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

Giovanni Di Leo, Erica Fisci, Francesco Secchi, Marco Alì, Federico Ambrogi, Luca Maria Sconfienza, Francesco Sardanelli

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)1-13
Number of pages13
JournalEuropean Radiology
DOIs
Publication statusAccepted/In press - Dec 11 2015

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Magnetic Resonance Angiography
Coronary Angiography
Meta-Analysis
Coronary Artery Disease
Sensitivity and Specificity
Publications
Contrast Sensitivity
MEDLINE
Sample Size
Pathologic Constriction
Confidence Intervals

Keywords

  • Coronary angiography
  • Coronary artery disease
  • Diagnostic accuracy
  • Magnetic resonance imaging
  • Meta-analysis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{d53b65c076af4fa09404d4169fbbb344,
title = "Diagnostic accuracy of magnetic resonance angiography for detection of coronary artery disease: a systematic review and meta-analysis",
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.",
keywords = "Coronary angiography, Coronary artery disease, Diagnostic accuracy, Magnetic resonance imaging, Meta-analysis",
author = "{Di Leo}, Giovanni and Erica Fisci and Francesco Secchi and Marco Al{\`i} and Federico Ambrogi and Sconfienza, {Luca Maria} and Francesco Sardanelli",
year = "2015",
month = "12",
day = "11",
doi = "10.1007/s00330-015-4134-0",
language = "English",
pages = "1--13",
journal = "European Radiology",
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TY - JOUR

T1 - Diagnostic accuracy of magnetic resonance angiography for detection of coronary artery disease

T2 - a systematic review and meta-analysis

AU - Di Leo, Giovanni

AU - Fisci, Erica

AU - Secchi, Francesco

AU - Alì, Marco

AU - Ambrogi, Federico

AU - Sconfienza, Luca Maria

AU - Sardanelli, Francesco

PY - 2015/12/11

Y1 - 2015/12/11

N2 - 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.

AB - 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.

KW - Coronary angiography

KW - Coronary artery disease

KW - Diagnostic accuracy

KW - Magnetic resonance imaging

KW - Meta-analysis

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