Skip to main content
SpringerLink
Log in

Combining cardiac magnetic resonance and computed tomography coronary calcium scoring: added value for the assessment of morphological coronary disease?

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

To investigate prospectively, in patients with suspicion of coronary artery disease (CAD), the added value of coronary calcium scoring (CS) as adjunct to cardiac magnetic resonance (CMR) for the diagnosis of morphological coronary stenosis in comparison to catheter angiography (CA). Sixty consecutive patients (8 women; 64 ± 10 years) referred to CA underwent CMR (1.5 T) including perfusion and late gadolinium-enhancement imaging as well as CS with computed tomography. Diagnostic performance was evaluated for CMR and CS separately, and for both methods combined, with CA as reference standard. Best CS threshold combined with a specificity >90% to predict significant stenosis in patients without abnormalities on CMR was determined from receiver operator characteristics (ROC) analysis. Abnormal CMR results were considered to indicate significant stenosis regardless of CS; CS above threshold reclassified patients to have CAD regardless of CMR. CA identified 104/960 (11%) coronary segments with coronary artery stenosis >50% in 36/60 (60%) patients. ROC revealed an area-under-the-curve of 0.83 (95%CI: 0.68-0.99) with the best CS threshold of 495 Agatston score (sensitivity 50%). CMR depicted 128/960 (13%) myocardial segments with abnormalities in 31/60 (52%) patients. Sensitivity, specificity, negative (NPV) and positive predictive value (PPV) of CMR were 78, 88, 72 and 90%. When adding CS to CMR, sensitivity and NPV increased to 89 and 83%, while specificity and PPV slightly decreased to 83 and 89%. Accuracy of the combined approach (87%) was significantly (P < 0.05) higher than that of CMR (82%) alone. Adding CS to CMR improves the accuracy for the detection of morphological CAD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Hendel RC, Patel MR, Kramer CM, Poon M, Hendel RC, Carr JC, Gerstad NA, Gillam LD, Hodgson JM, Kim RJ, Kramer CM, Lesser JR, Martin ET, Messer JV, Redberg RF, Rubin GD, Rumsfeld JS, Taylor AJ, Weigold WG, Woodard PK, Brindis RG, Hendel RC, Douglas PS, Peterson ED, Wolk MJ, Allen JM, Patel MR (2006) ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American college of cardiology foundation quality strategic directions committee appropriateness criteria working group, American college of radiology, society of cardiovascular computed tomography, society for cardiovascular magnetic resonance, American society of nuclear cardiology, North American society for cardiac imaging, society for cardiovascular angiography and interventions, and society of interventional radiology. J Am Coll Cardiol 48:1475–1497

    Article  PubMed  Google Scholar 

  2. Nandalur KR, Dwamena BA, Choudhri AF, Nandalur MR, Carlos RC (2007) Diagnostic performance of stress cardiac magnetic resonance imaging in the detection of coronary artery disease: a meta-analysis. J Am Coll Cardiol 50:1343–1353

    Article  PubMed  Google Scholar 

  3. Schwitter J, Wacker CM, van Rossum AC, Lombardi M, Al-Saadi N, Ahlstrom H, Dill T, Larsson HB, Flamm SD, Marquardt M, Johansson L (2008) MR-IMPACT: comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial. Eur Heart J 29:480–489

    Article  PubMed  Google Scholar 

  4. Berman DS, Hachamovitch R, Shaw LJ, Friedman JD, Hayes SW, Thomson LE, Fieno DS, Germano G, Wong ND, Kang X, Rozanski A (2006) Roles of nuclear cardiology, cardiac computed tomography, and cardiac magnetic resonance: noninvasive risk stratification and a conceptual framework for the selection of noninvasive imaging tests in patients with known or suspected coronary artery disease. J Nucl Med 47:1107–1118

    PubMed  Google Scholar 

  5. Higgins JP, Higgins JA, Williams G (2007) Stress-induced abnormalities in myocardial perfusion imaging that are not related to perfusion but are of diagnostic and prognostic importance. Eur J Nucl Med Mol Imaging 34:584–595

    Article  PubMed  Google Scholar 

  6. Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG, Greenland P, Guerci AD, Lima JA, Rader DJ, Rubin GD, Shaw LJ, Wiegers SE (2006) Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on cardiovascular imaging and intervention, council on cardiovascular radiology and intervention, and committee on cardiac imaging, council on clinical cardiology. Circulation 114:1761–1791

