Coronary MRI Good Alternative to SPECT for CHD Diagnosis

Cardiovascular MR has better sensitivity, negative predictive value than single-photon emission CT

MONDAY, Dec. 26 (HealthDay News) -- For patients with suspected coronary heart disease, a multiparametric cardiovascular magnetic resonance (CMR) protocol has better sensitivity and negative predictive value, and similar specificity as single-photon emission computed tomography (SPECT), according to a study published online Dec. 23 in The Lancet.

John P. Greenwood, Ph.D., from the Multidisciplinary Cardiovascular Research Centre in Leeds, U.K., and colleagues evaluated the diagnostic accuracy of a multiparametric CMR protocol, and compared CMR with SPECT in patients with suspected angina pectoris and at least one cardiovascular risk factor. CMR, SPECT, and invasive X-ray coronary angiography were performed on 752 participants. Cine imaging, rest and adenosine stress perfusion, late gadolinium enhancement, and MR coronary angiography comprised the CMR protocol. CMR diagnostic accuracy, based on X-ray coronary angiography as the reference standard, was the primary outcome measured.

The investigators found that X-ray angiography identified significant CHD in 39 percent of the participants. The sensitivity, specificity, positive predictive, and negative predictive values of multiparametric CMR were 86.5, 83.4, 77.2, and 90.5 percent, respectively. The sensitivity, specificity, positive predictive, and negative predictive values of SPECT were 66.5, 82.6, 71.4, and 79.1 percent, respectively. There were significant differences between CMR and SPECT sensitivities and negative predictive values, but not significant differences for specificities and positive predictive values.

"This trial has shown that, in a large population with suspected angina pectoris, CMR is an alternative to SPECT for the detection of clinically significant coronary heart disease, with better sensitivity and negative predictive values," the authors write.

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