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Diagnostic accuracy of magnetic resonance angiography for detection of coronary artery disease: a systematic review and meta-analysis

  • Magnetic Resonance
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Abstract

Objectives

To review the diagnostic performance of MR coronary angiography (MRCA) for coronary artery disease (CAD).

Methods

Two independent reviewers searched on MEDLINE/EMBASE with the following inclusion criteria: 01/01/2000-03/23/2015 publication date; per-patient sensitivity/specificity for >50 % stenosis confirmed by conventional coronary angiography with raw data provided or retrievable; sample size >10. Quality was appraised using QUADAS2.

Results

Nine hundred eighteen studies were retrieved, 24 of them, including 1,638 patients, were selected. Using a bivariate model, the pooled sensitivity was 89 % (95 % confidence interval 86–92 %), the pooled specificity 72 % (63–79 %). Meta-regression did not show a significant impact on sensitivity/specificity for both year of publication and disease prevalence (p ≥ 0.114). Sensitivity of contrast-enhanced examinations (95 %, 90–97 %) was higher (p = 0.005) than that of unenhanced examinations (87 %, 83–90 %). Specificity of whole-heart acquisition mode (78 %, 72–84 %) was higher (p = 0.006) than that of targeted mode (57 %, 45–69 %). Specificity at 3 T (83 %, 69–92 %) was higher (p = 0.067) than that at 1.5 T (68 %, 60–76 %). Risk of bias and concerns regarding applicability were low.

Conclusions

Sensitivity and specificity of MRCA for CAD were 89 % and 72 %, respectively. A specificity higher than 80 % may be obtained at 3 T. Whole-heart contrast-enhanced protocols should be preferred for a higher diagnostic performance.

Key Points

• MRCA sensitivity and specificity for CAD are below those of CTA.

• Contrast administration increased sensitivity to 95 % (90–97 %), comparable with that of CTA.

• Whole-heart mode increased specificity to 78 % (72–84 %), comparable with that of CTA.

• Specificity at 3 T was borderline-significantly higher (p = 0.067) than at 1.5 T.

• Whole-heart contrast-enhanced protocols are the best approach for MRCA.

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Acknowledgments

This work has been conducted within the framework of the Network for the Assessment of Imaging in Medicine (EuroAIM), research platform of the European Institute for Biomedical Research (http://www.eibir.org/scientific-activities/joint-initiatives/euroaim/). The scientific guarantor of this publication is Francesco Sardanelli. The authors of this manuscript declare relationships with the following companies: Bracco Imaging SpA and Bayer Healthcare AG. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was not required because this manuscript is a systematic review. Written informed consent was not required for this study because this manuscript is a systematic review. Methodology: systematic review.

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Authors and Affiliations

  1. Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097, San Donato Milanese, Italy

    Giovanni Di Leo, Francesco Secchi, Luca Maria Sconfienza & Francesco Sardanelli

  2. Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Genova, Via G.B. Alberti 4, 16132, Genova, Italy

    Erica Fisci

  3. PhD Course in Integrative Biomedical Research, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy

    Francesco Secchi & Marco Alì

  4. Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Vanzetti 5, 20133, Milan, Italy

    Federico Ambrogi

  5. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, via Morandi 30, 20097, San Donato Milanese, Italy

    Luca Maria Sconfienza & Francesco Sardanelli

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  1. Giovanni Di Leo
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  2. Erica Fisci
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Correspondence to Giovanni Di Leo.

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Di Leo, G., Fisci, E., Secchi, F. et al. Diagnostic accuracy of magnetic resonance angiography for detection of coronary artery disease: a systematic review and meta-analysis. Eur Radiol 26, 3706–3718 (2016). https://doi.org/10.1007/s00330-015-4134-0

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  • DOI: https://doi.org/10.1007/s00330-015-4134-0

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