    Article  PubMed  Google Scholar 

  7. Greenland P, Smith SC Jr, Grundy SM (2001) Improving coronary heart disease risk assessment in asymptomatic people: role of traditional risk factors and noninvasive cardiovascular tests. Circulation 104:1863–1867

    Article  PubMed  CAS  Google Scholar 

  8. Rumberger JA, Sheedy PF, Breen JF, Schwartz RS (1997) Electron beam computed tomographic coronary calcium score cutpoints and severity of associated angiographic lumen stenosis. J Am Coll Cardiol 29:1542–1548

    Article  PubMed  CAS  Google Scholar 

  9. Leber AW, Knez A, Mukherjee R, White C, Huber A, Becker A, Becker CR, Reiser M, Haberl R, Steinbeck G (2001) Usefulness of calcium scoring using electron beam computed tomography and noninvasive coronary angiography in patients with suspected coronary artery disease. Am J Cardiol 88:219–223

    Article  PubMed  CAS  Google Scholar 

  10. Lau GT, Ridley LJ, Schieb MC, Brieger DB, Freedman SB, Wong LA, Lo SK, Kritharides L (2005) Coronary artery stenoses: detection with calcium scoring, CT angiography, and both methods combined. Radiology 235:415–422

    Article  PubMed  Google Scholar 

  11. Diamond GA, Forrester JS (1979) Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 300:1350–1358

    Article  PubMed  CAS  Google Scholar 

  12. Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, McGoon DC, Murphy ML, Roe BB (1975) A reporting system on patients evaluated for coronary artery disease. Report of the ad hoc committee for grading of coronary artery disease, council on cardiovascular surgery, American Heart Association. Circulation 51:5–40

    PubMed  CAS  Google Scholar 

  13. Kramer CM, Barkhausen J, Flamm SD, Kim RJ, Nagel E (2008) Standardized cardiovascular magnetic resonance imaging (CMR) protocols, society for cardiovascular magnetic resonance: board of trustees task force on standardized protocols. J Cardiovasc Magn Reson off J Soc Cardiovasc Magn Reson 10:35

    Article  Google Scholar 

  14. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the cardiac imaging committee of the council on clinical cardiology of the American Heart Association. Circulation 105:539–542

    Article  PubMed  Google Scholar 

  15. Gebker R, Jahnke C, Paetsch I, Schnackenburg B, Kozerke S, Bornstedt A, Fleck E, Nagel E (2007) MR myocardial perfusion imaging with k-space and time broad-use linear acquisition speed-up technique: feasibility study. Radiology 245:863–871

    Article  PubMed  Google Scholar 

  16. Klem I, Heitner JF, Shah DJ, Sketch MH Jr, Behar V, Weinsaft J, Cawley P, Parker M, Elliott M, Judd RM, Kim RJ (2006) Improved detection of coronary artery disease by stress perfusion cardiovascular magnetic resonance with the use of delayed enhancement infarction imaging. J Am Coll Cardiol 47:1630–1638

    Article  PubMed  Google Scholar 

  17. Nagel E (2003) Magnetic resonance perfusion measurements for the noninvasive detection of coronary artery disease. Circulation 108:432–437

    Article  PubMed  Google Scholar 

  18. Steigner ML, Otero HJ, Cai T, Mitsouras D, Nallamshetty L, Whitmore AG, Ersoy H, Levit NA, Di Carli MF, Rybicki FJ (2009) Narrowing the phase window width in prospectively ECG-gated single heart beat 320-detector row coronary CT angiography. Int J Cardiovasc Imaging 25:85–90

    Article  PubMed  Google Scholar 

  19. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832

    Article  PubMed  CAS  Google Scholar 

  20. Hoff JA, Chomka EV, Krainik AJ, Daviglus M, Rich S, Kondos GT (2001) Age and gender distributions of coronary artery calcium detected by electron beam tomography in 35, 246 adults. Am J Cardiol 87:1335–1339

    Article  PubMed  CAS  Google Scholar 

  21. Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, Pasternak RC, Smith SC Jr, Stone NJ (2004) Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 110:227–239

