Diagnostic performance of combined cardiac MRI for detection of coronary artery disease

ObjectiveTo evaluate the diagnostic performance of stress perfusion cardiac MR (CMR) for detecting significant CAD (≥70% narrowing) in comparison with invasive coronary angiography (ICA) as a reference standard.MethodsExaminations of 54 patients who underwent both stress perfusion CMR and ICA for investigation of CAD between 2007 and 2009 were evaluated. The CMR protocol included dipyridamole stress and rest perfusion, stress and rest cine MRI for assessment of ventricular function and delayed gadolinium enhancement for assessment of myocardial viability and detection of infarction. CMR interpretation was performed by 2 observers blinded to the results of ICA and the clinical history.ResultsFrom a total of 54 patients, 37 (68.5%) showed significant CAD in 71 coronary territories. A perfusion defect was detected in 35 patients and in 69 coronary territories. Individual stress perfusion CMR evaluation showed the highest accuracy (83%) of the CMR techniques. The combined analysis using all sequences increased the overall accuracy of CMR to 87%.ConclusionCombination of perfusion and cine-MR during stress/rest, associated to delayed enhancement in the same protocol improves CMRI diagnostic accuracy and sensitivity for patients with significant coronary stenosis, and may therefore be helpful for risk stratification and defining treatment strategies.

► In this study, we evaluated the accuracy of a Combined CMR protocol in the detection of significant CAD. ► The invasive coronary angiography was the reference standard. ► Results obtained in our study indicate that combination of perfusion and cine-MR during stress/rest, associated to delayed enhancement in the same protocol improves CMRI diagnostic accuracy and sensitivity for patients with significant coronary stenosis. ► The Combined CMR protocol may therefore be helpful for risk stratification and defining treatment strategies.