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      MRI and CT in the diagnosis of coronary artery disease: indications and applications

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          Abstract

          In recent years, technical advances and improvements in cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI) have provoked increasing interest in the potential clinical role of these techniques in the non-invasive work-up of patients with suspected coronary artery disease (CAD) and correct patient selection for these emerging imaging techniques. In the primary detection or exclusion of significant CAD, e.g. in the patient with unspecific thoracic complaints, and also in patients with known CAD or advanced stages of CAD, both CT and MRI yield specific advantages. In this review, the major aspects of non-invasive MR and CT imaging in the diagnosis of CAD will be discussed. The first part describes the clinical value of contrast-enhanced non-invasive CT coronary angiography (CTCA), including the diagnostic accuracy of CTCA for the exclusion or detection of significant CAD with coronary artery stenoses that may require angioplastic intervention, as well as potentially valuable information on the coronary artery vessel wall. In the second section, the potential of CT for the imaging of myocardial viability and perfusion will be highlighted. In the third and final part, the range of applications of cardiac MRI in CAD patients will be outlined.

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          Magnetic resonance perfusion measurements for the noninvasive detection of coronary artery disease.

          With MRI, an index of myocardial perfusion reserve (MPRI) can be determined. We assessed the value of this technique for the noninvasive detection of coronary artery disease (CAD) in patients with suspected CAD. Eighty-four patients referred for a primary diagnostic coronary angiography were examined with a 1.5 T MRI tomograph (Philips-ACS). For each heartbeat, 5 slices were acquired during the first pass of 0.025 mmol gadolinium-diethylenetriamine pentaacetic acid/kg body weight before and during adenosine vasodilation by using a turbo-gradient echo/echo-planar imaging-hybrid sequence. MPRI was determined from the alteration of the upslope of the myocardial signal intensity curves for 6 equiangular segments per slice. Receiver operating characteristics were performed for different criteria to differentiate ischemic and nonischemic segments. Prevalence of CAD was 51%. Best results were achieved when only the 3 inner slices were assessed and a threshold value of 1.1 was used for the second smallest value as a marker for significant CAD. This approach yielded a sensitivity of 88%, specificity of 90%, and accuracy of 89%. The determination of MPRI with MRI yields a high diagnostic accuracy in patients with suspected CAD.
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            Diagnostic performance of stress cardiac magnetic resonance imaging in the detection of coronary artery disease: a meta-analysis.

            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). 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. 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 (> or =50% diameter stenosis); and 2) used catheter X-ray angiography as the reference standard. 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%). 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.
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              Radiation dose to patients from cardiac diagnostic imaging.

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                Author and article information

                Contributors
                +49-89-70953620 , +49-89-70958832 , konstantin.nikolaou@med.lmu.de
                Journal
                Insights Imaging
                Insights Imaging
                Insights into Imaging
                Springer-Verlag (Berlin/Heidelberg )
                1869-4101
                23 November 2010
                23 November 2010
                February 2011
                : 2
                : 1
                : 9-24
                Affiliations
                [1 ]Department of Clinical Radiology, University Hospitals Munich, Grosshadern Campus, Marchioninistr. 15, 81377 Munich, Germany
                [2 ]Institute of Diagnostic and Interventional Radiology, University Hospital, Zurich, Switzerland
                [3 ]Institute of Radiology, General Hospital, Saint Gall, Switzerland
                [4 ]University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, Toronto, Canada
                Article
                49
                10.1007/s13244-010-0049-0
                3259311
                22347932
                7474df42-a2e2-4726-b674-583cec83bbb2
                © European Society of Radiology 2010
                History
                : 30 August 2010
                : 27 September 2010
                : 19 October 2010
                Categories
                Review
                Custom metadata
                © European Society of Radiology 2011

                Radiology & Imaging
                ct,mri,coronary artery disease,diagnosis
                Radiology & Imaging
                ct, mri, coronary artery disease, diagnosis

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