    Article  PubMed  Google Scholar 

  22. Knez A, Becker A, Leber A, White C, Becker CR, Reiser MF, Steinbeck G, Boekstegers P (2004) Relation of coronary calcium scores by electron beam tomography to obstructive disease in 2,115 symptomatic patients. Am J Cardiol 93:1150–1152

    Article  PubMed  CAS  Google Scholar 

  23. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC (2004) Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA 291:210–215

    Article  PubMed  CAS  Google Scholar 

  24. Taylor AJ, Bindeman J, Feuerstein I, Cao F, Brazaitis M, O’Malley PG (2005) Coronary calcium independently predicts incident premature coronary heart disease over measured cardiovascular risk factors: mean three-year outcomes in the Prospective Army Coronary Calcium (PACC) project. J Am Coll Cardiol 46:807–814

    Article  PubMed  CAS  Google Scholar 

  25. Schepis T, Gaemperli O, Koepfli P, Namdar M, Valenta I, Scheffel H, Leschka S, Husmann L, Eberli FR, Luscher TF, Alkadhi H, Kaufmann PA (2007) Added value of coronary artery calcium score as an adjunct to gated SPECT for the evaluation of coronary artery disease in an intermediate-risk population. J Nucl Med 48:1424–1430

    Article  PubMed  Google Scholar 

  26. Schenker MP, Dorbala S, Hong EC, Rybicki FJ, Hachamovitch R, Kwong RY, Di Carli MF (2008) Interrelation of coronary calcification, myocardial ischemia, and outcomes in patients with intermediate likelihood of coronary artery disease: a combined positron emission tomography/computed tomography study. Circulation 117:1693–1700

    Article  PubMed  Google Scholar 

  27. Janssen CH, Kuijpers D, Vliegenthart R, Overbosch J, van Dijkman PR, Zijlstra F, Oudkerk M (2005) Coronary artery calcification score by multislice computed tomography predicts the outcome of dobutamine cardiovascular magnetic resonance imaging. Eur Radiol 15:1128–1134

    Article  PubMed  Google Scholar 

  28. Jahnke C, Nagel E, Gebker R, Kokocinski T, Kelle S, Manka R, Fleck E, Paetsch I (2007) Prognostic value of cardiac magnetic resonance stress tests: adenosine stress perfusion and dobutamine stress wall motion imaging. Circulation 115:1769–1776

    Article  PubMed  Google Scholar 

  29. Sarwar A, Shaw LJ, Shapiro MD, Blankstein R, Hoffman U, Cury RC, Abbara S, Brady TJ, Budoff MJ, Blumenthal RS, Nasir K (2009) Diagnostic and prognostic value of absence of coronary artery calcification. JACC Cardiovasc Imaging 2:675–688

    Article  PubMed  Google Scholar 

  30. Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van’ t Veer M, Klauss V, Manoharan G, Engstrom T, Oldroyd KG, Ver Lee PN, MacCarthy PA, Fearon WF (2009) Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 360:213–224

    Article  PubMed  CAS  Google Scholar 

  31. Plein S, Schwitter J, Suerder D, Greenwood JP, Boesiger P, Kozerke S (2008) k-space and time sensitivity encoding-accelerated myocardial perfusion MR imaging at 3.0 T: comparison with 1.5 T. Radiology 249:493–500

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Paul Stolzmann & Hatem Alkadhi

  2. Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland

    Paul Stolzmann, Hatem Alkadhi, Hans Scheffel, Sebastian Leschka & Olivio F. Donati

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

    André Plass & Volkmar Falk

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

    Sebastian Kozerke

  5. Department of Cardiology, University Hospital Zurich, Zurich, Switzerland

    Christophe Wyss

Authors
  1. Paul Stolzmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hatem Alkadhi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hans Scheffel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. André Plass
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sebastian Leschka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Volkmar Falk
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sebastian Kozerke
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Christophe Wyss
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Olivio F. Donati
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul Stolzmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stolzmann, P., Alkadhi, H., Scheffel, H. et al. Combining cardiac magnetic resonance and computed tomography coronary calcium scoring: added value for the assessment of morphological coronary disease?. Int J Cardiovasc Imaging 27, 969–977 (2011). https://doi.org/10.1007/s10554-010-9738-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-010-9738-5

Keywords

Search

Navigation