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A clinical strategy to improve the diagnostic accuracy of 1.5-T non-contrast MR coronary angiography for detection of coronary artery disease: combination of whole-heart and volume-targeted imaging

  • Cardiac
  • Published:
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Abstract

Objectives

To evaluate the diagnostic performance of 1.5-T non-contrast MR coronary angiography (MRCA) for detection of coronary artery disease (CAD) using whole-heart imaging combined with volume-targeted imaging.

Methods

Forty-five patients scheduled for conventional coronary angiography (CAG) underwent 1.5-T free-breathing non-contrast steady-state free-precession MRCA, including whole-heart and subsequent three-vessel volume-targeted imaging. Coronary stenosis was evaluated as follows: (1) by whole-heart MRCA alone; (2) by combined MRCA (whole-heart plus volume-targeted images). The diagnostic performance for significant stenosis (≥ 50% diameter reduction) was evaluated and compared using CAG as a reference standard.

Results

Combined MRCA was completed in all 45 patients with a total acquisition time of 16.6 ± 3.3 min. The sensitivity, specificity, and accuracy of combined MRCA per patient were 97% (95% confidence interval 84–100%), 83% (52–98%), and 93% (82–98%), respectively. The areas under the receiver operating characteristic curve of combined MRCA were significantly higher than those of whole-heart MRCA on a per patient (0.97 versus 0.85, p = 0.0078) and per vessel (0.96 versus 0.86, p < 0.0001) basis. Compared with whole-heart MRCA, combined MRCA showed equally high sensitivity but significantly improved specificity on a per patient (83% versus 25%, p = 0.016) and per vessel (85% versus 50%, p < 0.0001) basis.

Conclusions

1.5-T non-contrast MRCA combining whole-heart and volume-targeted imaging can detect significant CAD with high sensitivity and moderate specificity. Combined MRCA significantly improves specificity compared with whole-heart imaging alone.

Key Points

• 1.5-T non-contrast MRCA with combined whole-heart and volume-targeted imaging can detect CAD with high sensitivity and moderate specificity comparable with coronary CTA.

• Compared with whole-heart imaging alone, combined imaging provides improved diagnostic accuracy, especially specificity.

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Abbreviations

AUC:

Area under the ROC curve

CABG:

Coronary artery bypass graft

CAD:

Coronary artery disease

CAG:

Conventional coronary angiography

CI:

Confidence intervals

CTA:

CT angiography

CTO:

Chronic total occlusion

FH:

Feet-to-head

LAD:

Left anterior descending

LCX:

Left circumflex

MIP:

Maximum intensity projection

MRCA:

MR coronary angiography

NPV:

Negative predictive value

PPV:

Positive predictive value

RCA:

Right coronary artery

RL:

Right-left

ROC:

Receiver operating characteristic

SPIR:

Spectral presaturation with inversion recovery

SSFP:

Steady-state free-precession

VR:

Volume rendering

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Funding

This work was supported by the National Natural Science Foundation of China (Grant No. 81873891, for Yi-Ning Wang), the National Key R&D Program during the 13th Five-Year period (Grant No. 2016YFC1300402, for Yi-Ning Wang and Zheng-Yu Jin), the Non-profit Central Research Institute Fund of the Chinese Academy of Medical Sciences (Grant No. 2018RC320004, for Yi-Ning Wang), and the Fundamental Research Funds for the Central Universities of the Peking Union Medical College (Grant No. 3332020008, for Lu Lin).

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Author notes

  1. Lu Lin and Liang Wang contributed equally to this work

Authors and Affiliations

  1. Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China

    Lu Lin, Xiao Li, Jian Wang & Zheng-Yu Jin

  2. Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China

    Liang Wang, Zhu-Jun Shen & Wei Chen

  3. Department of Health Care & Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China

    Xiao-Na Zhang & Yi-Ning Wang

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  1. Lu Lin
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Corresponding authors

Correspondence to Zheng-Yu Jin or Yi-Ning Wang.

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Guarantor

The scientific guarantor of this publication is Zheng-Yu Jin.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Ethical approval

The study was approved by the Institutional Review Board of Peking Union Medical College Hospital, Beijing, China.

Informed consent

Written informed consent was obtained from all patients in this study.

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• prospective

• diagnostic study

• performed at one institution

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Yining Wang is the first corresponding author and Zheng-Yu Jin is the second corresponding author of this work.

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Lin, L., Wang, L., Zhang, XN. et al. A clinical strategy to improve the diagnostic accuracy of 1.5-T non-contrast MR coronary angiography for detection of coronary artery disease: combination of whole-heart and volume-targeted imaging. Eur Radiol 31, 1894–1904 (2021). https://doi.org/10.1007/s00330-020-07135-7

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  • DOI: https://doi.org/10.1007/s00330-020-07135-7

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