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Low-dose CT and cardiac MR for the diagnosis of coronary artery disease: accuracy of single and combined approaches

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Abstract

To prospectively compare the diagnostic performance of low-dose computed tomography coronary angiography (CTCA) and cardiac magnetic resonance imaging (CMR) and combinations thereof for the diagnosis of significant coronary stenoses. Forty-three consecutive patients with known or suspected coronary artery disease underwent catheter coronary angiography (CA), dual-source CTCA with prospective electrocardiography-gating, and cardiac CMR (1.5 Tesla). The following tests were analyzed: (1) low-dose CTCA, (2) adenosine stress-rest perfusion-CMR, (3) late gadolinium enhancement (LGE), (4) perfusion-CMR and LGE, (5) low-dose CTCA combined with perfusion-CMR, (5) low-dose CTCA combined with late gadolinium-enhancement, (6) low-dose CTCA combined with perfusion-CMR and LGE. CA served as the standard of reference. CA revealed >50% diameter stenoses in 68/129 (57.7%) coronary arteries in 29/43 (70%) patients. In the patient-based analysis, sensitivity, specificity, NPV and PPV of low-dose CTCA for the detection of significant stenoses were 100, 92.9, 100 and 96.7%, respectively. For perfusion-CMR and LGE, sensitivity, specificity, NPV, PPV, and accuracy were 89.7, 100, 82.4, and 100%, respectively. In the artery-based analysis, sensitivity and NPV of low-dose CTCA was significantly (P < 0.05) higher than that of perfusion-CMR and LGE. All combinations of low-dose CTCA and perfusion-CMR and/or LGE did not improve the diagnostic performance when compared to low-dose CTCA alone. Taking CA as standard of reference, low-dose CTCA outperforms CMR with regard to sensitivity and NPV, whereas CMR is more specific and has a higher PPV than low-dose CTCA.

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Acknowledgments

This research has been supported by the National Center of Competence in Research, Computer Aided and Image Guided Medical Interventions of the Swiss National Science Foundation, Switzerland.

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Authors and Affiliations

  1. Institute of Diagnostic Radiology, University Hospital Zurich, Raemistr 100, 8091, Zurich, Switzerland

    Hans Scheffel, Paul Stolzmann, Hatem Alkadhi, Stephan Baumueller, Lotus Desbiolles, Sebastian Leschka, Borut Marincek & Olivio F. Donati

  2. Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland

    Naim Azemaj, André Plass & Volkmar Falk

  3. Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland

    Christophe Wyss

  4. Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland

    Sebastian Kozerke & Peter Boesiger

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  1. Hans Scheffel
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Correspondence to Hans Scheffel.

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Scheffel, H., Stolzmann, P., Alkadhi, H. et al. Low-dose CT and cardiac MR for the diagnosis of coronary artery disease: accuracy of single and combined approaches. Int J Cardiovasc Imaging 26, 579–590 (2010). https://doi.org/10.1007/s10554-010-9595-2

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  • DOI: https://doi.org/10.1007/s10554-010-9595-2

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