Assessment of Coronary Artery Disease Using Magnetic Resonance Coronary Angiography

• Published in: Journal of the American College of Cardiology 2010-09, Vol.56 (12), p.983-991
• Main Authors: Kato, Shingo, MD, Kitagawa, Kakuya, MD, Ishida, Nanaka, MD, Ishida, Masaki, MD, Nagata, Motonori, MD, Ichikawa, Yasutaka, MD, Katahira, Kazuhiro, MD, Matsumoto, Yuji, MD, Seo, Koji, MD, Ochiai, Reiji, MD, Kobayashi, Yasuyuki, MD, Sakuma, Hajime, MD
• Format: Article
• Language: English
• Subjects: Cardiovascular; coronary artery; coronary artery disease; Internal Medicine; magnetic resonance angiography; national multicenter trial
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2010.01.071

Objectives This national multicenter study determined the diagnostic performance of 1.5-T whole-heart coronary magnetic resonance angiography (MRA) in patients with suspected coronary artery disease (CAD). Background Whole-heart coronary MRA using steady-state free precession allows noninvasive detection of CAD without the administration of contrast medium. However, the accuracy of this approach has not been determined in a multicenter trial. Methods Using a 1.5-T magnetic resonance imaging unit, free-breathing steady-state free precession whole-heart coronary MRA images were acquired for 138 patients with suspected CAD at 7 hospitals. The accuracy of MRA for detecting a ≥50% reduction in diameter was determined using X-ray coronary angiography as the reference method. Results Acquisition of whole-heart coronary MRA images was performed in 127 (92%) of 138 patients with an average imaging time of 9.5 ± 3.5 min. The areas under the receiver-operator characteristic curve from MRA images according to vessel- and patient-based analyses were 0.91 (95% confidence interval [CI]: 0.87 to 0.95) and 0.87 (95% CI: 0.81 to 0.93), respectively. The sensitivity, specificity, positive and negative predictive values, and accuracy of MRA according to a patient-based analysis were 88% (49 of 56, 95% CI: 75% to 94%), 72% (51 of 71, 95% CI: 60% to 82%), 71% (49 of 69, 95% CI: 59% to 81%), 88% (51 of 58, 95% CI: 76% to 95%), and 79% (100 of 127, 95% CI: 72% to 86%), respectively. Conclusions Non–contrast-enhanced whole-heart coronary MRA at 1.5-T can noninvasively detect significant CAD with high sensitivity and moderate specificity. A negative predictive value of 88% indicates that whole-heart coronary MRA can rule out CAD.