (Email: nandalurk{at}yahoo.com).

Objectives: The purpose of our study was to conduct an evidence-based evaluation of stress cardiac magnetic resonance imaging (MRI) in the diagnosis of coronary artery disease (CAD).

Background: Stress cardiac MRI has recently emerged as a noninvasive method in the detection of CAD, with 2 main techniques in use: 1) perfusion imaging; and 2) stress-induced wall motion abnormalities imaging.

Methods: We examined studies from January 1990 to January 2007 using MEDLINE and EMBASE. A study was included if it: 1) used stress MRI as a diagnostic test for CAD (50% diameter stenosis); and 2) used catheter X-ray angiography as the reference standard.

Results: Thirty-seven studies (2,191 patients) met the inclusion criteria, with 14 datasets (754 patients) using stress-induced wall motion abnormalities imaging and 24 datasets (1,516 patients) using perfusion imaging. Stress-induced wall motion abnormalities imaging demonstrated a sensitivity of 0.83 (95% confidence interval [CI] 0.79 to 0.88) and specificity of 0.86 (95% CI 0.81 to 0.91) on a patient level (disease prevalence = 70.5%). Perfusion imaging demonstrated a sensitivity of 0.91 (95% CI 0.88 to 0.94) and specificity of 0.81 (95% CI 0.77 to 0.85) on a patient level (disease prevalence = 57.4%).

Conclusions: In studies with high disease prevalence, stress cardiac MRI, using either technique, demonstrates overall good sensitivity and specificity for the diagnosis of CAD. However, limited data are available regarding use of either technique in populations with low disease prevalence.

Abbreviations and Acronyms   CAD = coronary artery disease   LR = likelihood ratio   MRI = magnetic resonance imaging   SPECT = single-photon emission tomography

This article has been cited by other articles:

				T. D. Karamitsos, J. M. Francis, S. Myerson, J. B. Selvanayagam, and S. Neubauer The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure J. Am. Coll. Cardiol., October 6, 2009; 54(15): 1407 - 1424. [Abstract] [Full Text] [PDF]

				M. Salerno and G. A. Beller Noninvasive Assessment of Myocardial Perfusion Circ Cardiovasc Imaging, September 1, 2009; 2(5): 412 - 424. [Full Text] [PDF]

				A. Saraste, S. G. Nekolla, and M. Schwaiger Cardiovascular molecular imaging: an overview Cardiovasc Res, September 1, 2009; 83(4): 643 - 652. [Abstract] [Full Text] [PDF]

				D. C. Lee and N. P. Johnson Quantification of Absolute Myocardial Blood Flow by Magnetic Resonance Perfusion Imaging J. Am. Coll. Cardiol. Img., June 1, 2009; 2(6): 761 - 770. [Abstract] [Full Text] [PDF]

				C. Doesch, A. Seeger, J. Doering, C. Herdeg, C. Burgstahler, C. D. Claussen, M. Gawaz, S. Miller, and A. E. May Risk Stratification by Adenosine Stress Cardiac Magnetic Resonance in Patients With Coronary Artery Stenoses of Intermediate Angiographic Severity J. Am. Coll. Cardiol. Img., April 1, 2009; 2(4): 424 - 433. [Abstract] [Full Text] [PDF]

				R. J. Gibbons, P. A. Araoz, and E. E. Williamson The year in cardiac imaging. J. Am. Coll. Cardiol., January 6, 2009; 53(1): 54 - 70. [Full Text] [PDF]

				B. L. Gerber MR perfusion imaging. What will be its impact for detection of coronary disease in the future? Eur. Heart J., February 2, 2008; 29(4): 434 - 435. [Full Text] [PDF]

				A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, P. Clopton, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, J. D. Knoke, W. Y.W. Lew, J. A.C. Lima, et al. Highlights of the year in JACC 2007. J. Am. Coll. Cardiol., January 29, 2008; 51(4): 490 - 512. [Full Text] [PDF]