Journal of Nuclear Cardiology

, Volume 23, Issue 2, pp 287–297

Comparison of stress cardiovascular magnetic resonance imaging (CMR) with stress nuclear perfusion for the diagnosis of coronary artery disease

  • Ijaz G. Ahmad
  • Raushan K. Abdulla
  • Igor Klem
  • Roman Margulis
  • Alexander Ivanov
  • Ambreen Mohamed
  • Robert M. Judd
  • Salvatore Borges-Neto
  • Raymond J. Kim
  • John F. Heitner
Original Article

Abstract

Objectives

To assess the diagnostic performance of stress cardiac magnetic resonance (stress CMR) vs stress single-photon emission computed tomography (SPECT) in patients presenting to the emergency department (ED) with chest pain.

Background

SPECT imaging is the most utilized outpatient procedure in the United States. The diagnostic accuracy of SPECT can be limited by soft tissue attenuation and low spatial resolution. Stress CMR has much higher spatial resolution and without the susceptibility to soft tissue attenuation.

Methods

Eighty-seven patients without a history of CAD presenting to the ED with chest pain were prospectively enrolled. Patients underwent both stress CMR and stress SPECT imaging within 12 hours of presentation. Both the stress imaging tests were interpreted immediately for clinical purposes and coronary angiography was performed if either was abnormal. Patients were considered to have significant CAD if identified by angiography (≥50%) or if a cardiac event (cardiac death, myocardial infarction or revascularization) occurred during follow-up (mean 2.6 ± 1.1 years).

Results

Thirty-seven patients were referred for coronary angiography; 29 due to a positive stress test and eight patients for persistent chest pain despite two negative stress tests. There were 22 patients who had significant CAD (≥50%). The remaining patients were followed for 2.6 ± 1.1 years. At the conclusion of the follow-up period, there were four clinical events. The sensitivity, specificity, and diagnostic accuracy of CMR are 85%, 93%, and 89%, respectively. The sensitivity, specificity, and diagnostic accuracy of stress SPECT are 84%, 91%, and 88%, respectively.

Conclusion

Stress CMR has similar diagnostic accuracy as stress SPECT in diagnosis of CAD.

Keywords

Magnetic resonance imaging myocardial perfusion imaging: SPECT coronary artery disease 

Abbreviations

CAD

Coronary artery disease

CE-MARC

Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease: a prospective trial

ECG

Electrocardiogram

ED

Emergency department

hsCRP

High-sensitivity C-reactive protein

LV

Left ventricular

MI

Myocardial infarction

MR-IMPACT

Comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicenter, multivendor, randomized trial

MR-IMPACT II

Magnetic resonance imaging for myocardial perfusion assessment in coronary artery disease trial: perfusion-cardiac magnetic resonance vs single-photon emission computed tomography for the detection of coronary artery disease: a comparative multicenter, multivendor trial

NPV

Negative predictive value

PET

Positron emission tomography

PPV

Positive predictive value

SPECT

Single-photon emission computed tomography

Stress CMR

Stress cardiac magnetic resonance

TE

Echo time

TR

Repetition time

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Copyright information

© American Society of Nuclear Cardiology 2015

Authors and Affiliations

  • Ijaz G. Ahmad
    • 4
  • Raushan K. Abdulla
    • 4
  • Igor Klem
    • 1
    • 2
  • Roman Margulis
    • 4
  • Alexander Ivanov
    • 4
  • Ambreen Mohamed
    • 4
  • Robert M. Judd
    • 1
    • 2
  • Salvatore Borges-Neto
    • 3
  • Raymond J. Kim
    • 1
    • 2
  • John F. Heitner
    • 1
    • 2
    • 4
  1. 1.Duke Cardiovascular Magnetic Resonance CenterDuke University Medical CenterDurhamUSA
  2. 2.Department of MedicineDuke University Medical CenterDurhamUSA
  3. 3.Department of RadiologyDuke University Medical CenterDurhamUSA
  4. 4.Department of CardiologyNew York Methodist HospitalBrooklynUSA

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